Health

Researchers Design Community-led Behavioural Change Model to Control Rate of Type 2 Diabetes among Rural Population

Published

5 years ago

October 5, 2021

Mark Wamai

Dr. Juliet Kiguli (3rd Left), Bob Kirunda (4th Right) and Sr. Nabwire Mary (Right) with some of the research team and health practitioners who conducted research on social norms influencing type 2 diabetes risk behaviours

_{By Joseph Odoi}

Globally the proportion of undiagnosed diabetes is high, standing at 46.5%. In high-income regions like Europe, of all persons with Type 2 Diabetes Mellitus (T2DM), 39.3% are undiagnosed. Low-income countries in Africa have the highest prevalence of undiagnosed diabetes, estimated at 66.7%. In Uganda alone, a steady increase in the number of diabetes cases has been observed.

Despite the increasing burden of diabetes in the country, little is known about the socio-cultural norms influencing type 2 diabetes risky behaviors, especially in rural areas to inform action.

In the bid to contribute to data driven interventions, Makerere University researchers with funding from Government of Uganda and Makerere University Research and Innovations Fund (Mak-RIF) carried out a study to understand the patterns of socio-cultural norms in two high incidence districts namely, Busia and Bugiri, in Eastern Uganda.

As part of this study, researchers engaged various health stakeholders who shared their experiences about behaviors factors influencing type two diabetes.

It is upon that background that researchers co-designed a contextual strategy to ensure behavioral change to limit type two diabetes among the rural population under the project titled; “Socio-cultural norms influencing Type 2 Diabetes risks Behaviours – an exploratory to intervention co-design innovative study in two high incidence districts of eastern Uganda”. The strategy was developed by a team of researchers led by Dr. Juliet Kiguli, a Senior Lecturer in the Department of Community Health and Behavioural Sciences at the School of Public Health, Makerere University.

According to Dr. Kiguli, despite evidence confirming a high rate of T2D in Uganda, there is hardly any innovation that speaks to the deep rooted causes of Type 2 Diabetes hence the justification for their new model.

‘’There is enough evidence in Uganda at the national and local/community level confirming a high rate of T2DM, compared to the measures/innovations that try to address the disease. We can argue with confidence that most of the research around T2DM in Uganda and Africa has been largely academic and hasn’t been translated into action at a comparable pace of disease incidence and prevalence. Additionally, since the T2DM is largely a lifestyle disease that is influenced by external factors, exposure and social constructs, the solution to T2DM needs to be socially constructed, and currently, there is no innovation that speaks to the deep rooted causes of T2DM – this is the reason why we designed an evidence based innovation that is socially constructed to address diabetes with prevention in mind too‘’she explained of the model

The Assistant Commissioner Non Communicable Diseases (NCDs) at Ministry of Health, Dr. Gerald Mutungi who participated in the study’s innovation co-design had this to say;

“This study is unique, I have learnt many things which I had never looked at from a perspective of social norms and I am glad that we are already designing an innovation together with the community stakeholders and influencers to mitigate and reduce T2DM”.

He also tasked researchers to give answers on why people doing their daily activities and living a normal lifestyle still get diabetes.

Approaches behind the model

As part of the behavioral change strategy, the research team came up with the following approaches to their community-led behavior change model.

T2DM organized diffusion messaging and practices

This approach of the model will work through community-level social networks and will be used to conduct myths bursting sessions, building new positive social norms and spreading them using social networks related to the norm. This approach will be complemented by deliberation and reflection methodologies and the intent is to create shared commitments to change negative and/or maladaptive risky behaviors around T2DM.

Community-leader-initiated behavior modeling for T2DM

Because of power, control and therefore influence, this approach will target political leaders, religious leaders, cultural leaders, informal community leaders and all individuals with influence to model, demonstrate and promote the recommended behaviors and practices. This will be the first level of establishing reference groups and this approach will complement other approaches.

T2DM Non-conforming trendsetters and positive deviants.

In the co-design process, evidence shows the existence of trendsetters and positive deviants who are willing and able to be the first movers in initiating positive normative change around T2DM risky behaviors. Their nonconformity to the social norms around T2DM will contribute to the erosion of strong perceptions in favor of the negative gendered social norms that facilitate entrenchment of T2DM risky behaviors. This approach will be complemented by creation of new risky-behavior-specific reference groups that are able to enact alternative social sanctions against T2DM risky behaviors.

On timing of this model, Mr. Ramadhan Kirunda who was key in innovating the model noted that evidence from the social-norms study revealed a disconnect between the health system and the social system constructs at community and family level, yet T2DM risky behaviors are gendered and influenced by power, control and sanction around submission.

‘’Social norms are responsible for the harmful constructions of dominant masculinity engineered by power and control over women, hence the social-cultural acceptance of inferiority on the part of women. Therefore, even on matters of diet, women have to submit and follow what men prefer, and can become violent in asserting their dominance if women don’t comply. It is important to note that while gender-injustice related consequences affect mostly women, gendered social norms undermine the health and wellbeing of all people, regardless of age, sex, gender, or income setting. Therefore, our proposed model is informed by this reality, it is inclusive by design since it was co-designed together with all community stakeholders/duty bearers and targets risky behaviors that accelerate T2DM, but also other health outcomes.

KEY FINDINGS FROM THE SOCIAL NORMS STUDY

The main behavioral factors influencing type 2 diabetes were a) consuming processed and added sugar products, b) consuming high cholesterol fatty foods, c) excessive alcoholism, d) smoking (traditional and contemporary), e) mental/psychosocial stress and f) lack of exercise. The analysis shows that dietary factors contribute the greatest threat to the fight against type 2 diabetes in Busia and Bugiri according to the researchers.

In terms of social norm strength around dietary factors, the two strongest norms were “people who don’t prepare fried food are poor people”, “taking tea without adding sugar is mistreatment to your husband” and “Bwita/kalo is our staple food, we eat it daily”. Some of the less strong norms included; “eating greens is mistreatment to your man/husband”, “fat people especially men are respected in the community”, and “A true Samia meal must contain meat or fish daily” said one of the study participants

The strongest social norms around alcoholism.The strongest social norms around alcoholism were “alcohol takes away negative thoughts and stress”, “when you take alcohol with your friends, they can’t abandon you”, “Waragi reduces diabetes because it is sour”, “religion does not allow us to take alcohol” explained one of the key informants.

The social norms around smoking included; “if you want to feel good, you have to smoke”, “most old people and our grandparents lived long and were smokers” and “traditional religion demands and allows smoking of pipes, it’s part of our culture”. Affirmed another study participant

The main social norm around physical exercise was that “men are expected to rest/lie down and wait to be served by women”. They have to sit and wait for food’’ added a participant

On drivers that support norm entrenchment, the researchers outlined easy access to alcohol, gender based violence, cultural set up, poverty, wrong peers, poor parenting, one sided food systems as areas that need serious attention.

MORE ABOUT THE STUDY

The study used Social Norms Exploration Tools (SNET). It was conducted in Eastern region in the districts of Bugiri and Busia in December, 2020. This study covered a total of 4 health facility catchment areas: Bugiri Hospital, Nakoma H/C IV, Masafu Hospital and Lumino H/C III.

A number of data collection methods were used including Focus Group Discussions. Key Informant Interviews, In-depth Interviews, Observation and Photography.

This study builds on previous studies funded by Swedish Embassy and conducted in Iganga and Mayuge by the School of Public Health’s Prof. Guwatudde David, Dr. Barbara Kirunda, Dr. Elizabeth Ekirapa, Dr. Roy Mayega and Prof. Buyinza Mukadasi (Research and Graduate Training, Makerere University)

The research team consisted of the following researchers: Dr. Juliet Kiguli (Principal Investigator), Dr. Roy William Mayega, Dr. Francis Xavier Kasujja, Mr. Ramadhan Kirunda, Ms. Gloria Naggayi, Ms. Joyce Nabaliisa, Ms. Rita Kituyi, Sr. Nabwire Mary, and Sr. Nampewo Evarine Wabwire. The social norms study was made possible with funding by Mak-RIF (led by Prof. Bazeyo William) and Government of Uganda.

Related Topics:Bugiri Busia Diabetes lifestyle Mak-RIF MakSPH Model prevalence Research rural social study T2DM Type 2 Uganda

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Health

WIN-WIN Call for Proposals: Wetland Restoration in the Greater Kampala Metropolitan Area

Published

23 hours ago

September 30, 2026

Mak Editor

The Makerere University School of Public Health (MakSPH) Building, Mulago Hospital Complex. Kampala Uganda, East Africa.

Makerere University School of Public Health (MakSPH), on behalf of the WIN-WIN in the Wetlands for Climate Resilience project, invites eligible organisations to submit proposals for selection as the Implementing Partner responsible for designing and delivering a community-based urban wetland restoration and sustainable livelihood intervention in the Greater Kampala Metropolitan Area (GKMA).

This is an open, competitive Call for Proposals (CfP). In line with good practice for evidence-generation projects, this CfP intentionally does not prescribe the restoration model, livelihood package, or implementation methodology. Applicants are instead invited to propose their own technically sound, innovative, and locally appropriate approach in response to the problem statement, objectives and outcomes set out in the attached Terms of Reference (ToR). The selection process will be conducted in two stages: (1) a short Concept Note stage, open to all eligible applicants, and (2) a Full Proposal stage, open only to organisations shortlisted at Concept Note stage.

Key details:

What: Selection of an Implementing Partner for Community-Based Urban Wetland Restoration and Sustainable Livelihood Development
Reference No.: MakSPH/WIN-WIN/CfP/2026/01
Who can apply: Registered NGOs/CSOs, CBOs/cooperatives, private firms or social enterprises, or consortia of these
Where: Urban and peri-urban wetland communities in Wakiso, Mukono, and Mpigi districts (Greater Kampala Metropolitan Area)
Concept Note deadline: 16 October 2026, 5:00 PM (EAT)
Submission: winwinwetlands@musph.ac.ug, subject line “WIN-WIN CfP – [Applicant Organisation Name]”
Contact for questions: Ms. Winnie Kansiime, winniekansiime@musph.ac.ug, +256 783 640 210

See below for detailed call.

Makerere-SPH-WIN-WIN-Call-for-Proposals-TOR Download

Health

MakCHS Lecturer selected for Global Atlantic Fellowship to Advance Brain Health Equity

Published

2 weeks ago

September 18, 2026

Zaam Ssali

Dr. Joy Louise Gumikiriza-Onoria, a Clinical Psychologist and Assistant Lecturer in the Department of Psychiatry at Makerere University College of Health Sciences, has been selected for the prestigious 2026–27 Atlantic Fellows for Equity in Brain Health program.

Based at the Global Brain Health Institute (GBHI) at the University of California, San Francisco (UCSF), the global fellowship brings together leaders across multiple disciplines to develop innovative, equitable solutions for brain health and dementia care worldwide. Dr. Gumikiriza-Onoria, who holds a PhD in Brain Health, is an accomplished academician and researcher whose expertise spans neuropsychology, mental health, cognitive functioning, behavioural science, and implementation research.

Uganda currently faces a rising prevalence of dementia, compounded by limited public awareness and a shortage of specialized care facilities. Dr. Gumikiriza-Onoria’s work directly addresses these challenges by focusing on dementia, HIV and aging, neuropsychology, and community-based interventions. Through her strategy of generating rigorous evidence and developing scalable interventions, she aims to enhance cognitive and mental health outcomes for older adults—particularly those aging with HIV—in sub-Saharan Africa.

As part of the 2026–27 cohort, Dr. Gumikiriza-Onoria joins 15 other incoming fellows at UCSF representing diverse fields including medicine, public health, advocacy, policy, and the arts. Together, they become part of a lifelong global network of more than 330 Atlantic Fellows spanning over 70 countries. Over the coming year, the fellows will collaborate across disciplines, hone their leadership skills, and design scalable approaches to reduce brain health inequities.

Through the fellowship, Dr. Gumikiriza-Onoria plans to establish key international partnerships to translate her research into practical, culturally relevant solutions. Her goal is to strengthen local brain health systems, support dementia caregivers, and improve healthy aging outcomes for vulnerable populations across Uganda and the broader African continent.

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Health

Ministry of Health Launches National University Health Screening Initiative at Makerere 92nd Guild Medical Camp

Published

2 weeks ago

September 17, 2026

Elvis Lubanga

L-R: Prof. Josaphat Byamugisha, Prof. Richard Idro, and H.E. Kadondi Gracious present a plaque to Hon. Anifa Kawooya appreciating the Ministry of Health Support to the Medical Camp on 17th September 2026. Launch of the two-day 92nd Makerere University Guild Annual Medical Camp and intensified testing and active case finding for Malaria, HIV/AIDS and Sickle Cell Disease in universities and tertiary institutions, 17th September 2026, Freedom Square, Makerere University, Kampala Uganda, East Africa.

Despite a morning downpour, the two-day 92^nd Makerere University Guild Annual Medical Camp successfully commenced on September 17, 2026 with a launch at the Freedom Square.

The Launch marks a strategic partnership between the Ministry of Health and higher education institutions to advance physical well-being and awareness of students from public and private universities.

Presiding over the event, the Minister of State for Health (General Duties), Hon. Anifa Kawooya Bangirana, launched the intensified testing and active case finding for Malaria, HIV/AIDS and Sickle Cell Disease.

Ministry officials emphasized that laboratory screening and diagnostic testing are critical entry points for early detection, linkage to care, appropriate clinical management, surveillance and prevention, and the Ministry of Health pledges full support to strengthen these services across universities nationwide.

A section of students that attended the Annual Medical Camp 2026. Launch of the two-day 92nd Makerere University Guild Annual Medical Camp and intensified testing and active case finding for Malaria, HIV/AIDS and Sickle Cell Disease in universities and tertiary institutions, 17th September 2026, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***A section of students that attended the Annual Medical Camp 2026.***

Held under stewardship of the Makerere University Dean of Students office, the camp offered a comprehensive suite of health services to the student body and the wider community. Attendees had access to the following services:

General and Specialist Consultations
Sickle Cell, Malaria RDT and HIV Screening
Eye Care and Laboratory Diagnostics
Free Essential Medicines
Reproductive Health Counseling
Mental Health Counseling

While addressing the attendees, Hon. Kawooya emphasised that health is synonymous with national economic productivity.

She guided the youth to prioritise well-being, and avoid living in denial for it is the first step to refusing help. This will help build a firm foundation for any future contributions to national development.

Hon. Anifa Kawooya accompanied by Guild Health Ministers from various institutions tours the exhibition. Launch of the two-day 92nd Makerere University Guild Annual Medical Camp and intensified testing and active case finding for Malaria, HIV/AIDS and Sickle Cell Disease in universities and tertiary institutions, 17th September 2026, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***Hon. Anifa Kawooya accompanied by Guild Health Ministers from various institutions tours the exhibition.***

The Minister further warned students against risky behaviours, including substance abuse and sexual immorality, which she described as poisonous.

She advocated for responsible reproductive health practices, urging students to utilise resources available to protect themselves for the future.

Why you should Know Your Status

Prof. Charles Olaro, who is the Director General of Health Services at the Ministry of Health, Uganda reflected on his time at the university during the peak of the HIV epidemic, recalling a visit from the late Bongole Lutaya.

He noted that today’s youth have not witnessed the severity of the AIDS due to the availability of care and ARVs, which can create a false sense of security.

“People are in care and you have not seen the real slim disease. You have not seen it”

Prof. Charles Olaro. Launch of the two-day 92nd Makerere University Guild Annual Medical Camp and intensified testing and active case finding for Malaria, HIV/AIDS and Sickle Cell Disease in universities and tertiary institutions, 17th September 2026, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***Prof. Charles Olaro.***

He added that some attending are products of mothers that undertook prevention of mother-to-child transmission of HIV, and they gave birth to negative children. But now when we are grown up, they are reckless with their sexual life.

Prof Olaro summarized his remarks by noting that health is an irreplaceable asset and that decisions made today have significant future ramifications. They urge the audience to take the opportunity to know their status, whether for HIV or sickle cell disease, as this is the essential entry point for care and life planning.

Benefits of knowing your status:

It serves as the entry point for receiving necessary care.
It allows for better life planning.
It enables individuals to manage other aspects of their lives effectively.
It prevents future health complications.

Genetic Awareness and Blood Donation

Associate Professor Richard Idro the Deputy Principal of the Makerere University College of Health Sciences (MakCHS) emphasised the importance of seeking appropriate information with a focus on genetic awareness. He advised the students to know their status before marriage to prevent passing on genetic conditions.

“One day when you fall in love, you know that preferably you should not marry somebody who is also carrying a certain gene.”

Prof. Richard Idro. Launch of the two-day 92nd Makerere University Guild Annual Medical Camp and intensified testing and active case finding for Malaria, HIV/AIDS and Sickle Cell Disease in universities and tertiary institutions, 17th September 2026, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***Prof. Richard Idro.***

He then delved into the importance of treating HIV and clearing malaria parasites, which he addressed exhaustively.

From this, Dr Idro’s focus turned to blood donation where he acknowledged a number of people that had already participated in the exercise at the Uganda Red Cross Society tent.

“I see the Red Cross at one corner. As we passed there, 36 people had donated blood. Although, gentlemen, I saw very few of you donate blood.”

He concluded by challenging the young men present and reminding them that they can donate blood up to four times a year and still remain healthy.

Empowering Ambassadors of Global Health Awareness

The Ministry of Health called upon the students attending the camp to serve as ambassadors for global health awareness in their respective institutions.

The Executive Director/Commissioner National Health Laboratory and Diagnostic Services (NHLDS), Dr. Susan Nabadda Ndidde advised the students to make sure that they mobilise and intensify testing for all these diseases.

Dr. Susan Nabadda Ndidde. Launch of the two-day 92nd Makerere University Guild Annual Medical Camp and intensified testing and active case finding for Malaria, HIV/AIDS and Sickle Cell Disease in universities and tertiary institutions, 17th September 2026, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***Dr. Susan Nabadda Ndidde.***

“We will work with you as a Ministry to provide the tests to make sure that we know your status and prevent these diseases in time.”

She wrapped up her message by thanking Makerere for allowing the Ministry of Health to partner on this cause and urged the students to embrace this opportunity and make sure they leave after establishing their status.

By bringing these critical services directly to campuses, the government fosters a healthier, and more informed generation capable of driving Uganda’s future development.

Students Appreciate the Medical Camp

According to Denise Kainomugisha, the Chairperson of the Makerere University School of Public Health (MakSPH) and Vice Minister of Health in the 92^nd Guild, the Camp served as a vital platform for capacity building.

92nd Guild Health Minister Hon. Wamezaya Ebenezer (R) and his Vice Hon. Denis Kainomugisha (L). Launch of the two-day 92nd Makerere University Guild Annual Medical Camp and intensified testing and active case finding for Malaria, HIV/AIDS and Sickle Cell Disease in universities and tertiary institutions, 17th September 2026, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***92nd Guild Health Minister Hon. Wamezaya Ebenezer (R) and his Vice Hon. Denis Kainomugisha (L).***

“The screening, the testing, the sports science, was all handled by the student volunteers under supervision” she confessed.

She also explained that the camp extended to broader public health goals and additionally fostered leadership and collaboration among students, who were encouraged to work together to address community health needs.

Concluding her remarks, Kainomugisha expressed gratitude to the respective partners for providing both financial support and the opportunity for students to take on active roles throughout the Medical Camp.