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Mak Researcher Designs “COVID Alphabet” for Awareness and Behavioral Change

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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.

Dr. Seruwagi unveiling the COVID Alphabet

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

Health

Boy Children Report More Physical & Emotional Abuse

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Men in the intervention group during the Parenting for Responsibility (PfR) project training session.

By George Kisetedde

On 3rd August, 2022, the CHDC (Child Health and Development Centre) disseminated study findings from one of the research studies carried out at the centre. These findings were presented under the title,“The Prevention of Violence against Children and Women: Baseline and Implementation Science Results from Parenting Cluster Randomised Trial.” Moderated by Dr. Anthony Batte, a lecturer at CHDC. Study findings were presented by Joseph Kahwa, the trial manager of the Parenting for Responsibility (PfR) project, under which this study falls.

Kahwa described PfR as a community based parenting programme delivered to both male and female parents. This programme aims to improve parenting skills, prevent violence against children, and to improve spousal relationships.

Findings from the study

Findings from this study showed that parents maltreat boy children more than girl children. The boys reported more emotional and physical violence than girls. Furthermore, the boy children reported that male caregivers specifically, maltreat them more. On the other hand, the girl children reported more sexual violence from caregivers than boys. On the whole, the children reported that female caregivers emotionally and physically abused them more compared to male caregivers.

More findings, according to Kahwa, showed that 46.5% of parents in Amuru can provide their children with soap to wash, 44.5% can provide school fees, 44.4% can provide school materials, 44.2% can provide new clothes, 43.3% can buy school uniform, and 35.9% can provide a pair of shoes.

How the research is conducted

The study is divided into 16 group sessions. The first 9 sessions are single sex, that is, male caregivers and female caregivers train separately. The next 7 sessions are mixed with male and female participants combined during training.

A mixed group parenting session for both men and women.
A mixed group parenting session for both men and women.

Kahwa explained that this programme was initiated to deal with VAC (violence against children) and IPV (intimate partner violence). These two vices are closely linked and have a significant impact on how children turn out.

Kahwa added that the PfR research programme aims at addressing the four major factors that may lead to VAC/IPV. These include; poor parental bonding, harsh parenting, unequal gender socialisation and spousal relationships.Poor parental bonding refers to the absence of a healthy close connection between a parent and their child. When a parent and child are not close, the parent may lack empathy for the child and the ability to perceive and respond to their child’s needs. When this bond is weak, a parent is unable to appreciate a child’s needs and can end up being unrealistically tough, which results in harsh parenting. Unequal gender socialisation generally refers to the different expectations that parents have of their children depending on their gender-male or female. The quality of the spousal relationship between parents also affects a child’s life. These four areas are what the parenting sessions concentrate on during the training.

The PfR study employed a cluster randomised controlled trial (RCT) design. Male and female caregivers were recruited from cluster villages in the Wakiso and Amuru districts in Uganda. One child aged 10 to 14 per household was randomly selected and assessed.

The caregivers were divided into two groups; the intervention group and the control group. The intervention group underwent all the 16 sessions of the training while the control group underwent a 2 session lecture on parenting. The impact of the PfR intervention was then ascertained by comparing baseline and endline results (or the before-and-after experiences of parents). The study participants were from 54 Villages selected in both Amuru and Wakiso districts. 108 caregiver groups (54 groups per intervention)were selected. This resulted in 2328 parents recruited and 886 children.

In conclusion, Mr. Kahwa said that maltreatment is still prevalent in the population. Generally, the PfR programme was well-received by parents and it had ad good attendance from parents. The programme also registered good male engagement. The peer facilitators who were recruited also had great potential in expanding the PfR programme at community level.

This study was conducted by Dr Siu Godfrey as the Principal Investigator. Other members of the team included Carolyn Namutebi, Richard Sekiwunga, Joseph Kahwa, Dr Betty Okot, and Martha Atuhaire. They were supported by the Director from CHDC, Dr. Herbert Muyinda and the CHDC Finance & Administration team. The team from Glasgow & Oxford Universities in the UK included, Prof Daniel Wight, Dr Jamie Lachman , Francisco Calderon and Dr Qing Han. On the other side, the team from the SOS Children’s Village from Gulu and Wakiso included, Rachel Kayaga, Sindy Auma Florence and Godfrey Otto.

Contact: George Kisetedde – kisetedde@gmail.com | Edited by Agnes Namaganda – agnesvioletnamaganda@gmail.com

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Makerere Medical Journal: Golden Jubilee Edition 2022

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Cover Page of the Makerere Medical Journal Golden Jubilee Edition 2022.

It’s with great pleasure that I welcome you to the Golden Jubilee edition of this phenomenal journal. Yes, The Makerere Medical Journal marks 50 years of publication with this year’s edition and all this has been made possible by the endless efforts and contributions of the Makerere University College of Health Sciences Staff and students because without your research submissions and financial support, the journal wouldn’t have made it this far. To you reading this, thank you for contributing to the sustainability of this great project, year in year out.

Here’s a quote to ponder on as you delve into this year’s well-crafted articles and it’s by Zora Hurston (1891-1960), “Research is formalized curiosity. It is poking and prying with a purpose.” And doesn’t that just define our purpose as researchers?!

This edition’s articles cover pertinent topics ranging from Antimicrobial Stewardship, COVID-19 interventions, Oral Health amongst others. It also features student projects, write-ups on student-led organizations and societies that are making a difference in the life of a health sciences’ student and many more interesting writings. Featured in this issue are international manuscripts from countries like Nigeria and we were also honored to work with other universities within the country and feature some of their students’ articles.

I would like to extend my most sincere gratitude to my team of editors that engaged in a rigorous peer review process to ensure that the articles published are up to standard. As the editorial team, we are quite pleased to see the number of undergraduates involved in research steadily increasing and all the efforts that have been put in by the different stakeholders to see this happen are commendable.

With that said, I hope you enjoy every second of your read!!!

LINDA ATULINDA,
MBChB IV

EDITOR-IN-CHIEF,
Research and Writers’ Club 2021-2022

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Call for Applications: HEPI Masters Support Fellowship

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Panelists L-R: Professor Elsie Kiguli-Malwadde, Professor Francis Omaswa, Professor Jehu Iputo and Professor Joel Okullo at the HEPI-ACHEST Health Professions Education Symposium, 17th June 2022, Makerere University.

Applications are invited for the Health Professional Education Partnership Initiative (HEPI-SHSSU) Masters fellowship programme support from postgraduate students of:

  • Makerere University College of Health Sciences (MakCHS)
  • Kabale University School of Medicine
  • Clarke International University
  • Faculty of Health Sciences, Busitema University

The programme will support graduates in their final year of training leading to the award of a Masters degree on any of the Master’s graduate training programs at the stated University for a maximum of 19 successful candidates.

The closing date for the receipt of applications is 30th September 2022.

Inquiries and Applications must be submitted to hepishssu@gmail.com

See attachment for more details 

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