Health

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

Published

3 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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Uganda One Health Epidemiological Bulletin Sept-Nov 2021

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Health

Exciting PhD Opportunity in Health Innovation – Starting 2025

Published

1 week ago

January 22, 2025

Mak Editor

The NTU-Mak delegation posing with some of the community health workers at the field office in Nakawuka, Wakiso district.

We are happy to share this exciting PhD studentship opportunity through the NTU-Makerere University partnership under the theme Health Innovation. Starting in 2025, this project will focus on One Health drivers of antibiotic-resistant bacterial infections in rural Ugandan communities.

The research will combine microbiological and public health approaches to explore the prevalence, transmission, and contributing factors of antibiotic-resistant bacteria in these communities. Key research questions include:

What human, animal, and environmental factors contribute to the spread of antibiotic-resistant bacteria?
How can Community Health Workers (CHWs) help mitigate their spread?

Requirements:

Essential: Willingness to spend time in both Uganda and the UK during the project and proficiency in Luganda.
Desirable: Wet lab microbiology skills.

For full details, visit:
<https://www.ntu.ac.uk/study-and-courses/postgraduate/phd/phd-opportunities/
studentships/health-innovation-phd-studentships/one-health-drivers-of-antibi
otic-resistant-bacterial-infections-in-rural-ugandan-communities> NTU Health Innovation PhD Studentships.

Application Deadline: Friday, 14 February 2025.

For inquiries, contact Dr. David Musoke at dmusoke@musph.ac.ug or Jody Winter at jody.winter@ntu.ac.uk.

Health

75th Graduation Ceremony of Makerere University: MakCHS presents Graduands

Published

2 weeks ago

January 14, 2025

Zaam Ssali

Graduands jubilate during the Mak75thGrad Ceremony. 75th Graduation Ceremony, Day 2, CoBAMS, CHS and CoNAS. 14th January 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa.

The Makerere University College of Health Sciences (MakCHS), College of Natural Sciences, and College of Business and Management Sciences presented graduands for conferment of degrees on the 14^th January, 2025 which was the day 2 of the 75^th Graduation Ceremony of Makerere University that commenced on Monday 13^th January 2025.

MakCHS presented a total of 886 graduands including (23) Doctor of Philosophy (PhD), (456) Masters and (407) Bachelors. For the second year, MakCHS produced the researcher with the biggest number of publications, Prof. Moses Kamya and he received an award for the achievement.

PhD recipients on Day2 of the Mak75thGrad Ceremony. 75th Graduation Ceremony, Day 2, CoBAMS, CHS and CoNAS. 14th January 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***PhD recipients on Day2 of the Mak75thGrad Ceremony.***

Speaking to the congregation, Professor Barnabas Nawangwe – Vice Chancellor, Makerere University welcomed everyone to Makerere University’s 75^th Graduation. He congratulated the 13,658 graduates, including 143 PhD recipients, 53% female graduates and 47% male graduands who will be awarded degrees through the graduation week. He commended the efforts of staff, parents, and sponsors in supporting the students’ journeys. Professor Nawangwe praised the achievements of Makerere’s Colleges and Schools, he commended MakCHS for the leadership in research and innovation flying the Makerere flag globally. He noted, ‘The College of Health Sciences is our flagship college for research and community engagement. This college accounts for 50% of all research grants won and also 50% of all the publications by the University. The College celebrated 100 years last year, making it the oldest college at Makerere University’.

MakCHS Principal Assoc. Prof. Bruce Kirenga (2nd left) with MakCHS Faculty. 75th Graduation Ceremony, Day 2, CoBAMS, CHS and CoNAS. 14th January 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***MakCHS Principal Assoc. Prof. Bruce Kirenga (2nd left) with MakCHS Faculty.***

Prof. Barnabas Nawangwe speaking during the Graduation. 75th Graduation Ceremony, Day 1, CoCIS, CEES, CoVAB and School of Law. 13th January 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***Prof. Barnabas Nawangwe speaking during the Graduation.***

Prof. Nawangwe reiterated Makerere’s transformation to a research-led institution supported by the government funded Makerere University Research and Innovations Fund (Mak-RIF). “We are addressing national priorities, such as improving the Parish Development Model and advancing e-governance,” he stated. The Vice Chancellor also congratulated Dr. Crispus Kiyonga on his appointment as Chancellor and urged graduates to leverage their education to create solutions for societal challenges.

Professor Nawangwe advised the graduands thus, ‘We have equipped you with the knowledge and skills that will make you employable or to create your own businesses and employ others. Do not despair if you cannot find employment, instead reflect on the immense opportunities around you and raise them as an entrepreneur.’

Professor Puleng LenkaBula, Principal and Vice-Chancellor of the University of South Africa (UNISA) delivered the commencement speech where she called on the graduands to remain resilient and emancipate Africa’s people. Her address titled “The Power of Resilience – African Woman, Find Your Generational Mission and Redefine Your Worth”, Professor LenkaBula highlighted the critical role of African women in shaping the continent’s destiny.

Prof. Puleng LenkaBula, Vice Chancellor of the University of South Africa delivering her commencement lecture. 75th Graduation Ceremony, Day 1, CoCIS, CEES, CoVAB and School of Law. 13th January 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***Prof. Puleng LenkaBula, Vice Chancellor of the University of South Africa delivering her commencement lecture.***

Professor LenkaBula expressed gratitude for being invited to such a significant occasion and extended greetings from South Africa, including from UNISA’s Chancellor, former South African President Dr. Thabo Mbeki. She praised Makerere University for its legacy of academic excellence and contributions to the African continent, emphasizing its role in anti-colonial struggles, post-colonial development, and its steadfast commitment to African unity. She called for a renewed focus on gender equity in academia and leadership, noting the disproportionate burdens faced by women in society. Citing the achievements of Makerere University in gender mainstreaming, she expressed optimism about the role of young leaders in dismantling patriarchal systems and fostering inclusive development.

Professor LenkaBula concluded her address to graduands with a call to action: “Your graduation is not merely a personal achievement but a contribution to Africa’s collective progress. History has thrust upon you the task of creating a future defined by resilience, innovation, and equality.”

In his remarks, Dr. Crispus Kiyonga – Chancellor, Makerere University congratulated graduands upon making it to the 75^th Graduation Ceremony of Makerere University. Dr. Suruma expressed his appreciation of His Excellency the President and First Lady/Minister of Education and Sports for giving him the opportunity to serve Uganda and for the continuous support extended to Makerere University, requesting the congregation to join him and give them a warm applause. Dr. Kiyonga reiterated President Museveni’s directive to Makerere University to integrate the teaching of political economy across all courses to enhance students’ understanding of the country’s socioeconomic conditions. The directive, welcomed by the university’s top management, will be incorporated into the curriculum to align education with the needs of the people and the nation.

Hon. Dr. Crispus Kiyonga addresses the congregation. 75th Graduation Ceremony, Day 1, CoCIS, CEES, CoVAB and School of Law. 13th January 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***Hon. Dr. Crispus Kiyonga addresses the congregation.***

He expressed appreciation that the government has pledged to bolster Makerere’s research funding and he encouraged the University to strengthen partnerships with the private sector to commercialize innovations developed at the institution.

The new Chancellor pledged support to the University management in saving its land and urged that an agro-industrial park be established. “This park would serve three purposes: teaching, generating income, and acting as a demonstration site for communities across the country,” Dr. Kiyonga noted. He also emphasized the urgency of addressing Uganda’s food insecurity, highlighting that 40% of children in the Rwenzori region are stunted, with malnutrition affecting most regions of the country.

Dr. Kiyonga also pointed out Africa’s underperformance despite its vast resources, describing it as a contradiction. “It is our responsibility to change the conditions of our people and ensure Africa rises to its potential,” he urged.

The ceremony was graced by Hon. Joyce Moriku Kaducu, Minister of State for Primary Education, who represented the First Lady and Minister of Education and Sports, Hon. Janet Kataaha Museveni. Other dignitaries included members of Parliament, the judiciary, the diplomatic corps, and academics.

The Minister lauded Makerere University for its dedication to academic excellence and innovation. “Today reflects the resilience, hard work, and commitment of our graduates, supported by the university staff, management, and parents,” she said. The Minister commended the Vice Chancellor and management for fostering research and innovation while urging them to maintain robust quality control systems to uphold the institution’s integrity.

Min. Kaducu representing the Minister of Education. 75th Graduation Ceremony, Day 1, CoCIS, CEES, CoVAB and School of Law. 13th January 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***The Minister of State for Primary Education Hon. Dr. Joyce Moriku Kaducu represented the Minister of Education and Sports, Hon. Janet Kataaha Museveni.***

She also reflected on Makerere’s recent milestones, including the commissioning of a new the launch of the School of Graduate Studies and Research. “Your achievements stem from hard work, transparency, and accountability. They set Makerere apart as a leader in higher education,” she noted. Addressing the graduates, Hon. Kaducu encouraged them to apply their skills to solve societal challenges. “Makerere has equipped you with critical thinking and creativity. Use this to seize opportunities, make a difference, and shine wherever you go,” she concluded. During the 75^th graduation ceremony held from the 13^th -17^th January, 2025, a total of 13,658 graduands were awarded degrees and diplomas in various disciplines. Of these, 143 received PhDs, 1,813 Masters Degrees, 243 postgraduate Diplomas, and 11,454 Bachelor’s Degrees. 53% of the graduands are female and 47% are male. 44% of the PhD graduands are female. A total of 491 graduands received first class degrees.

Health

Certificate in Water, Sanitation and Hygiene 2025

Published

1 month ago

December 17, 2024

Mak Editor

The Head, Department of Epidemiology and Biostatistics-Prof. Nazarius Mbona Tumwesigye (6th L) and the Head, Department of Disease Control and Environmental Health-Dr. Esther Buregyeya (4th L) pose with 25 graduands of the WASH Short Course on 20th July 2018, MakSPH, Mulago Campus, Makerere University.

Course Objectives

The course is intended to strengthen the capacity of practicing workers to successfully identify and manage Water, Sanitation and Hygiene (WASH) opportunities and problems by facilitating the acquisition of adequate knowledge, development of skills and attitudes through understanding and use of the 6 essential services of WASH. These are to:

Monitor WASH status to identify and solve community environmental health problems.
Diagnose and investigate WASH problems and health hazards in the community.
Inform, educate and empower people about WASH issues.
Mobilise community partnerships and actions to identify and solve WASH problems.
Evaluate effectiveness, accessibility and quality of personal and population-based WASH services.
Research for new insights and innovative solutions to WASH problems.

Course Structure

The course is an 8-weeks programme of study. Participants will spend 3 weeks (full-time) at Makerere University School of Public Health (MakSPH) while 4 weeks will be spent at suitable workplaces / field sites. The final week of the course will be spent at MakSPH for presentation of project / field work, final examination, and the certificate awarding ceremony. This is a day programme and will run from 26^th May to 18^th July 2025.

Course Modules

Water Resources Management
Environmental Sanitation
Hygiene Promotion
WASH Policy, Planning and Financing
Field / Project Work

Mode of delivery of the course includes lectures, tutorials, seminars, practicals and field work.

Dates	26^th May to 18^th July 2025
Fees	Ugandans	Internationals
	UGX 900,000	USD 500

Dates and Fees for the Certificate in Water, Sanitation and Hygiene 2025

Who should apply?

Practicing officers in the WASH sector including those working in local government, non governmental organizations (NGOs) or the private sector.
Environmental Health workers who wish to broaden their knowledge and skills as a form of Continuous Professional Development (CPD) so as to be better equipped to implement WASH activities.

Entry requirements for admission to the course are Uganda Advanced Certificate of Education (UACE) or its equivalent with at least 1 year working experience in WASH.

How to apply?

Application forms and procedure can be obtained from the Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hospital Complex or from the website below:
https://sph.mak.ac.ug/academics/water-sanitation-and-hygiene-wash

The deadline for receiving applications is Wednesday 26^th March 2025.

For further details, contact:

Course Administrator
Ms. Irene Nassazi
Makerere University School of Public Health
New Mulago Hospital Complex
E-mail: inassazi@musph.ac.ug Tel. +256771671354

Course Coordinator
Dr. David Musoke
Makerere University School of Public Health
New Mulago Hospital Complex
E-mail: dmusoke@musph.ac.ug Tel. +256788572129

Co-Course Coordinator
Mr. Allan Ssembuusi
Makerere University School of Public Health
New Mulago Hospital Complex
E-mail: assembuusi@musph.ac.ug Tel. +256759955067

Makerere-SPH-WASH-Course-2025-Poster Download