Health
Mak Researcher Designs “COVID Alphabet” for Awareness and Behavioral Change
By Joseph Odoi
With the increasingly worrying situation of the novel coronavirus and its devastating global effect, Makerere University has once again taken an institutional lead by designing a behavioral change communication model to support government efforts in fighting against the pandemic. The COVID Alphabet (A-Z of COVID in Uganda) was developed by Dr. Gloria Seruwagi, a lecturer at Makerere University’s College of Humanities and Social Sciences (CHUSS) and School of Public Health (MakSPH).
While briefing journalists during the model’s unveiling at Makerere University on February 17th, 2021, Dr. Seruwagi shared that she got the inspiration to design the simple and relatable evidence-based product after conducting a series of COVID-19 studies in different communities including the REFLECT study in humanitarian contexts and ALERTs study in different informal settlements within Kampala.
“If somebody wants to know what the key issues are about COVID-19 in Uganda, they can look at this Alphabet and have it all at a glance, without having to go through the long process of reading a 4 or 15-page document. This is not just an alphabet for learning phonetics or numbers. It is a Know, Think and Act (KTA) tool packed with nuggets of information” Dr. Seruwagi emphasized.
The COVID Alphabet is not only easy on the eye and deliberately simple but is also factual and anchored in research. It should resonate with anyone at any level – from the busy policymaker or program manager to someone outside Uganda in need of quick facts.
The Alphabet also speaks to today’s virtual workplace teams, community leaders, and any person on the street or at home. It contains critical study findings compressed into a quick and concise summary of the COVID trajectory, experiences, and outcomes. It also gives key pointers on key population groups, sectors, mitigation strategies, and action points for different stakeholders.
The Alphabet begins by stating that Awareness of COVID-19 is high but Adherence extremely low. It then flags up the increasingly urgent need for effective Behavioral change messages now more than ever, even more than knowledge-only messages. Community transmissions are on the rise; as is prevention complacency while Deaths, infection and recovery from COVID-19 remain shrouded in mystery.
Uganda continues to face another battle of the serious infodemic challenge with myths, falsehoods and risky perceptions being plenty. Enforcement fatigue has become more pronounced with relaxation of some restrictions and unfortunately Fatigue from the enforcement side is coinciding with high community transmission. The Alphabet acknowledges the important role and success registered by Government-led approaches; however, it shows that these more community support and leadership.
Hand washing is listed as a more feasible prevention measure compared to sanitizing, social distancing, wearing masks and staying at home. This is in harmony with research carried out by other studies which showed that hand washing was the most adhered to guideline at the peak of COVID-19 as most households had hand washing points.
Dr. Seruwagi says adds that Infection control has largely been well managed at public places and offices compared to communities. And while the model recognizes that mass distribution of Masks did not reach everybody; mask use among those who have is low, inconsistent and improper.
This also alludes to study findings which found a lot of negative face mask practices including chin-masking, sharing masks, wearing ill-fitting masks, keeping them in pockets and back or not having a mask at all. Moving forward, Seruwagi advises the government to not only give out masks but revitalize enforcement of SOPs, reminding people of the dangers and health risks posed by the pandemic.
Norms and culture are both drivers and barriers to compliance. This alphabet statement agrees with research findings which show that the practice of hand washing with soap was much higher in Muslim communities because it’s in tandem with their beliefs and socio-cultural practices. The model also highlights the need to Optimally leverage existing community structures, systems and resources for compliance.
Since the outbreak of COVID-19, Psychosocial and mental health challenges that have taken on new and more complex forms. And while the need for social networks and connections is very important, Dr Seruwagi also recommends that Quiet spaces and isolation should be championed as positive and potentially productive.
This is in line with trying to get the community avoid unnecessary movement and avoid or behave responsibly while in public gatherings. It will enable communities to not feel punitively restricted but rather appreciate the protective effect of measures such as curfews.
In terms of Reproductive health, the Alphabet shows that services are severely constrained and products very scarce, inaccessible or expensive. Related to this is that the pandemic has worsened SRH outcomes, especially among adolescents and youth since the advent of the pandemic.
Teenage pregnancies and transactional sex by children and youth have increased; calling for parents, teachers, leaders and other stakeholders to act. ‘’If we are saying that there is a lot of teenage pregnancies and transactional sex by adolescents, what should teachers do, what are parents doing to protect their children?” she remarked in a call for action.
Dr. Seruwagi’s landmark model then turns to the country’s globally lauded success in refugee-hosting. It highlights the Uganda’s porous borders and high refugee population, noting that this comes with daily interaction across borders and some of this interaction risky with potential for disease transmission and other risks beyond health for example security risks.
The model shows that Violence of various forms increased during COVID-19; and everyone was affected including men and children. In some of the studies conducted, Violence against Men (VAM) is emerging as a key theme but the Ugandan culture largely operates in a culture of silence and there are not enough or effective services addressing male survivors of violence – most interventions have focused more on women. Moreover, child protection systems were rendered more fragile by the pandemic.
All these services and intervention points need strengthening. The Willingness and resourcefulness of community leaders needs to be harnessed and effectively utilized. And Dr Seruwagi says that the timing is a good one in terms of policy implementation, with the recent launch of the Community Engagement Strategy where VHTs, community leaders and other local structures are critically positioned to make a significant contribution if well-resourced and supported. It mentions Xanic and resilient approaches for COVID-19 while also highlight children, adolescents and Youth as a severely-affected but largely “invisible” group during Uganda’s the first wave.
Finally, the model recognizes the role of technology like Zoom meetings and while it acknowledges that virtual spaces are the ‘new normal’, Dr Seruwagi calls for a thorough and ongoing review on their safety and impact on productivity or team cohesion. “For example, the people delivering essential services needed during these difficult COVID times might, themselves, be in serious need of mental health and psychosocial support or specific workplace provisions,” she said.
Dr. Seruwagi implored leaders, teachers, parents, civil society organizations, policymakers and all health stakeholders to pick an action point from each Alphabet letter to implement if COVID-19 is to be countered. “As a country we already crossed a line where infections were managed at facility level. With the current community spread, let’s reflect on this COVID Alphabet and let each person pick at least one action point”. She called upon senior policymakers and BCC specialists to take up the model as guiding tool to support the national response.
The COVID Alphabet is the first of its kind in Africa and has attracted media attention with different people describing it as factual, precise, simple and easy to understand.
Article originally published on MakSPH
A new study conducted in Wakiso district has determined the ideal waist circumference for detecting metabolic syndrome among Ugandan women. Study findings closely align with the International Diabetes Federation (IDF) cut-off for predicting ill health risks.
The researchers at Makerere University’s School of Public Health (MakSPH) aimed to establish an ethnically appropriate waist circumference cut-off point for Ugandan women to enhance early detection and prediction of metabolic syndrome. About 2 in 10 of the women studied in Wakiso district, Uganda, suffer from metabolic syndrome, which is associated with diabetes and heart disease.
Findings indicated that for women aged 18–49 years in the Wakiso district, 80.3 cm is the optimal waist measurement to flag potential metabolic syndrome risks.
The threshold increases with age:
• 79.9 cm for young women (25-34 years)
• 85.6 cm for mid-life (35-44 years)
• 91.1 cm for pre-menopausal women (45-49 years)
Unlike the Body Mass Index (BMI), a calculated measure of weight relative to height used to assess an individual’s weight status and potential health risks, waist measurement better detects dangerous abdominal fat linked to diabetes and heart disease.
Dr. David Lubogo, a lead researcher on this study and Senior Lecturer in the Department of Community Health and Behavioral Sciences at Makerere School of Public Health, noted that with hormonal and physiological changes making women particularly vulnerable during reproductive years, these Uganda-specific benchmarks will help clinics identify at-risk patients earlier, using just a measuring tape.
“Our findings confirm waist measurement as a powerful, low-cost tool for preventive care. While aligning with global standards, we have refined thresholds for Uganda’s context,” Dr. David Lubogo notes.
A cross-sectional study was carried out in Wakiso District from June to August 2021, involving 697 randomly selected women aged 15–49. Participants had lived in Wakiso for at least a year and underwent physical, biochemical, and anthropometric tests to help determine the prevalence of metabolic syndrome (MetS). “We excluded pregnant and postpartum women, alcoholics, smokers, and those with chronic or infectious diseases to ensure accurate results,” explained Dr. David Lubogo.
The study, published in PLOS Global Public Health, underscores the importance of age-sensitive screening in tackling metabolic diseases in sub-Saharan Africa. In response, health officials in the study area should explore practical ways to weave these findings into everyday programs for community health screening.
The study was funded by the Government of Uganda through the Makerere University Research and Innovation Fund (MakRIF) and the Strengthening Education and Training Capacity in Sexual and Reproductive Health and Rights (SET-SRHR) Project in Uganda. Other investigators included Dr. Henry Wamani, Dr. Roy William Mayega, and Professor Christopher Garimoi Orach.
Kampala, 09 April 2025— Makerere University has officially launched the Social Innovation in Health Initiative Community of Practice (SIHICOP)—a new platform designed to connect local health innovators with policymakers, donors, and researchers. The goal: to turn scattered success stories into a powerful, nationwide movement that reimagines healthcare from the ground up.
The launch, held during the 6th National Social Innovation in Health Stakeholders’ Workshop at Hotel Africana in Kampala, drew a dynamic mix of changemakers, health innovators, academics, donors, and government leaders, all rallying around one idea: that equitable, sustainable healthcare must be rooted in communities.
While Uganda has made notable progress, cutting under-five deaths by 66% since 2000, challenges remain. Fifty out of every 1,000 children still die before their fifth birthday. Nearly half suffer from stunting due to malnutrition. In rural areas, pregnant women walk for hours to reach clinics. Across the country, hospitals battle frequent drug shortages.
Dr. Phyllis Awor, Director of the SIHI Uganda Hub at Makerere University’s School of Public Health (MakSPH), emphasized the critical role of social innovation in closing healthcare gaps. “Half of Ugandan children lack basic vaccinations, and 40% face stunting. These challenges demand creative, inclusive solutions co-created with communities,” she said.
“We’ve spent a decade identifying, studying, and strengthening grassroots innovations. Through our six-month fellowship program, we train innovators in monitoring and evaluation, research, communication, impact assessment, and fundraising so their work doesn’t just survive but scales,” she said. “Today, we’re awarding them completion certificates and launching them into a vibrant community of practice.”
Dr. Awor, who is also a Lecturer and Researcher maintains Social Innovation is about solving these real problems with real people. With the support of the Swedish Embassy and the World Health Organization’s TDR program, SIHICOP, she says, will foster peer learning, capacity-building, and scaling of innovations like mobile health platforms and community-based maternal care.
Since 2017, Uganda’s SIHI hub has supported 30 homegrown innovations, impacting tens of thousands of lives. “We’ve identified 21 standout solutions so far,” Dr. Awor shared. “But if we want them to go national, we need enabling policies.”
Globally, SIHI was founded in 2014 to bring together innovators, communities, policymakers, and academics across the Global South. With 15 hubs, including Uganda’s, SIHI has documented over 200 innovations and 40 case studies that demonstrate the power of grassroots solutions to improve health systems.
Dr. Olaro Charles, Uganda’s Acting Director General of Health Services, acknowledged that bureaucracy often stifles good ideas. “Sometimes, a small change in how you look at a problem can produce the best and most marketable solution,” he said.
He spoke from experience. As a clinician, Dr. Olaro led efforts to curb drug theft and stockouts by tightening distribution and boosting accountability. “It’s not like people walk off with whole boxes,” he explained. “But if you have 300 employees and each takes just one dose… that adds up. We introduced medicine returns, round-the-clock pharmacies, and ward-level audits. At first, there was resistance, but it worked.”
Another one of his most memorable innovations was setting up a neonatal unit for premature babies while he was a Medical Superintendent. “I remember a baby who weighed less than a kilo, barely six months old, and survived. We pushed survival rates to 85%. Eventually, we ran out of space. We began asking ourselves: Where had these children been going before? Previously, these children may have died within the community. These are innovations that create real, tangible impact. And I’m sure many of the things you’re doing here are creating similar results.”
He urged the Fellows to treat their innovations like living systems: “If they survive infant mortality, they’ll live longer. These ideas deserve to grow.”
Mr. Tomas Lundström, Health Counsellor at the Swedish Embassy, spoke with deep conviction about Sweden’s long-standing investment in Uganda’s future. “For decades, Sweden has believed in Uganda’s greatest asset, its people,” he said. “Through Sida, we funded the training of over 500 Makerere staff for PhDs. I didn’t start it. I didn’t train your PhDs. The Swedish taxpayers actually funded the training. Now that wasn’t just investment; it was transformation. It’s one reason Makerere is the powerhouse it is today.”
Lundström also shared a memory that continues to shape his view of development. While inspecting UNICEF projects in Zambia in 1998, he recalled visiting five villages where only one had shown some success. A driver suggested they visit the last village, the 5th. “We went. No one was there. We waited, then a man came running, covered in dirt. He was the village chief,” Lundström recounted. “He said something I’ve never forgotten: ‘Thomas, when the rainy season comes, we can’t take pregnant women to the clinic. Do you know where I can learn to build a bridge’?”
“That was different from what I usually hear—‘Can we have some money?’ Real change doesn’t come from handouts. It starts within communities.”
But Lundström warned that international aid is under strain. “We’ve already lost a lot of funding from U.S. and other donors. Ukraine, Sudan—global crises are pulling resources away. We must get creative. We must find new ways to secure resources.”
Still, he was optimistic. “We’re seriously considering continued support for another year. We’re also pushing for deeper collaboration between Makerere and Karolinska Institutet. But it’s up to you too,” he said.
He praised Dr. Phyllis Awor and her team: “What sets them apart is not just competence, but passion. She doesn’t do this because it’s her job; she does it because she believes in it. Because everyone deserves a fair chance, a seat at the table, a bit of hope.”
Makerere University Vice Chancellor, Professor Barnabas Nawangwe, echoed those sentiments, describing the School of Public Health as the university’s “engine of change.” He noted that the School contributes to nearly 30% of all university publications—and brings in 40% of its research funding.
“That’s no accident,” he said. “Public health is critical. Without health, there is no progress. That’s why donors invest in public health issues.”
He described the social innovation initiative as a model for how academia and communities can work together, not just to publish but to transform lives. “When global rankings name Makerere the most community-impactful university, they’re recognizing what happens when scholars step beyond lecture halls. This is what happens when researchers dig deep into the ground to cultivate solutions that transcend national boundaries.
The Vice Chancellor also paid tribute to Sweden’s role in that transformation. “We cannot thank the people of Sweden enough. Their support through Sida trained over 500 of our staff to the PhD level—the largest staff development initiative I’ve seen at any university, anywhere. It came when we needed it most, after the war. That’s why Makerere stands today as a leading research institution in Africa.”
He congratulated the 2024/25 Fellows, praising their inspiring journeys, and commended Dr. Awor and her remarkable team of researchers for achieving what only world-class institutions can: “melding razor-sharp academia with the wisdom of villages, policy muscle with frontline innovations.”
By Joseph Odoi
Every newborn deserves the best start to life. Yet, in Uganda, the burden of newborn morbidity and mortality remains high. The newborn mortality rate stands at 22 deaths per 1000 live births (UDHS 2022). According to most recent UN annual estimates, Uganda records 62,000 deaths around the time of birth. Of these, 32,000 are neonatal deaths, 26,000 are stillbirths and 4,800 are maternal deaths. Majority of the newborn deaths occur within the first week after delivery- a period considered very vulnerable for both the mother and baby.
Uganda’s high fertility rate translates to about 1.7 million births per year; and of these 250,000 babies need special newborn care as they are either born too small or fall sick within the first month of life. This has placed a huge burden on the country and strained the already limited investment for neonatal care.
Despite national efforts, newborn deaths continue to account for nearly half of all under-five deaths in Uganda, according to the Uganda Demographic and Health Survey (UDHS) 2022.
To contribute to addressing this challenge, a coalition of institutions namely; Makerere University School of Public Health, Baylor Foundation Uganda, Adara Development Uganda, Nsambya Hospital, and the Ministry of Health with funding from ELMA Philanthropies launched a national health systems strengthening initiative known as the Uganda Newborn Programme (UNP) in 2022. This program uses a regional approach to improve newborn care in three regions of Uganda namely Kampala, North Central and Western regions.
According to Dr. Monica Okuga, the Uganda Newborn Programme Coordinator at Makerere University School of Public Health (MakSPH), the Uganda Newborn Programme (UNP) made huge strides in providing quality newborn care in 36 health facilities across the three regions of Uganda.
Uganda New Born Programme Achievements
‘’Under the UNP, there have been so far many achievements. Institutional neonatal mortality rate has reduced in the facilities where the program is implemented and this has contributed to overall reduction in neonatal mortality in the regions. For example, Institutional neonatal mortality reduced to 7/1000 and 2/1000 live births by the end of Year 2, down from the baseline rates of 8.4/1000 and 11.9/1000 in Bunyoro and Tooro, representing reductions of 16.7% and 85.3% respectively’’ Dr. Okuga stated.
Dr. Okuga further explained that, ‘’Overall asphyxia case fatality rates across program areas have also reduced from 8.9% to 5%; adherence to infection prevention and control measures has improved across the facilities; and the quality of newborn care provided has also improved.
In addition to revamping many newborn care units, Dr. Okuga revealed that the programme supported the construction of newborn care units, citing Kyegegwa Hospital, Buliisa General Hospital, Masindi General Hospital, and Kyangwali HCIV.
In line with the SDGs programme objectives, specifically SDG 3; Good Health and Well-Being, Makerere University School of Public Health, together with partners including the National Planning Authority (NPA), UNICEF, FHI360, and the Ministry of Health, produced the Situation Analysis of Newborn Health in Uganda-2023 update.
This document has now been taken up by the Ministry of Health and is being used to develop a strategy for implementing the suggested recommendations therein, as well as costing the investment for improving newborn health in Uganda.
The previous newborn situation analysis was conducted 17 years ago in 2008’’ she explained of programme contribution at a multi-sectoral level
Establishment of Uganda’s First Breast Milk Bank
Still under this programme, the first ever Breast Milk bank was established at Nsambya hospital with other donor milk satellite sites at Mengo, Rubaga, Kibuli and Naguru hospitals in Kampala. This donor breast milk has benefited over 275 babies across Kampala and its neighboring districts.
Hospital-to-Home (H2H) Initiative
Another innovation that has been scaled up through the programme is the Hospital to Home (H2H) initiative by Adara Uganda. While many newborn interventions focus primarily on in-hospital care, the Uganda Newborn Programme, in partnership with Adara Development Uganda, pioneered the Hospital-to-Home (H2H) Model, extending its newborn care continuum to the household level. This innovative model ensures that high-risk newborns continue to receive vital support after hospital discharge, addressing the gaps in follow-up care that are common in low-resource settings.
According to Beatrice Niyonshaba, Deputy Director of Maternal, Newborn, and Child Health at Adara Development; “In Uganda, many families struggle to return for follow-up visits due to cost, transport challenges, and lack of caregiver awareness. The H2H model addresses this by involving caregivers early, equipping them with knowledge on newborn danger signs, and ensuring post-discharge follow-up through community health systems like village health teams.”
She adds, “The model not only reduces post-discharge mortality but also builds trust and ownership among families, which is critical but often an overlooked aspect of newborn survival in low-income settings. ‘’We also run regular community sensitization and awareness initiatives about the causes and survivability of small and sick newborns, preventative measures, as well as the services”. The model was initially piloted at Kiwoko Hospital, with strong support from both healthcare staff and the community. This phase allowed for continuous refinement and strengthening of the model, ensuring it met the needs of both families and healthcare providers.’’ Ms. Niyonshaba explained of the H2H Model uniqueness
Currently, the model is being implemented in Nakaseke hospital, a government facility. This will provide insights for scale up to other government facilities. The programme has seen tremendous success due to the engagement and motivation of CHWs, who are provided with incentives, extensive training, and ongoing support. Regular check-ins and monthly meetings ensure these workers remain accountable and connected to the Programme’s objectives.
Challenges in Newborn Care
According to Dr. Monica Okuga and Prof. Peter Waiswa, the Uganda Newborn Programme team lead from MakSPH, in spite of the many achievements, several challenges persist. They explain that many health facilities in Uganda were built without infrastructure to support Newborn Care Units (NCUs). There are no standard floor plans for these units. In many facilities, the neonatal care units are housed in improvised rooms, while in some cases, completely new NCUs are built.
However, even where NCUs are present, they are often let down by an unstable power supply, despite the fact that most equipment in the NCUs require consistent electricity to function. In addition, there are other health system challenges such as insufficient drug supplies from the government, inadequate staffing, and the low involvement of medical officers in neonatal care. Internal rotation of already trained nurses to other units further worsens the situation. Other issues include untimely or late referrals of mothers and babies, as well as challenges with the low quality of data produced in these units.
In terms of lessons learnt while implementing the UNP, The Uganda Newborn Programme team observed and noted several key lessons during the implementation of the programme
- The importance of leadership engagement in the uptake of interventions is very critical. The leaders to be engaged not only include those at the facility level but also those at the district level. The support of political district leaders such as the Chief Administrative Officer (CAO) is also very crucial. One way of engagement is through sharing performance dashboards with key indicators to the District Health Officers (DHOs), CAO, and Health Facility In-charges.
- There is a need for continuous engagement of district leadership for sustainability in public health facilities, especially the human resource aspect for established Newborn Care Units (NCUs).
- There is a need to intervene across the board/spectrum of the health system. Addressing one challenge, for example, the provision of equipment, may not result in the required benefits without addressing human resources and skills.
- Using a regional approach to care, which includes all hospitals and high-volume health centres, is a more rapid and cost-effective way to scale up maternal and newborn care. It also improves access, quality, and referral, thus reducing unnecessary mortality.
- Regional Local Maternity and Neonatal Systems (LMNS) provide avenues/platforms to share lessons and share feedback to teams/facilities on gaps identified.
- Targeted mentorships not only maintain skills but also support teams in innovating for problem-solving.
- Continuous engagement of medical officers in facilities creates buy-in and brings them on board to support and bridge gaps in newborn care in the neonatal care units.
In terms of sustainability, the team stated that the programme’s design took into account the potential for continuation beyond the initial funding from ELMA Philanthropies. From the outset, the Ministry of Health was actively involved in the co-creation of the programme. The programme also made effective use of existing staff and infrastructure to enhance the quality of newborn care. While there was occasional catalytic provisions of drugs and equipment, the programme primarily relied on the government’s drug supply and delivery systems to ensure long-term sustainability.
About The Uganda Newborn Programme (UNP)
The Uganda Newborn Programme (UNP) has been actively working since its launch in July 2022, with the goal of significantly improving the care for small and sick newborns across the country. With support from ELMA Philanthropies, the programme has brought together a consortium of partners, including Makerere University School of Public Health, Baylor Uganda, Adara Uganda, and Nsambya Hospital, in collaboration with the Ministry of Health.
The programme is focusing on 20 high-burden districts across three regions of Uganda ie Western, Kampala, and North-Central, serving approximately 1.5 million births annually. Since its inception, the programme has been making strides in enhancing the capacity of health facilities, including the refurbishment and equipping of 30 specialized neonatal care units. These units are designed to meet the needs of small and sick newborns, in line with the National Essential Newborn Care (NEST) Toolkit.
Key activities that have been rolled out include
- Training and mentorship of Health Workers; More than 800 health workers have been trained and mentored in essential neonatal care practices such as neonatal resuscitation, Kangaroo Mother Care (KMC), Continuous Positive Airway Pressure (CPAP), and infection prevention and control. This has significantly improved the clinical competencies of healthcare providers in the management of small and sick newborns.
- Strengthening Infection Prevention and Control; The programme has focused on improving infection control measures at hospitals, which is critical in managing the high rates of sepsis and other infections among newborns.
- Effective implementation of newborn resuscitation and warm transport: This includes establishing standardized protocols and providing essential equipment like mabu bags plus masks, CPAP machines
- Improving Data Utilization; Efforts have also been made to ensure that health workers are using data-driven evidence for decision-making. Monthly perinatal death audits and support for data quality review have allowed for continuous improvement in service delivery.
- Enhanced Postnatal Care; Community-based postnatal care using Village Health Teams (VHTs) being trained to conduct home visits for newborns discharged from neonatal units. This helps ensure that infants receive timely follow-up care in the critical days after discharge.
The programme is set to run up to July 2025, and by then, it aims to have reached 120,000 small and sick newborns, helping to reduce newborn mortality by 40% in the target regions.
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