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

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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.

  1. 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.

  1. 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.

  1. 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 MayegaDr. 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.

Mark Wamai

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College of Health Sciences Inspires Future Health Professionals at Career Fair

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Prof. Bruce Kirenga addresses the senior six students and their teachers on 10th July 2026. Makerere University College of Health Sciences (MakCHS) Career Fair for Ngora High School and Wiggins Secondary School guiding senior six science students on careers in health sciences and introducing them to the wide range of academic programmes offered by the College, 10th July 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.

The Makerere University College of Health Sciences (MakCHS) on July 10, 2026, welcomed senior six science students from Ngora High School and Wiggins Secondary School to an inspiring Career Fair aimed at guiding them on careers in health sciences and introducing them to the wide range of academic programmes offered by the College.

The event brought together students pursuing Physics, Chemistry, Biology (PCB) and Biology, Chemistry, Mathematics (BCM), providing them with a unique opportunity to interact with the College leadership, tour laboratories and teaching facilities, and learn first-hand about careers in medicine and other health science disciplines.

Welcoming the students, the College Principal, Prof. Bruce Kirenga, described the College of Health Sciences as one of Africa’s oldest and most distinguished medical schools, with a legacy spanning more than a century.

“We started in 1924, making us one of the oldest medical schools on the continent. You have made the right decision to visit Makerere, and we are delighted to welcome you,” he said.

Prof. Kirenga commended the school administrators and teachers for organizing the visit, noting that exposing learners to university environments early helps them make informed career choices. He explained that the College introduced the Open Day concept after receiving numerous requests from schools seeking career guidance visits.

Prof. Bruce Kirenga. Makerere University College of Health Sciences (MakCHS) Career Fair for Ngora High School and Wiggins Secondary School guiding senior six science students on careers in health sciences and introducing them to the wide range of academic programmes offered by the College, 10th July 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.
Prof. Bruce Kirenga.

He congratulated the students for choosing science subjects, describing science as the foundation for solving society’s most pressing challenges.

“You have already made one of the most important decisions by choosing to become scientists. Even more importantly, you have chosen life sciences—a field dedicated to preserving and improving life,” he remarked.

The Principal emphasized that careers in life sciences extend far beyond medicine, encouraging students to remain open-minded as they consider their future.

“Everything that has life requires professionals to keep it healthy—from human beings and animals to crops and the environment. The opportunities are immense, including agriculture, veterinary medicine, biomedical sciences, public health and many other emerging fields.”

A section of senior six students and their students at the career fair. Makerere University College of Health Sciences (MakCHS) Career Fair for Ngora High School and Wiggins Secondary School guiding senior six science students on careers in health sciences and introducing them to the wide range of academic programmes offered by the College, 10th July 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.
A section of senior six students and their students at the career fair.

He also advised students not to limit themselves to only one academic programme during university applications, recalling instances where highly qualified students narrowly missed admission because they selected only one course.

“Remain open to the opportunities available. Medicine is an excellent profession, but there are many other programmes that are equally rewarding and are shaping the future of healthcare and scientific innovation,” he said.

Prof. Kirenga further encouraged the students to embrace lifelong learning, reminding them that scientific knowledge remains valuable regardless of the career path they eventually pursue.

Addressing the students, the Dean of the School of Medicine, Prof. Annette Nakimuli, acknowledged the growing competition for admission into medical programmes and urged learners to work hard while keeping an open mind about the diverse opportunities available within health sciences.

Prof. Annettee Nakimuli. Makerere University College of Health Sciences (MakCHS) Career Fair for Ngora High School and Wiggins Secondary School guiding senior six science students on careers in health sciences and introducing them to the wide range of academic programmes offered by the College, 10th July 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.
Prof. Annettee Nakimuli.

She explained that admission into the Bachelor of Medicine and Bachelor of Surgery (MBChB) programme has become increasingly competitive due to the rising number of high-performing applicants.

“This year we witnessed unprecedented competition for government sponsorship, with many applicants scoring triple A at Advanced Level and outstanding grades at Ordinary Level. That tells you that you must prepare yourselves to excel academically,” she said.

Prof. Nakimuli noted that while many students aspire to become medical doctors, the health sector today offers numerous innovative programmes that are equally important.

“There are many programmes that parents, teachers and students are still not familiar with. Biomedical Engineering, for example, is one of the exciting fields driving the future of healthcare, yet many students overlook it because they focus only on medicine.”

Students and Teachers pose for a group photo with CHS staff. Makerere University College of Health Sciences (MakCHS) Career Fair for Ngora High School and Wiggins Secondary School guiding senior six science students on careers in health sciences and introducing them to the wide range of academic programmes offered by the College, 10th July 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.
Students and Teachers pose for a group photo with CHS staff.

She encouraged students to explore emerging disciplines that combine medicine, engineering, technology and research, noting that the future of healthcare increasingly depends on multidisciplinary professionals.

The Dean also introduced students to the structure of the School of Medicine, explaining that it comprises twelve academic departments and two specialised units covering a broad spectrum of clinical disciplines, including Internal Medicine, Surgery, Obstetrics and Gynaecology, Orthopaedics, Ophthalmology, Ear, Nose and Throat (ENT), Family Medicine, Anaesthesia and Critical Care, among others.

She explained that students are trained by specialists across these disciplines to become competent general practitioners before pursuing further specialization.

Prof. Erisa Mwaka, the Chair of the Department of Human Anatomy, shared with the students about the School of Biomedical Sciences (SBS). He said the school is one of the four schools that make up the Makerere University College of Health Sciences (MakCHS). As the foundation of medical education, the School provides students with a comprehensive understanding of the biological and molecular sciences that underpin modern healthcare, disease prevention, diagnosis and treatment.

Prof. Erisa Mwaka with students in one of the teaching spaces. Makerere University College of Health Sciences (MakCHS) Career Fair for Ngora High School and Wiggins Secondary School guiding senior six science students on careers in health sciences and introducing them to the wide range of academic programmes offered by the College, 10th July 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.
Prof. Erisa Mwaka with students in one of the teaching spaces.

The School comprises several departments, including:

  • Human Anatomy
  • Biochemistry
  • Physiology
  • Pharmacology and Therapeutics
  • Pathology
  • Microbiology
  • Medical Illustration

The School offers undergraduate programmes such as the Bachelor of Science in Biomedical Sciences, which equips students with strong laboratory, research and analytical skills, and the Bachelor of Science in Biomedical Engineering, an interdisciplinary programme that integrates engineering, medicine and technology to develop innovative healthcare solutions.

At postgraduate level, the School offers a wide range of master’s and doctoral programmes, including Human Anatomy, Physiology, Pharmacology, Bioinformatics, Immunology and Clinical Microbiology, Health Bioethics, Medical Illustration, Pathology and other biomedical specializations that prepare graduates for careers in research, academia, diagnostics, biotechnology and the pharmaceutical industry. The school also offers a wide range of diploma courses.

Dr. Isaac Magulu Kimbowa from the Department of Pharmacology and Therapeutics (Right) and colleagues interact with the students. Makerere University College of Health Sciences (MakCHS) Career Fair for Ngora High School and Wiggins Secondary School guiding senior six science students on careers in health sciences and introducing them to the wide range of academic programmes offered by the College, 10th July 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.
Dr. Isaac Magulu Kimbowa from the Department of Pharmacology and Therapeutics (Right) and colleagues interact with the students.

Throughout the Career Fair, students interacted with faculty members, toured laboratories and learning facilities, and received guidance on university admission, academic programmes and career prospects within the health sciences.

The Career Fair forms part of the College’s broader outreach programme aimed at nurturing the next generation of healthcare professionals by exposing learners to university life and equipping them with the information needed to make informed academic and career decisions.

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Betty Kyakuwa
Betty Kyakuwa

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Makerere University Promotes Prof. Peter Waiswa to Full Professor

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Congratulations Prof. Peter Waiswa. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.

By Joseph Odoi

Makerere University has promoted Prof. Peter Waiswa from the rank of Associate Professor to Full Professor of Health Policy, Planning and Management at the School of Public Health, following the decision of the Appointments Board at its 811th meeting held on 10th July 2026.

The promotion recognises his outstanding contributions to the University’s core functions of teaching and learning, research and innovation, institutional development, mentorship, leadership, and service to society.

Throughout his academic career, Prof. Waiswa has distinguished himself as a leading scholar in implementation science, health systems strengthening, policy and health services research. His work has influenced practice and decision-making in Uganda, across Africa, and globally.

His research has strengthened the connection between evidence generation, policy development, and implementation of health programmes, particularly in resource-limited settings where stronger health systems are critical to improving population health outcomes.

Reflecting on the promotion, Prof. Peter Waiswa described the recognition as a collective achievement, acknowledging the contribution of his students, colleagues, partners, and communities that have supported his journey.

“I am deeply grateful to Makerere University for this promotion. This is not a personal achievement, but a recognition of the collective work of my students, colleagues, partners, and the communities we serve.  

We must build systems, mentor the next generation, and work with government to deliver evidence-based results so that no one is left behind. The journey continues’ ’he emphasized of the task ahead

A Public Health Scholar with Continental and Global Influence

Prof. Waiswa is recognised as one of Sub-Saharan Africa’s leading public health researchers, with a research portfolio that has shaped health systems thinking and practice.

According to Google Scholar data, Prof. Waiswa has accumulated 17,701 citations, with an H-index of 57 and an i10-index of 209. Since 2021, his work has received 10,649 citations, including more than 2,400 citations in 2025, reflecting the growing global relevance of his scholarly work.

In 2020, Expertscape ranked Prof. Waiswa among the top 0.22 percent of global authors on infant mortality, recognising his contribution to advancing knowledge in child health and survival.

Leading Research, Innovation and Health Systems Transformation

Prof. Waiswa has led major multi-sectoral research and implementation science initiatives that have contributed to strengthening health systems in Uganda, Africa, and globally.

Between 2021 and 2024, he led a multi-sectoral team across 28 Anglophone and Francophone African countries through the Digital Health Payment Initiative and Research (DHPI-R) for campaign health workers. The research is strengthening accountability in health campaigns, informing policy discussions with global partners including WHO, UNICEF, and the Gates Foundation, and contributed to the establishment of Digital Health Payment Initiative Centres at Makerere University, Uganda, and the University of Dakar, Senegal.

In 2025, Prof. Waiswa led a team in implementing the Uganda Newborn Programme, one of the country’s major health systems strengthening initiatives, supporting more than 120,000 newborns and sick newborns through a regional and life-course approach.

Prof. Peter Waiswa grew up in Naigobya Village, Luuka District, Uganda where early experiences shaped his lifelong dedication to improving health. Witnessing newborn and community health challenges inspired his commitment to building resilient, equitable health systems.

Building the Next Generation of Researchers

Beyond his research contributions, Prof. Waiswa has played a significant role in mentorship and capacity building. He has mentored numerous PhD graduates and emerging researchers who are now contributing to health programmes, academia, and policy across Africa and the globe.

In 2025, he was elected a Fellow of the African Academy of Sciences in recognition of his transformative contributions to research and innovation in women’s health, maternal, newborn and child health, and health policy.

Driving Future Health Innovations

As of 2026, Prof. Waiswa, in collaboration with researchers from Johns Hopkins University, Makerere University, and Mbarara University of Science and Technology (MUST), is leading the Ekyaalo Diagnostics project — a low-cost, AI-powered innovation designed to reduce delays in breast cancer diagnosis and improve access to timely care, especially for women in hard-to-reach communities.

Global Leadership and Institutional Contributions

Prof. Waiswa serves in several global and national advisory roles, contributing to health policy, implementation, and systems strengthening. His roles include membership on WHO Guideline Development Groups, the WHO–UNICEF Informal Technical Advisory Group on norms for small and/or sick newborn care, the Lancet Commission on Evidence-Based Implementation in Global Health, and other global health platforms.

He also leads Makerere University’s Centre of Excellence for Maternal, Newborn and Child Health and heads the INDEPTH Network Maternal, Newborn and Child Health Working Group.

To engage with Prof. Peter Waiswa visit: https://peterwaiswa.com/

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MakSPH 2025 Annual Report: A Defining Year of Growth, Partnership and Public Health Impact

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Cover page of the MakSPH 2025 Annual Report. Makerere University School of Public Health, Kampala Uganda, East Africa.

The Makerere University School of Public Health 2025 Annual Report documents a defining year in the School’s institutional journey. Effective January 2025, MakSPH attained stand-alone status within Makerere University, recognising seven decades of growth in public health training, research, policy engagement and community service. The transition gives the School greater focus and institutional agility to respond to Uganda’s and Africa’s evolving health priorities.

During the 2024/2025 academic year, MakSPH had more than 1,000 students across 12 degree programmes and different years of study. It presented 269 graduands at Makerere University’s 75th Graduation Ceremony, more than 80 per cent at graduate level, while 12 doctoral candidates successfully defended their studies. Training remained closely connected to practice through eight district field-training sites and student participation in outbreak response, disease surveillance and community-based public health action.

The School produced more than 350 peer-reviewed publications. Its evidence informed national and global action across HIV, tuberculosis, maternal and newborn health, antimicrobial resistance, health systems, climate change, urban health, injuries and noncommunicable diseases. MakSPH’s contribution to the PURPOSE 1 trial supported evidence showing more than 99 per cent protection from twice-yearly injectable lenacapavir, while locally led programmes expanded HIV screening, prevention and referral services for underserved populations.

This work was sustained through partnerships with government, communities, funders, universities and implementation agencies. MakSPH’s research and training network extended across more than 35 African countries, while longstanding collaborations were renewed and new institutional relationships established. Strong research governance, unqualified audits and positive due-diligence assessments continued to reinforce partner confidence in the School’s ability to manage complex national and multi-country programmes with accountability.

Construction of the new MakSPH building on Makerere University Main Campus advanced during 2025, with completion targeted for 2026. Designed as a modern public health hub, the facility will expand teaching and specialised laboratory space, strengthen digital learning and research, and provide improved environments for students, faculty, innovation and collaboration.

These achievements reflect the shared contribution of faculty, staff, students and partners. Guided by its 2025–2030 Strategic Plan, MakSPH remains committed to training public health leaders, generating evidence that informs policy and practice, strengthening health systems and improving health in Uganda, across Africa and beyond.

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John Okeya

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