Etheldreda Nakimuli-Mpungu is a rising researcher and clinician doing innovative work in mental health and HIV in sub-Saharan Africa. She is a Senior Lecturer and psychiatric epidemiologist in the Department of Psychiatry at Makerere University College of Health Sciences (MakCHS) and head of the consultation–liaison psychiatric service at Mulago National Referral Hospital, Kampala, Uganda. Almost a decade ago, she recalls that “around that time, there were researchers who had resolved that Africans cannot comprehend psychotherapy; therefore, they gave persons living with HIV antidepressants as first-line treatment for mild-to-moderate depression in their research studies. In fact, there was an NIH funded grant in my department at the time that was evaluating the use of antidepressants for depression among people living with HIV. I said to myself, but this is not right because antidepressants are not the first-line treatment.” She “strongly believed that what we should be doing was to develop culturally appropriate psychotherapy for depression” in this population.
Nakimuli-Mpungu’s PhD had shown depression was fairly common among patients attending rural HIV clinics in Uganda and it affected their adherence to antiretroviral treatment. She successfully submitted a research proposal to Grand Challenges Canada and, together with her colleagues, teamed up with Edward Mills in Canada to develop and test in a pilot trial a culturally sensitive group support psychotherapy (GSP) for people with mild-to-moderate major depression and HIV. Nakimuli-Mpungu and colleagues went on to complete a cluster randomised trial to evaluate the model on a large scale, with trained lay health workers delivering the GSP. They showed that the effect of GSP on depression was sustained at 2 years, and treating depression resulted in improved adherence to antiretroviral medication. Nakimuli-Mpungu and colleagues are now seeking to replicate their work on GSP outside of Uganda. “That is the next step…If we have that evidence as well, then we’re at the stage of scaling up.” They are also adapting their model for young people aged 10–18 years and are creating an online platform to deliver psychotherapy because, she notes, the COVID-19 pandemic has created a need for digital health.
Mills, Professor at the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada, comments: “Ethel is among the most important clinical researchers in Africa as she has the unique ability to ask important questions, get the clinical trials funded and conducted reliably, and personally analyses the data. Very few researchers anywhere can do all of this themselves.”
Her parents encouraged Nakimuli-Mpungu to pursue medicine. “Our parents really wanted us to get educated and become worthwhile citizens”, she says. “My earliest memory was that my mum used to say that girls become doctors”. Fortunately, Nakimuli-Mpungu found sciences interesting and excelled in them. She studied medicine at MakCHS, graduating in 1999. Her path to psychiatry and research came during a job as a medical officer at Butabika National Referral Mental Hospital in Kampala. She initially thought she would be working in the hospital’s general ward. But when she arrived, she was assigned to the female psychiatric ward and told to start seeing patients. “Almost immediately, I noticed there were really physically sick people on the psychiatric ward, and I had never seen this in my training. Very sick people: wasted, coughing, chronic diarrhoea. It didn’t take long to realise that these were patients with HIV.” But she could find little information on HIV and mental health in her psychiatric textbooks and searched online for research on HIV and mental disorders. “When I read those papers, immediately I said, I think this is the research I should also be doing, here in these patients who I’m seeing on a daily basis.” Butabika Hospital gave her a scholarship and she enrolled in the masters in psychiatry programme at MakCHS in 2003, graduating in 2006. Her research was a comparative study of primary mania versus secondary mania of HIV/AIDS. “It was, to my knowledge, the first time on the African continent that that kind of research was done”, she says. In 2007, she was awarded an International Fulbright Science and Technology Award for PhD studies and went on to complete her PhD in psychiatric epidemiology at Johns Hopkins University, Baltimore, MD, USA, in 2012.
Seggane Musisi, Professor of Psychiatry at MakCHS’s Department of Psychiatry, describes Nakimuli-Mpungu as “a bright and gifted scholar…She has impacted Ugandan and world psychiatry by working to improve access to care of stigmatised, marginalised, and hard to reach people with severe mental illness in LMICs.” Nakimuli-Mpungu believes the mental health focus in Uganda needs to shift. “The problem in Uganda, maybe not only in Uganda, is that our focus is on the extreme end of the mental health spectrum, severe mental disorders…I feel that we should prioritise mental health. This requires creating awareness, education, and identifying the mild cases and then you step in at that stage…All health workers need to have at least the basic knowledge; they need to learn simple mental health screening to recognise depression. And when you identify a problem, immediately do something, give them an intervention. This does not call for specialised health workers because they’re not there. But we all have mental health, and our mental health needs to be taken care of. Otherwise, it makes our physical health worse, we can’t work, so we can’t develop our communities.”
Students and researchers from Makerere University and other institutions pitched 12 innovations addressing challenges in healthcare, clean energy, agriculture, waste management and community resilience during the inaugural Falling Walls Lab Kampala, held at the School of Public Health Auditorium, Makerere University.
The competition brought together emerging innovators to present solutions to practical challenges through a three minute pitch, followed by questions from a panel of judges.
Modelled on the Falling Walls format that originated in Berlin, the event required each participant to identify a “wall” a problem or barrier, and demonstrate how their innovation seeks to break it down.
Mudhasi wins with newborn jaundice screening device
Andrew Mudhasi of Makerere University emerged as the overall winner with a score of 90 per cent for a low cost medical device designed to improve newborn jaundice screening across different skin tones.
Overall competition winner Andrew Mudhasi (left) receives his first Place award certificate for his innovation
Mudhasi explained that the device uses optical sensor technology and a skin tone targeting algorithm to provide a rapid reading, with the aim of helping nurses and clinicians identify jaundice more efficiently.
During questions from the jury, Mudhasi said the device had not yet been tested on actual babies but had undergone laboratory testing using simulated skin tones.
He reported an accuracy rate of 94 per cent when the device was compared with laboratory spectrophotometers.
The innovation is intended initially for use in clinics and hospitals, with Mudhasi saying the team is also considering a version that could eventually allow mothers to screen babies at home.
Mudhasi’s innovation has previously received recognition at the African Business Concept Challenge and the iF Design Student Award, according to his presentation.
Rhonda’s innovation tackles diaper waste
Rhoda John of the University of Nairobi emerged in second place with 89.6 per cent for an innovation addressing the problem of used diaper waste.
Rhondah John pitches her innovation repurposing diaper waste into soil moisture retention
Under the theme “Breaking the wall of diaper waste and drug soils,” Rhonda explained that her team extracts sodium polyacrylate, the absorbent polymer found in diapers, and replaces the sodium with potassium.
The resulting potassium based superabsorbent material is designed to act as a “water battery” in soil by absorbing and retaining water for plants during dry periods.
John said testing showed a 99 per cent increase in germination and a 23 per cent increase in drought resistance.
The innovation also seeks to reduce the amount of used diapers ending up in landfills and the environmental effects associated with their decomposition.
During the question and answer session, John explained that her team was working with government environmental officials in Nairobi on a pilot collection system to address the challenge of gathering used diapers at scale.
Mahera takes third place with herbal peptic ulcer treatment
Stuart Mahera of Makerere University finished third with 86.2 per cent for a herbal formulation targeting peptic ulcers.
Stuart Mayira (left) receives his 3rd Place award certicate at the school of Public Health Auditorium.
Presenting under the theme “Breaking the wall of Nature and Modern Medicine,” Mahera argued that conventional treatment for peptic ulcers can involve multiple medicines and may be associated with side effects and antimicrobial resistance.
His proposed formulation, MARAC capsules, is intended as a monotherapy, combining properties required for peptic-ulcer treatment in a single capsule.
Mahera said his team had carried out quality control work, including characterisation and dose quantification, and had conducted preclinical trials on laboratory mice.
He also told the jury that an application had been submitted to the National Drug Authority as the team awaits the next stage of the regulatory process.
According to Mahera, the proposed seven day treatment would cost about Shs21,000, compared with the existing 14 day treatment approach.
Innovators present solutions to practical challenges
The remaining presentations covered a wide range of challenges.
Esther Nakungu of Utamu University presented Agri-Track, a digital record keeping solution intended to improve visibility, accountability and management of farm operations and financial information.
Dr. Jimmy Chachiga, a Makerere University participant, presented a solar photovoltaic cooker with a heat storage system designed to provide a cleaner and more reliable cooking option during both sunny and non sunny periods.
His presentation focused on reducing dependence on biomass fuels and addressing the challenges associated with intermittent solar energy.
Abdul Noor Luttamaguzi, a PhD student and senior government fisheries officer, presented a mobile application aimed at helping fish farmers and extension officers report, track and manage disease outbreaks.
Henry Duke Tamale presented a herbal cream targeting antibiotic resistant biofilm infections associated with diabetic foot ulcers.
Marvin Seruwu proposed adapting existing near infrared brain monitoring technology to help detect extra-axial brain bleeds in health facilities where access to CT and MRI equipment is limited.
His proposal seeks to repurpose existing technology towards a diagnostic need that could be particularly important in settings where advanced imaging facilities are not readily available.
Kennedy Kisame presented a poultry alert and diagnosis system combining satellite weather information with computer vision disease detection. The proposed system could be accessed through a smartphone application, SMS or USSD, making it potentially usable by farmers with limited internet access.
Frank Atwiine proposed a solar powered mobile diagnostic van designed to bring ultrasound and other diagnostic services closer to rural communities.
Johnson Makmot, a software and blockchain developer, presented a platform that combines GPS tracking and blockchain-based tokens to incentivise and verify plastic-waste collection in Kampala.
Dr. Nelson Ndugu, from a partner university, presented an artificial intelligence tool designed to translate agricultural research publications into local Ugandan languages and generate voice notes for radio-based extension delivery.
The final presentation came from Dr. Juliet Akola, a Ugandan post doctoral researcher at Mangosuthu University of Technology in South Africa.
Akola presented a community digital resilience initiative focused on mapping risks in Kampala’s informal settlements, including flooding, fire, poor sanitation, waste management and inadequate infrastructure.
Her proposal seeks to combine local community knowledge with geographical information systems and link identified risks to action plans involving municipalities and other stakeholders.
Nawangwe calls for more investment in innovation
Closing the event, Prof. Nawangwe congratulated all the participants and described their presentations as an important beginning for Makerere University, Uganda and the wider region.
Vice Chancellor, Prof. Banabas Nawangwe giving his remarks
Drawing on his experience attending the Falling Walls conference in Berlin, the Vice Chancellor said initiatives of this nature are important because innovation will play a major role in determining the future of countries.
He encouraged participants to make their pitches more precise by clearly identifying the problem they are addressing, explaining their proposed solution and demonstrating what they have already achieved.
Prof. Nawangwe also welcomed the participation of innovators from other universities and countries, noting that the Kampala event had attracted participants beyond Makerere.
He thanked the Africa Office of the Falling Walls Foundation for its role in bringing the initiative to Makerere and encouraged continued support for innovation.
The Vice Chancellor further linked innovation to Uganda’s growing youth population and the need to develop home-grown solutions to address challenges such as youth unemployment.
The inaugural Falling Walls Lab Kampala ultimately provided a platform for innovators to move ideas beyond the classroom and laboratory and demonstrate how research, technology and creativity can be applied to challenges affecting communities.
What will it take for Uganda’s health financing to match the scale of its ambitions? How does a nation ensure that the systems it builds are ones the government can fully own, sustain, and grow? And who are the leaders being shaped today to carry this work into the future?
The inaugural issue of the Makerere University School of Public Health (MakSPH) newsletter follows these questions through six months of research, partnership, and institutional growth. Inside: MakSPH’s role in the national dialogue on sustainable health financing; the milestone handover of 16 MakSPH-METS digital health systems, built over 15 years, to Ministry of Health stewardship; and the research and academic investment shaping the School’s next phase of growth.
The edition also covers Vice-Chancellor’s Research Excellence Awards for MakSPH faculty, a new CARTA doctoral cohort, progress on the School’s new building, fresh leadership in the Department of Disease Control and Environmental Health, expanding partnerships in malaria, environmental health, and maternal care, and MakSPH students stepping into leadership across Makerere‘s 92nd Guild Government.
Research has the greatest value when it moves beyond publication to improve lives.
At Makerere University’s Centre of Excellence for Maternal, Newborn and Child Health (MNCH Centre) housed at Makerere University School of Public Health, research, partnerships and innovation are being translated into action to strengthen reproductive, maternal, newborn, child and adolescent health (RMNCAH) in Uganda and beyond.
Welcome to the September MNCH Centre e-Post 135.
This month, we spotlight how evidence is informing action across reproductive, maternal, newborn, child and adolescent health (RMNCAH) at the centre.
Explore how Centre researchers and partners are advancing innovations to reduce early perinatal mortality, how Makerere University through the Centre and WHO are strengthening capacity to monitor health inequalities, and how the Centre and its partners are leveraging AI to strengthen health systems and improve malaria surveillance.
Discover what these innovations could mean for scale, stronger health systems and greater impact.