Health
Researchers Design Community-led Behavioural Change Model to Control Rate of Type 2 Diabetes among Rural Population
Published
4 years agoon

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.
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Health
Sickle Cell Disease Stakeholders’ Engagement calls for raising awareness at grassroots
Published
6 days agoon
October 24, 2025By
Eve Nakyanzi
Makerere University, through the College of Health Sciences (CHS), hosted the Sickle Cell Disease Stakeholders’ Engagement Meeting on 24th October 2025. The event was organized by the Center of Excellence for Sickle Cell Disease and Neglected Tropical Diseases, in partnership with Enhancing Research Capacity for Sickle Cell Disease and Related Non-Communicable Diseases Across the Lifespan in Uganda (ENRICH) and the Sickle Pan Africa Research Consortium (SPARCo). The meeting brought together a diverse group of stakeholders, including religious leaders from the Catholic Medical Bureau, Protestant Medical Bureau, and the Uganda Muslim Supreme Council, as well as members of academia and public health practitioners.
During the Stakeholders’ Engagement Meeting held under the theme; Addressing Sickle Cell Disease in Schools and Communities, panelists emphasized the importance of early detection and effective communication in managing the disease. One of the speakers highlighted the critical role of medical interns as the first point of contact in identifying symptoms such as unexplained anemia and limb swelling, urging them to take detailed patient histories for timely diagnosis and referral. Another panelist, Ms. Penina Agaba, a lecturer at the Makerere University, underscored the need to translate data-driven research into simple, accessible formats for policymakers and community leaders. She noted that findings should be communicated in local languages through channels such as workshops, radio programs, and community meetings to ensure wider understanding and practical policy action.

In her remarks, Dr. Rosemary Byanyima, the Executive Director of Mulago National Specialised Hospital, shared her personal and professional commitment to improving the management of sickle cell disease in Uganda. A sickle cell warrior herself, Dr. Byanyima revealed that Mulago is planning to establish a medical campus that will offer specialized care, including hip replacements for patients suffering from sickle cell disease. She also noted that the hospital has supported the establishment of several service centers in Mukono General Hospital, Pallisa District, and Kayunga, aimed at bringing services closer to the communities. Dr. Byanyima urged all stakeholders to work together to raise awareness, increase testing, and encourage early healthcare seeking among those affected by the disease.
The panel discussions at the Sickle Cell Disease Stakeholders’ Engagement Meeting underscored the shared responsibility of all sectors in creating a more inclusive and informed society for people living with the condition. The conversations, moderated by Dr. Deo Munube and Ms. Evelyn Mwesigwa, explored how schools, faith institutions, and communities can work together to support those affected. Speakers emphasized the need for inclusive school policies that accommodate children with sickle cell disease—such as allowing extra clothing, flexible restroom access, and special exam arrangements—alongside guidance and counseling services to combat stigma and nurture self-esteem. They also stressed the importance of honesty from parents in disclosing their children’s health conditions to enable appropriate care.

From a broader perspective, panelists like Mr. Kajiiko Shafik from the Uganda Muslim Supreme Council highlighted the potential of faith-based structures to advance community sensitization and advocacy. The discussions collectively called for greater collaboration between the Ministries of Education and Health, improved psychosocial support, and stronger legal and policy frameworks to ensure that every child and adult living with sickle cell disease can thrive in a compassionate and supportive environment.

In her closing remarks, Dr. Sarah Kiguli, the Director of the Centre of Excellence for Sickle Cell Disease and Neglected Tropical Diseases at Makerere University, expressed gratitude to all stakeholders for their active participation and thoughtful contributions. She noted her optimism about the existing systems that can be leveraged to strengthen collaboration and awareness efforts, saying, “I’m happy that there are systems already in place that we can use to engage everyone on this cause.” Dr. Kiguli emphasized the importance of collective responsibility in the fight against sickle cell disease, adding, “It is impossible for us here in Makerere to reach everyone, but I love the message of ‘train the trainers’ so that sensitisation work can be efficient and far-reaching.”

Makerere University’s continued commitment to public health research extends beyond academia into real community impact. Through the College of Health Sciences, the University has strengthened partnerships with the Ministry of Health and regional hospitals to enhance early screening, diagnosis, and management of Sickle Cell Disease. Recent efforts include supporting the expansion of the national Sickle Cell Registry and developing community-based counselling programs to raise awareness at the grassroots level. Despite progress, Uganda still faces significant gaps in screening and treatment, with thousands of children born each year with the condition remaining undiagnosed. Makerere’s initiatives, therefore, aim to bridge these gaps through research, training, and collaboration with government, faith-based, and cultural institutions to ensure that no child or family faces Sickle Cell Disease in silence.
Health
Makerere, Karolinska Reflect on 25 Years, Encourage University Research Equality
Published
2 weeks agoon
October 17, 2025
STOCKHOLM — Makerere University and Karolinska Institutet (KI-Mak) marked 25 years of collaboration on Oct. 15, 2025, with a hybrid forum on research equity, highlighting lessons for universities striving toward fair and sustainable global partnerships.
The event, part of the Global Conversations on Sustainable Health, explored the theme, “Exploring Power Dynamics & Equity in Partnerships.” Scholars, policymakers, and university leaders gathered to discuss how institutions can build collaborations grounded in trust, shared ownership, and mutual respect.
Organized by the Centre of Excellence for Sustainable Health (CESH), a joint initiative between Makerere University and Karolinska Institutet, the forum reflected on how equitable partnerships drive progress toward the 2030 Sustainable Development Goals.
Hours before the event, Sweden’s Ambassador to Uganda, H.E. Maria Håkansson, posted on X (formerly Twitter):
“The partnership between Makerere University and Karolinska Institutet is both dynamic and exemplary in how many years of development cooperation can lay the foundation for mutually beneficial relations between institutions in Sweden and Uganda.”

Equity, Trust, and Warmth at the Core
Panelists navigated questions of power, agency, and mutual respect. Policymakers, researchers, and academics agreed that successful partnerships depend not only on fairness but also on warmth, the human connection that sustains collaboration and ensures initiatives respond meaningfully to local realities.
Dr. Andreas Göthenberg, executive director of the Swedish Foundation for International Cooperation in Research and Higher Education (STINT), recalled that earlier models often reduced African researchers to “data farmers” in one-directional projects led from the North.
“We now support balanced research collaborations, not capacity building alone,” he said.
Over the past decade, he added, STINT has seen a surge of high-quality proposals from African researchers seeking genuine collaboration.
“When partners bring different expertise and learn from each other, that is when collaborations work well,” he said. “Institutions with fewer resources can now do very advanced things; that’s a real game changer.”
Göthenberg said Africa’s rapid advances in microfinancing, cloud computing, and even space research show that “technology development means institutions with fewer resources can still do very advanced things,” offering lessons for innovation systems in Europe.

Why Equitable Partnerships Matter
Professors Rhoda Wanyenze and Stefan Swartling Peterson have argued that traditional models often concentrate leadership and funding in the Global North, thereby limiting the agency of Southern partners.
Their work from long-term collaborations in Ethiopia, Uganda, Lao PDR, and Vietnam shows that shifting leadership to where research occurs strengthens local capacity and aligns agendas with community needs.
They demonstrate that equity relies on mutual trust, transparency, and shared decision-making, principles that transform funding into a tool for empowerment rather than dependency. Joint PhD programs, reciprocal staff exchanges, and twinned supervision models have further enabled two-way knowledge flow and reduced brain drain.
“Partnerships grounded in reciprocity, inclusion, and respect are not only ethically sound but also more effective,” Wanyenze said. “They build local ownership, lasting capacity, and context-driven innovation.”

Championing South-to-South Knowledge Exchange
Associate Professor Caroline Wamala-Larsson, director of the SPIDER program at Stockholm University, underscored that the Global South must set its research agendas.
“The agenda must be set by Southern institutions. Swedish institutions act as collaborators, not directors,” she said.
She cited projects in Uganda, Tanzania, Rwanda, Bolivia, and Mozambique where South-to-South learning has flourished.

“Bolivians traveled to Tanzania to share source codes from a research management system. Now, the University of Dar es Salaam wants to adopt it,” she said. “Solutions developed within the South often fit local contexts better than Northern models.”
Wamala-Larsson added that innovation and digital transformation have strengthened institutional systems. “We need new funders, private sector partners, and universities to participate equally.” Respect for each partner’s contribution is essential for sustainability,” she said.
Adapting to a Changing Global Landscape
Shifting global priorities and limited funding are reshaping how universities collaborate. Ms. Brenda Wagaba, partnerships officer at Makerere University, noted that while funding remains limited, the Government of Uganda, for instance, has taken steps to support local research through the Research and Innovation Fund. “The government started setting aside money for university research even before the recent cuts,” she said.
“Now, with those cuts, the need for sustained domestic investment is even greater.” She added that such initiatives strengthen the confidence of Southern partners to engage as equal contributors in global collaborations.
Dr. Rawlance Ndejjo, a Makerere University researcher, said local initiatives could help sustain momentum. “Local funding opportunities allow countries to find resources for research and partnerships. Such efforts can improve equity through bottom-up collaborations,” he said.

Göthenberg noted that new opportunities lie in multidisciplinary work. “Many of the challenges we face today demand broadly defined solutions,” he said. “Multidisciplinary projects lead to broader societal impact and stronger partnerships.”
He also pointed to Africa’s demographic advantage: “With its young population and rapid innovation, Africa is driving technological development in ways that can benefit both continents.”
Equitable Partnerships Deliver Results
Wagaba said engaging communities early is key to success. “When we engage communities early, we can bridge the gap between large-scale interventions and local acceptance. Whether it’s water, vaccines, or health infrastructure, success depends on understanding immediate community priorities,” she said.
She cautioned that top-down projects often fail to deliver lasting impact.
“You may build a vaccine plant or develop a vaccine, but if a community’s immediate need is safe water, your intervention will falter,” she said, adding that warmth, respect, and open communication are as critical as technical expertise.
Makerere Vice Chancellor Prof. Barnabas Nawangwe highlighted tangible results from Sweden’s long-term support.

“Under the SIDA program, 500 PhD students were trained, all of whom returned to Uganda,” he said. “The program made them feel at home while gaining knowledge abroad. Without mutual respect, equity will always face challenges.”
Prof. Annika Östman Wernerson, president of Karolinska Institutet, said sustainable partnerships depend on continuous engagement.
“Every collaboration begins with people meeting. Warmth and curiosity are crucial between individuals and institutions,” she said. “Equity is not static; it requires continuous work. Trust and transparency are critical.”

A Global Model for Sustainable Partnerships
The 25-year collaboration between Makerere University and Karolinska Institutet demonstrates how long-term, equitable partnerships can strengthen research systems and inform policy.
As Nawangwe put it:
“Students return home, communities benefit, and research informs global health policy. This is a model of how equity and trust drive sustainable partnerships.”

The Makerere–Karolinska (KI-Mak) partnership shows how universities, funders, and governments can work together fairly and Like many others working in this field, the Center recognises that there is still much to learn and discuss about how partnerships can continue to evolve through openness, dialogue, and shared reflection.
As Makerere and Karolinska look to 2030, their renewed agreements promise more than ceremonial goodwill. The two universities will intensify exchanges between students and faculty, expand joint research, share academic output, and organise lectures, conferences, and workshops. They will also open new paths for training, scientific collaboration, and shared learning. After 25 years, the partnership has proven that long-term cooperation can endure and excel with mutual respect, steady investment, and a clear purpose.
Health
TWAS recognises Dr. Angelina Mwesige Kakooza for her research
Published
2 weeks agoon
October 13, 2025By
Zaam Ssali
Dr. Angelina Mwesige Kakooza, Associate Professor of Paediatrics in the Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences (MakCHS) received the 2025 TWAS-Fayzah M. Al-Kharafi Award in Medical Sciences. She was recognised for her research on neurodevelopmental disorders – particularly epilepsy, cerebral palsy, and nodding syndrome – and for advancing policy and research, mentorship, as well as local community interventions to enhance children’s health.
The award was given at the recent 17th General Conference of The World Academy of Sciences (TWAS) held in Rio de Janeiro, Brazil under the theme ‘Building a Sustainable Future: The Role of Science, Technology, and Innovation for Global Development.’ Organized in partnership with the Brazilian Academy of Sciences (BAS) and TWAS, the conference brought together leading scientists, policymakers, and institutional leaders from across the global South and beyond.
In her remarks after receiving the award, Dr. Kakooza said, “This award highlights the importance of neurodevelopmental disorders which are a great health problem worldwide, often diagnosed late and treated poorly,” said Kakooza. “It affirms my contribution to science in Africa, strengthens advocacy for gender equity in science and education and makes me a role model for others, increasing my influence in the scientific community.”

Dr. Angelina Kakooza Mwesige is a Ugandan scholar with over 25years teaching experience whose research focuses on neurodevelopmental disorders in children centred on their epidemiology, early screening, identification and community based interventions in Uganda. Her current areas of research cover studies on early detection and interventions for young infants at high risk of neurodevelopmental delay and disability in Nepal and Uganda; development of community engagement projects to empower adolescents living with epilepsy in Uganda reduce stigma in their communities; as well as development and testing of an interactive epilepsy smart phone application to improve resilience among them.
TWAS is a global merit-based science academy based in Trieste, Italy, and administered as a UNESCO Programme Unit. Read more here: https://twas.org/
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