Health
Govt. Asked to Scale up Successes in Buikwe, Mukono CVDs Interventions to the Rest of the Country
Africa continues to record the highest prevalence of hypertension globally. Studies show that Uganda’s hypertension prevalence stands at 26.4% and public health experts are worried that rising prevalence of noncommunicable diseases (NCDs) should be curbed lest it contributes to the disease burden.
In Africa, just like other low- and middle-income countries, the burden of disease is transitioning from infectious diseases to NCDs and the World Health Organisation predicts that they are likely to become a major health system challenge in Africa as they are predicted to become the leading cause of death in the region by 2030.
Studies estimate Uganda’s NCDs prevalence at 33 in every 100 people die of cardiovascular diseases (CVDs). The prevalence of hypertension for instance among adults stands at 26.4% with the highest prevalence in central Uganda (28.5%) which hosts Mukono and Buikwe districts.
In Mukono and Buikwe districts, among persons aged 15 years and above, the age standardized prevalence of hypertension is 27.2%.
Makerere University School of Public Health has for close to three (03) years now been impacting the communities in Mukono and Buikwe districts through its project; Cardiovascular Disease prevention program -Scaling -up Packages for Interventions for Cardiovascular diseases prevention in selected sites in Europe and sub-Saharan Africa (SPICES) Uganda.
The SPICES project focuses on prevention of diseases of the heart and blood vessels. The project has conducted a comprehensive study at both health facility level and community level where a number of community workers and health workers from randomly selected villages and health facilities in Mukono and Buikwe have been trained in cardiovascular disease prevention and control.
So far, a total of 366 health workers and 80 community health workers (CHWs/VHTs) received training. In addition, the project provided the health centers with equipment to support screening and management of cardiovascular diseases. The project team has, with support of health facilities been involved in screening CVD risk, care and management as well as health promotion and profiling at community level.
As a result of this intervention, there are higher volumes of hypertension and diabetes patients being received as a result of sensitization by the community health workers. There are also reports of changes in behavior in lifestyles especially diet and physical activity as well as improved patient health seeking behaviors for chronic services.
For instance, while presenting results at a dissemination workshop held on December 8th 2021 at Colline Hotel in Mukono district, Dr. Geofrey Musinguzi, the Principal Investigator of the SPICES Project expressed that the project has had significant impact in terms of knowledge changes, and in terms of profiles.
“Much as the prevalence of smoking didn’t seem to change, there was a change in frequency of smoking. For example, those who were smoking daily, we saw a reduction from 2018/19 to 2021,” says Dr. Musinguzi.
He adds that there was a significant difference in passive smoking. “Passive smoking is as dangerous as active smoking. At the baseline, people were smoking and exposing their love ones to tobacco but when they were trained from the health facilities and from the community on the dangers of smoking and passive smoking. So, we have seen an attitude of people in families where people are smoking, of if they can’t avoid smoking, doing it away from their families.”
Arising out of the successes of the project so far, Dr. Rhoda Wanyenze, Professor and Dean of Makerere University School of Public Health (MakSPH) has asked government and the Ministry of Health in particular to support noncommunicable diseases care in the districts of Mukono and Buikwe.
Prof. Wanyenze who is also co-principal investigator of the project SPICES project intervention in Mukono and Buikwe could be used as a yardstick to pick lessons for the Ministry of Health to extend the services to other parts of the country.
“We can use this as a learning hub so that we can also get the other regions that do not have the standard for NCD care at the level that we have in these districts. Let us maintain it because it is an opportunity for us to show that it is doable, that we can do something about NCDs and that others can learn something from these districts and facilities and we can do better across the country,” Professor Wanyenze said.
Tereza Ssenjova, a resident of Busabala Mukono said; “I used to be diagnosed with fever, yet I did not have it. Not until recently through SPICES screening that I was told I have high blood pressure and diabetes.”
Prof. Wanyenze urged for the Ministry of Health to rally Ugandans, the leadership at all levels to aggressively advocate for a safer population by preventing and reducing cardiovascular diseases.
“Please do speak about NCDs like the way we speak about COVID-19 lately and the way we have been speaking about other diseases. Encourage people to screen. If there is an opportunity, why not have a machine around you in your place so that you can encourage people to screen periodically. Think of how you can creatively encourage the communities to screen, so that we can discover these diseases early and be able to do something,” says Prof. Wanyenze.
Dr. Gerald Mutungi, assistant Commissioner Health Services- Non-Communicable Diseases (NCDs) department at the Ministry of Health admits that cardiovascular diseases are on a rise but hastens to add that they can be prevented.
“What we have found out is that the communities, once educated, sensitized can come for screening, but also can follow some of the guidelines given to prevent cardiovascular diseases. This has been shown and we have the data now,” Dr. Mutungi says.
Dr. Mutungi welcomes the results and noted that government will scale-up the interventions.
“We are in evidence-based policy and decision making. This is going to influence our policy. We had already started sensitizing VHTs but we were not sure that actually they can play a big role in prevention of cardiovascular diseases. Now this study is showing that yes, they can. We thought they could only support in distributing bed nets, simple things but they have shown us that they can do a lot in prevention and control of diseases,” he said.
Dr. Musinguzi said the project has had a multi-component intervention including health promotion, screening, training among others.
“We think that this intervention can reach many people. I gave an example of the talking T-Shirt. It has the modifiable risk factors. ‘don’t smoke’, ‘do more exercise’, ‘reduce/avoid alcohol,’ ‘maintain a healthy weight’, ‘go for checkup’ ‘control stress’, ‘eat healthy diet’ among others. In fact, we got reports from VHTs that the messages were received by the population. So, we think all ways of delivering messages must be explored to be able to enhance awareness about CVDs and other NCDs,” Dr. Musinguzi contends.
hailed the SPICES project team for the “wonderful research” and requested the project to include Buvuma and Kayunga districts on the study scope.
“I thank you so much for training the VHTs and our health workers around Mukono and Buikwe districts. This is very good,” said Hajat Nabitaka.
She underscores the need for continued sensitization of the population with a view of changing mindsets to be able to fully realise the benefits.
“Some people think these are diseases of the rich people. Not knowing that even a child in primary school can get diabetes. Not knowing that even an ordinary person in community can get pressure due to the various stress factors. Let us utilize the VHTs to solve many problems including social societal problems such as stress,” Hajat Nabitaka.
Dr. Rawlance Ndejjo, the SPICES Project coordinator said the project has been able to enroll 23 health facilities where it has greatly impacted lives.
He adds that the dissemination is; “a great opportunity to share what we have been doing in field with the rest of the world.”
Some health facilities have have adopted strategies to acquire hypertension and diabetes drugs, and all enrolled facilities are now able to identify and manage Type 1 diabetes, unlike in the past.
SPICES project is currently implemented in Uganda, South Africa, France, Belgium and the United Kingdom. It is an implementation science project funded by the European Commission through the Horizon2020 research and innovation.
Article originally published on MakSPH website.
Health
Mak Researchers Partner with Safe Bangle Technologies to Roll out a Real-Time Domestic Violence Reporting Bracelet
By Joseph Odoi
A Consortium of Researchers from Makerere University School of Public Health/Resilient Africa Network (MakSPH/RAN), Medical College of Wisconsin (MCW), Somero Uganda together with Safe Bangle Technologies have rolled out a real time domestic violence reporting bracelet.
This roll out was made possible with support from the United States Agency for International Development (USAID) under the PARTNERSHIPS FOR ENHANCED ENGAGEMENT IN RESEARCH (PEER) program and the National Academies of Sciences.
Dr. Juliet Kiguli, the Principal Investigator from Makerere University, along with Dr. Roy Mayega, Deputy Chief of Party at RAN, and Dr. Agnes Nyabigambo, the study coordinator, initiated the PEER program to identify entry points for testing SafeBangle Technologies (a social enterprise based at Resilient Africa Network (RAN) with a mission to create a safer and more secure environment for women and children through innovative, affordable, and creative technology solutions to curb GBV in Africa.) wearable safety bracelet in the informal settlements. This decision stemmed from findings of increased intimate partner violence (IPV) and gender-based violence (GBV) in three informal settlements in Kampala, Uganda, following a longitudinal study, geospatial mapping, and interviews. The project, titled ‘The Impact of the COVID-19 Pandemic on Gender-Based Violence among Women and Girls in Informal Settlements in Kampala,’ highlighted the urgent need for affordable and immediate reporting mechanisms for violence.”
‘’While carrying out a study after the Covid-19 Pandemic, we identified gaps when it comes to reporting and response to Gender Based Violence (GBV) among women in informal settlements. Therefore, we used incorporated the SafeBangle intervention to solve the problem of lack of affordable and immediate reporting mechanisms for violence using a bracelet that reports violence in real time’’ explained Dr. Kiguli.
Innovation details
According to Saul Kabali and Messach Luminsa, the innovators behind SafeBangle from SafeBangle Technologies, hosted at the Resilient African Network Lab. ‘’The inspiration behind SafeBangle came from a deeply personal place. ‘’We heard countless stories of women who couldn’t call for help during moments of danger. We were deeply affected by the story of Aisha, a young woman in a rural village who was attacked while walking home alone at night. With no way to call for help, she felt helpless and vulnerable. This incident made us realize the critical need for immediate reporting alert tools, accessible to women like Aisha. We knew technology could play a crucial role and this incident awakened a strong desire in us to create a solution’’
“While developing SafeBangle, we tested with the users in both rural and urban contexts. We piloted the innovation around Kampala with support from Digital Human Righs Lab and Naguru Youth Health Network as well as it in five districts of Karamoja region with support from Save the Children and Response Innovation Lab. Right now it has become handy in Kamapala‘s informal settlements. We envision a future where SafeBangle becomes a standard tool in the fight against GBV, ensuring every woman feels safe and secure as it has the potential to transform how we respond to GBV in Africa” added Kabali.
HOW THE SAFEBANGLE TECHNOLOGY WORKS
The SafeBangle is wearable technology similar to a smartwatch that sends an alarm by SMS to people chosen by a woman herself if she feels threatened.
In terms of the acceptability of the SafeBangle innovation as a solution to GBV among at-risk women in informal settlements Of the 72 adolescent girls and women who received the SafeBangle, 22 activated the reporting button, resulting in 19 receiving immediate and appropriate support, including counseling, police intervention, and health services.
All adolescent girls and women who experienced GBV received a phone call from Somero Uganda to discuss the most appropriate intervention, including counseling, police cases being handled by the probation office, referral for health services, and post-exposure prophylaxis. All the GBV survivors received support and are still receiving continuous follow-up.
Researchers conducted a survey among 644 girls and women in Kinawataka (Nakawa Division) and Bwaise (Kawempe Division) to gain insights into awareness and understanding of sexual and gender-based violence among adolescent girls and women in informal settlements. The survey measured socioeconomic factors, mental health symptoms, and exposure to GBV. Focus group interviews were conducted with a separate sample of women over 18 in the settlements to explore responses to GBV.
A tabular representation of the key findings and lessons learned from your study on gender-based violence (GBV)
| Key Findings | Lessons learned |
| Prevalence of GBV. – Overall prevalence: 34.1% of women and girls reported experiencing GBV. – Among adolescents (15-19 years): Over 50% reported experiencing GBV. | – The pandemic highlighted the need for accessible and comprehensive support services for GBV survivors. – Schools emerged as crucial safe spaces for girls, emphasizing their well-being during crises. – Economic independence proved crucial, enabling women to leave abusive environments. – Involving men and boys as allies in GBV prevention efforts is essential. |
| Age-related trends | – GBV prevalence tends to decrease with increasing age. |
| Physical and health consequences. | – Women and girls suffered physical violence, injuries, and deaths, primarily from domestic violence and unsafe abortions due to limited healthcare access. – GBV resulted in unintended pregnancies, unsafe abortions, and increased risk of sexually transmitted diseases (STIs) like HIV/AIDS. |
| Social and economic impact. . | – GBV contributed to family breakups, strained marriages due to financial stress. – Economic hardships forced some women and girls into transactional sex, exposing them to further health risks and exploitation. – Pandemic-related job losses and economic constraints increased financial dependence on abusers, trapping women in violent situations. – School closures and increased household responsibilities limited women’s job opportunities and subjected them to sexual harassment. |
| Psychological effects | – Survivors experienced guilt, shame, anxiety, fear, and suicidal thoughts due to ongoing abuse. |
| Long-term effects | – Post-COVID-19, survivors faced disrupted education, early marriages, pregnancies, social stigma, and persistent mental health issues. |
Reproductive Health Consequences: GBV resulted in unintended pregnancies, unsafe abortions, and increased risk of sexually transmitted diseases (STIs) like HIV/AIDS.
Family Breakdown: The rise in GBV led to family breakups as women fled abusive relationships. Marriages were strained due to increased financial stress.
Transactional Sex for Survival: Desperate for basic needs due to job losses and economic hardship, some women and girls resorted to transactional sex, exposing them to further health risks and exploitation.
One study participant stated, “The time of COVID-19 was so terrible for some of us. We in fact got a lot of diseases from it because you would want to get food and didn’t have money. That way you would be forced to get a man who would use you and pay.” – (FGD_Girls_19–24years_Kinawataka).
Economic Effects: COVID-19 restrictions caused job losses and limited economic opportunities, particularly for women in the informal sector. This increased financial dependence on abusers and trapped women in violent situations.
Limited Access to Employment: School closures and increased household chores limited women’s ability to seek employment, perpetuating gender inequality in the workforce. Some faced sexual harassment from potential employers.
Psychological Effects: Survivors of GBV experienced guilt, shame, anxiety, fear, and even suicidal thoughts due to the constant threat and unpredictability of abuse.
Post-COVID Effects: GBV survivors faced long-term consequences, including disrupted education, early marriage, early pregnancy, social stigma, and persistent mental health issues.
Lessons learned
The pandemic highlighted the need for accessible and comprehensive support services for survivors of GBV, the significance of schools as safe spaces for girls, and the need to prioritize their well-being during crises. Economic empowerment emerged as a significant protective factor for women and girls. Those with greater economic independence were better equipped to leave abusive environments and secure their safety and well-being, while dependent ones suffered abuses. Engaging men and boys as allies in the fight against GBV and involving them in prevention efforts can help promote positive behavior change and foster more equitable relationships.
Recommendations
To address GBV against women and girls, the researchers recommend the following moving forward;
- There is need to integrate technology-driven solutions like SafeBangle into national GBV prevention and response strategies. SafeBangle can be a valuable tool for policymakers as cases of violence that would have gone unreported will be brought to light and the would-be victims will be able to get immediate help from trusted relatives and friends.
- Provide economic opportunities and vocational training for women and girls to enhance their financial independence and reduce vulnerability to violence. There is therefore a need to introduce education and training programs that empower women and girls, by providing them with skills, resources, and opportunities to start their own ventures and to participate fully in community affairs.
- Strengthen and enforce existing laws and policies related to GBV, including laws against domestic violence, child marriage, and sexual assault without discrimination be it for law enforcers, leaders, and employers where such cases were suffocated. Ensure that perpetrators are held accountable through swift and fair legal processes that have no room for corruption.
- Establish and promote effective, accessible, and confidential reporting mechanisms for GBV incidents that provide confidence and can be trusted by survivors to enhance reporting of such incidences of GBV. Community Engagement and Involvement: Involve community leaders, religious leaders, and elders in discussions about GBV to promote gender equality, change social norms, and reinforce the message that violence against women and girls is unacceptable.
- Launch extensive public awareness campaigns to challenge harmful gender norms, report cases of GBV, raise awareness about the consequences of GBV, and promote positive behaviors and attitudes towards women and girls.
- Implement comprehensive sexuality education in schools and communities, educating young people about healthy relationships, consent, and reproductive rights to be able to make informed decisions about their own lives and well-being.
- Engage men and boys as allies in the fight against GBV, encouraging them to challenge harmful masculinity norms and behaviors. This will help minimize GBV because mostly they are the perpetrators. Strengthening Support for Survivors: Provide ongoing support and follow-up services for survivors of GBV mostly counselling services to aid their recovery and facilitate their reintegration into society.
- Provide ongoing support and follow-up services for survivors of GBV, mostly counseling services to aid their recovery and facilitate their reintegration into society.
- Provide avenues to seek free or subsidized services by survivors of GBV medical services and legal processes by survivors of GBV to enhance reporting of GBV cases, access to medical care, counseling, legal support, and other essential services.
- Encourage and support more research and innovations like SafeBangle to curb incidents of GBV.
- A comprehensive and inclusive approach is required. The efforts should involve government institutions, civil society organizations, community leaders, and individuals working together to address the root causes and provide support to survivors.
- Involve media in GBV prevention activities and for enhancing campaigns against GBV mostly on radio and TV.
MORE ABOUT THE STUDY
The core project team, included researchers at Makerere University School of Public Health (MakSPH), Medical College of Wisconsin (MCW) led by Prof. Julia Dickson-Gomez, SafeBangle Technologies, and Somero Uganda, a community-focused NGO, began the project by designing their research protocol and taking a CITI Program course on human subjects social/behavioral research. Team members also met with the Ministry of Gender, Labour, and Social Development (MGLSG) in support of the gender-based violence policy process, Ministry of Health and local government. They also established relationships with the Kampala Capital City Authority (KCCA) and Nakawa and Kawempe probation offices to support legal processes for the GBV survivors. SafeBangle Team also received an award from Defenders Protection Initiative.
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