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Ugandan Legislators applaud MakSPH for Road Safety & Injuries Research

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Members of Parliament under the Parliamentary Forum on Road Safety (PAFROS) have commended research efforts by the Makerere University School of Public Health’s Trauma and Disability Unit (TRIAD) for its leadership in injury and prevention research. The legislators signed a commitment to support all efforts aimed at improving road safety in Uganda.

 The legislators said this while at an engagement meeting with researchers at MakSPH that took place on Thursday 17th February 2022 at Sheraton Hotel. In a well-attended session, the research team shared evidence from a number of publications that have influenced policy, and over 10-11 years, and the several achievements the School has achieved in collaboration with partners both national and international.

Members of Parliament under the Parliamentary Forum on Road Safety (PAFROS)
Members of Parliament under the Parliamentary Forum on Road Safety (PAFROS) alongside TRIAD PI Dr. Olive Kobusingye during a breakfast meeting.

The 2014 WHO Global Health Estimates show high burden of injuries with over five million people dying of injuries every year. Mr. Frederick Oporia, a PhD fellow says nearly every six seconds, someone dies from an injury leaving over 50 million people with disabilities.

Despite this, there is insufficient research capacity to drive prevention and management of these injuries which makes multidisciplinary approach in handling multidisciplinary nature of injuries.

Mr. Frederick Oporia, a PhD fellow speaks at the dialogue with MPs.
Mr. Frederick Oporia, a PhD fellow speaks at the dialogue with MPs. 

TRIAD’s main objective is to contribute to the reduction of injury burden in Uganda by strengthening research capacity on injuries and their medical, social and economic consequences both at Individual, community and National level.

There are various kinds of injuries that range from being intentional and non-intentional. Some of these include violence, burns, poisoning, drowning, falls and road traffic crashes. In all these injuries, road traffic contributes the highest burden 24% hence a big problem.

Currently, TRIAD focuses on mobility, Road Traffic Injury prevention, drowning prevention, childhood injury prevention and emergency Trauma Care and emergency medical services.

“When we compare HIV, tuberculosis and Malaria rates, we see that injuries alone almost double what these other Disease claim and it’s a problem we need to tackle,” says Oporia.

Goal 3 of the Sustainable Development Goals (SDGs) seeks to ensure health and well-being for all, at every stage of life. Equally so, the UN Decade of Action included road safety in the framework of Sustainable Development Goals with an ambition to halve road traffic deaths and injuries by 2020.

The 2011-2020 decade of action for road safety was premised on five pillars that included road safety management, safer roads and mobility, safer vehicles, safer road users, and post-crash response.

However, trends analysis in the Uganda Police Reports show that Uganda instead increased road traffic crashes. The SDG Goal 11 that commits UN member States to make cities and human settlements inclusive, safe, resilient and sustainable ambitiously states that by 2030, the member states should be able to provide access to safe, affordable, accessible and sustainable transport systems for all, improving road safety, notably by expanding public transport, with special attention to the needs of those in vulnerable situations, women, children, persons with disabilities and older persons.

Hon. Naome Kabasharira, the Rushenyi County Constituency MP shares a light moment with the TRIAD Unit research team at Sheraton. Listening in is Dr. Olive Kobusingye, the PI
Hon. Naome Kabasharira, the Rushenyi County Constituency MP shares a light moment with the TRIAD Unit research team at Sheraton. Listening in is Dr. Olive Kobusingye, the PI

The Road safety performance review report of 2018 show that Uganda’s road safety management is managed in the Ministry of Works and Transport under the Directorate of Road Transport. Some of the road transport legislations include, the Traffic and Road Safety Act (Amended) 2020, the Uganda National Roads Authority Act, 2006, the Uganda Road Fund Act, 2008, the National Road Safety Policy, 2014 and the Non-Motorized Transport policy, 2012.

Hon. Bright Amooti
Hon. Bright Tom Amooti, MP Kyaka Central appends his signature on the commitment from MakSPH to promote road safety in Uganda.

Speaking to the legislators, Esther Bayiga Zziwa, a PhD fellow at MakSPH’s TRIAD unit says however that Uganda has legislative gaps in majority of the risk factors for instance, while Uganda has national drink-driving law in place, and drink – driving based on Blood Alcohol Content (BAC) or equivalent breath alcohol concentration (BrAC), the BAC limit for the general population is way higher than the global standard. The global standard is at below 5 gram per blood liter. However, in Uganda, the law puts it at 7 gram per blood liter which is high. Ms. Bayiga says there is a need to handle this back to the global level.

Uganda has a national motorcycle helmet law in place which applies to motorcycle drivers and adult passengers and to all road types an engine type. However, the law does not require helmets to be properly fastened as well as meet the national and or international standards.

“Helmets standards for motorcyclists put up by Uganda National Bureau of Standards (UNBS) need to make sure that those ones on market meet the standards and if you are found wearing a fake helmet, you are not better off than one not wearing any because in case of a crash, it will damage your head instead of protecting it, and people need to fasten their Helmets for better effectiveness,” says Bayiga.

Research on road safety has found that behaviour interventions area not as effective as environmental, legislative and enforcement actions. Bayiga says the Behavioural component alone cannot be effective. She recommends a multipronged approach that includes bbehavioural, environmental modification, enforcement and legislation in road safety regulation.

Uganda lacks a national child restraint law based on age, weight, height or a combination of these factors that would restrict children under a certain age-height from sitting in the front seat.

“In Uganda, even here in Kampala, those who can afford cars do not buy child safety seats for their babies and the children are carried by other adults and do not have a seat on their own. However, in case of a clash, those are the first ones that fall off the car because of their body mass and can’t survive with the normal seat,” Bayiga says.

Esther Bayiga Zziwa, a PhD fellow at MakSPH’s TRIAD unit
Esther Bayiga Zziwa, a PhD fellow at MakSPH’s TRIAD unit presenting at a meeting with members of PAFROS at Sheraton Hotel during a breakfast meeting on February 17, 2022.

According to Bayiga, other countries have the regulations but; “Our law does not take account any with regarding children, and probably some people think cannot afford, but this can not be compared to the lives and value of children, they too need safe seat because every life matters and a law should be put in place to address this.”

Hon. Linda Irene Mugisa, the Fort portal City Woman MP and member of the Road Safety Forum acknowledges the role of legislators to make laws and policies that would protect Ugandans.

Hon. Linda Irene Mugisa, the Fort portal City Woman MP and member of the Road Safety Forum
Hon. Linda Irene Mugisa, the Fort portal City Woman MP and member of the Road Safety Forum signs a MakSPH-Road Safety commitment

“We have a big role of sensitizing the masses. Right now, we have very many youths who are earning income through riding boda-bodas. And the unfortunate part of this is that most of these youths have not gone through training and most of them are riding illegally because some cannot afford the driving permits. As members of parliament we feel we should advocate for the reduction in the amount of money a rider requires in order to acquire a driving permit,” says Hon. Linda.

Juliet Bashiisha Agasha, the Woman MP for Mitooma District said she was impressed by the dialogue and was excited to learn that indeed, the Trauma, Injury and Disability Unit at Makerere University School of Public Health was the only unit in Uganda that focuses on research of injury and prevention.

Juliet Bashiisha Agasha, the Woman MP for Mitooma District submits during a MakSPH-PAFROS breakfast meeting at Sheraton in Kampala on road safety.
Juliet Bashiisha Agasha, the Woman MP for Mitooma District submits during a MakSPH-PAFROS breakfast meeting at Sheraton in Kampala on road safety.

According to Hon. Agasha, there are many unqualified drivers on Uganda’s road who commit a lot of traffic offenses and sometimes walk away without punishment due to lack of monitoring systems. She also says most drivers lack good training and that some simply acquire driving permits without ever going to the driving schools.

“If we can have the measures that can monitor whoever makes a mistake, and then they charge accordingly, I know as Ugandans, we fear fines very much. The moment they fine you today, I don’t think tomorrow you can repeat the same mistake,” says Hon. Agasha.

She advocates for more cameras to track traffic crimes in order to improve road safety. “In fact, you find someone who is driving without a seatbelt and when he senses a traffic person, that is when he remembers that seatbelts are supposed to be used. So there is a lot of effort that we have to put in in order to reduce on road accidents especially on these motorcycles. You find a big group of motorcycles driving when there are red lights and they don’t mind whether there is red or green for them they keep moving. But if they can be controlled or sensitized about dangers of a vehicle that coming from a different direction, I believe we can reduce on the road accidents,” says Hon. Agasha.

The MP for Iki-Iki County in Budaka district, Robert Kasolo agrees that using technology in enforcement of traffic order is the way to go. He expresses concern that cameras in Uganda are largely not for road traffic law enforcement but for security reasons. “But I think that would be the ideal situation. In developed countries, cameras are part of the gadgets for enforcing traffic laws. We need to move in that direction. Policemen cannot be everywhere. But a camera can record a wider area and can be a source of evidence,” says Hon. Kasolo, who also doubles as Vice Chairperson of the Physical Infrastructure Committee of Parliament.

MP for Iki-Iki County in Budaka district, Robert Kasolo at the Breakfast meeting.
MP for Iki-Iki County in Budaka district, Robert Kasolo at the breakfast meeting. 

Tonny Ayo, the Member of Parliament for Kwania County, and Vice chairperson Parliamentary committee on Road Safety wants the Uganda Police Traffic department to begin to use the cameras both within the cities and high ways to bring drivers to book.

“One of our concerns of ensuring that people follow the traffic regulations and laws is that government put in place the cameras on streets and highways and we have spent money on this and the purpose was not only to deal with crime and terrorism but one of them was enforcement of traffic rules and regulations which unfortunately as a Forum as parliament and a public are wondering why government cannot come up to enforce this,” says Hon. Ayo.

Hon. Tonny Ayo, the Member of Parliament for Kwania County, and Vice chairperson Parliamentary committee on Road Safety
Hon. Tonny Ayo, the Member of Parliament for Kwania County, and Vice chairperson Parliamentary committee on Road Safety

He opines that; “When you drive along highways and roads within Kampala, the reckless driving of high speed, the bad overtaking, we expected that cameras could take stock of what is happening. We are calling on government to move in to ask police to begin to use these cameras to enforce the laws.”

According to Hon. Ayo, using video and pictorial evidence from the cameras, government will go a long way in collecting huge non-tax revenue through fines of traffic offenders.

“If we do this consistently for 6 months, then we are going to see discipline by the motorist in in this country and I think by the decade plan of action we were supposed to have reduced road crashes and injuries in the country by half by 2020. Now we are in 2022, and instead of reducing, the crashes and injuries have increased. That means now we need to act because we have noticed that sensitization and talking to people,” says Hon. Ayo.

Dr. Olive Chifefe Kobusingye, an accident & emergency surgeon, injury epidemiologist at MakSPH says TRIAD’s biggest concern is road safety and accessible for all road users. She ads that this can be achieved through good road designs.

“Designing for all road users not just for motorists. Making sure that there is space to accommodate pedestrians, cyclists, motorcyclists and accommodate those that are using wheel chairs for instance and to pay attention to the size of the population so that we in the design cater for heavy pedestrian presence, those spaces are adequate for them,” says Dr. Kobusingye.

Dr. Olive Chifefe Kobusingye, an accident & emergency surgeon, injury epidemiologist at MakSPH
Dr. Olive Chifefe Kobusingye, an accident & emergency surgeon, injury epidemiologist at MakSPH speaking during the breakfast meeting at Sheraton Hotel.

In addition to the design, Dr. Kobusingye also agrees with the legislators on the need to increase enforcement of traffic regulations in Uganda to ensure road safety.

“There are areas where we need to enforce for instance where there is limited access to motorized traffic. These are all provided for in the non-motorized transport policy. So, the implementation of that policy is key to ensuring that transportation is safe, its accessible, its affordable and that its equitable that we do not prioritize certain types of road users over others,” Dr. Kobusingye observes.

The TRIAD research team in a group photo with Members of Parliament under the Parliamentary Forum on Road Safety (PAFROS) at Sheraton Hotel, Kampala on
The TRIAD research team in a group photo with Members of Parliament under the Parliamentary Forum on Road Safety (PAFROS) at Sheraton Hotel, Kampala on Feb. 17, 2022

Davidson Ndyabahika

Health

Ugandan sickle cell researchers keep pace with aging patients

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Dr. Sarah Kiguli of Makerere University leads the Fogarty-funded program: Enhancing Research capacity for Sickle Cell Disease and related NCDs across the Lifespan in Uganda (ENRICH).

Article courtesy Fogarty International Center

September/October 2024 | Volume 23 Number 5

Until recently in Uganda, most children with sickle cell disease (SCD) never celebrated their fifth birthday—only 30% lived past this milestone. This low survival rate was mainly due to inadequate health care interventions for these children, plus lack of widespread newborn screening, explains Dr. Sarah Kiguli , a professor at Makerere University College of Health Sciences. Things are different today. Over the past decade, the East African nation has instituted a policy of screening newborns while strengthening strategies to manage their health. This means more children with SCD are growing into adolescence and adulthood.

Challenges still exist, says Kiguli. For example, the community and district facilities where many Ugandan children are born cannot provide comprehensive services, including newborn screening. Another issue: the risk of SCD complications related to kidneys, lungs, heart—almost all organs—grows higher as patients grow older, yet scientific research in Uganda hasn’t caught up with the reality of these longer lives. As a result, teens and adults with SCD don’t get “the care they deserve,” says Kiguli.

“It’s very painful for us pediatricians to see our patients encounter challenges and problems when they transition to adult care.”

Renewed research focus

Despite years devoted to children’s health, Kiguli believes it’s time to prioritize studies exploring appropriate SCD management in teens and adults. “We need solutions that address all the patients’ needs, including reproductive health, as they transition out of childhood.” She’s spearheaded a multidisciplinary research training program for researchers focused on the needs of people with SCD at all ages: Enhancing Research capacity for Sickle Cell Disease and related NCDs across the Lifespan in Uganda (ENRICH).

“Among our PhDs, we don’t have anyone from pediatrics—and that’s fine,” says Kiguli. Importantly, the researchers are trained as a group to amplify the benefits of multidisciplinary collaboration. “We’ve been working in silos—pediatricians alone, physicians alone, social scientists alone—that won’t help us address the comprehensive needs of these patients.”

Methodology has also been given sufficient consideration. “We provide both individual and team mentorship from the beginning,” said Kiguli. Monthly meetings help trainees develop personal development goals and career path plans in the hope they will continue in the field. The program also provides research training to health professionals, such as medical doctors, laboratory personnel, and nurses, who are not necessarily doing degree programs, “so those who manage patients routinely might also benefit,” said Kiguli.

South-to-South unity

For the project, Makerere University has partnered with Busitema University, located in eastern Uganda, where “prevalence of the sickle cell trait is as high as 20%,” says Kiguli. (Sickle cell trait refers to when a person has inherited one mutated allele of the sickle cell gene, not two.) This local prevalence contrasts with about 13% prevalence elsewhere in the country. Studying the disease in a high burden locale is highly relevant, because results may influence policy and treatment guidelines.

Kiguli has other reasons for collaborating with Busitema University, which is less than 15 years old. “We want to build capacity at this young institution since our colleagues there have less chance of doing research than we at Makerere do.” Working and supervising trainees together will give Busitema’s faculty much-needed experience, while providing opportunities for faculty at both universities to learn from each other. Kiguli also hopes the new collaboration will advance progress made as result of the universities’ past partnerships. “Capacity must be built in a sustainable way,” says Kiguli.

“It’s important to work collaboratively and not competitively—this is just as important for Makerere University as it is for Busitema University.”

ENRICH trainees talk about their projects

Dr. Jackline Akello
Photo courtesy of Jackline Akello

Dr. Jackline Akello, PhD candidate

Dr. Jackline Akello, PhD candidate

My project is “Sickle cell disease in pregnancy: Experiences in provision and access to care and adverse pregnancy outcomes at Mbale and Kawempe Referral Hospitals.” As an obstetrician and gynecologist, I work as a lecturer at Makerere University and provide clinical care at the two national referral hospitals. I have encountered significant challenges in managing pregnant women with sickle cell disease (SCD) due to a number of healthcare navigation challenges. Additionally, the diverse cultural beliefs associated with SCD in Uganda affect access to care and ultimately outcome and quality of life for the patient.

By October, I will have started the enrolment of 161 pregnant women with confirmed SCD for my project. These participants will be followed throughout their pregnancies to track maternal and fetal complications, including stillbirths and low birth weight. Their experiences with the healthcare system will also be explored. As a Safe Motherhood champion, I have been focusing on hypertensive disorders in pregnancy, including pre-eclampsia, but this October at the Safe Motherhood Conference I will discuss the effects of SCD during pregnancy with the Ministry of Health. One of the endpoints of my study is to improve care for pregnant women who have SCD to enhance their pregnancy experience and outcomes.

Dr. George Paasi
Photo courtesy of George Paasi

Dr. George Paasi, PhD candidate

Dr. George Paasi, PhD candidate

My project is “The Clinical Epidemiology, Spatiotemporal Patterns and Disease Modifiers of Severe Malaria among Children with Sickle Cell Disease in Eastern Uganda.” Uganda ranks fourth among countries with high burden of SCD and is in the top 10 with respect to malaria burden. Eastern Uganda has the highest burden of both diseases. My project addresses this dual burden of SCD and malaria in eastern Uganda—I want to decipher the SCD-malaria syndemic in this region.

I’m a medical doctor, I have a master’s in public health, and I just finished a fellowship in infectious disease, epidemiology, and biostatistics. I’ve worked at Mbale Clinical Research Institute for the last 10 years. Previously, I worked on an NIH-funded trial in Africa called Realizing Effectiveness Across Continents with Hydroxyurea (REACH) as a medical officer, and now I’m embarking on this PhD training. My hope is that the findings from my study will improve the identification of patients with SCD at risk of adverse outcomes when they get malaria. I also want to identify, through spatial temporal analysis, hotspot locations that require priority interventions. I also want to gain skills as an independent researcher in SCD and make a meaningful contribution to this field.

Dr. Anita Arinda
Photo courtesy of Anita Arinda Dr. Anita Arinda, PhD candidate

Dr. Anita Arinda, PhD candidate

My project is “Prevalence, associated factors, course and impact of major depressive disorder in adolescents with SCD in Mulago National Referral Hospital.” We have limited data on mental health of adolescents with SCD, so that’s why my project mainly looks at depression in adolescents (ages 10 to 17).

In our setting, we are fortunate that children with SCD live past their fifth birthday thanks to improved health care, but this presents new challenges. During adolescence, patients enter a crucial stage where they’re trying to develop their identity, yet they’re also beginning to understand the implications of their condition—that having this serious health condition cuts their life short. I want to understand their experiences. How does depression in adolescents with SCD differ from depression in adolescents without SCD? We know that sickle cell disease causes inflammation, so does that contribute to their depression? How does depression affect clinical outcomes, if at all?

If we can understand the underlying mechanisms of depression in teens with SCD, then we might find new ways to manage their care (as opposed to conventional treatment with antidepressants). I’ll do my research at Mulago National Referral Hospital, which has a clinic dedicated to children and teens with sickle cell disease. The clinic provides many services, but unfortunately no specialized mental health services. One day I hope that changes, so that children with SCD and depression can get help early.

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Job Advert: Position of Principal -College of Health Sciences

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Makerere University seeks to fill the position of Principal, College of Health Sciences. The College of Health Sciences is a semi-autonomous academic unit, which consists of Schools, Academic Institutes, Departments and Centers that carry out general and professional training, teaching, outreach and research in various disciplines.

Job description
The Position is a Senior Post in the University created to give leadership to a College of Makerere University.

The Principal is the Chief Administrative, Academic and Financial Officer of the College and is responsible to the Vice Chancellor, University Senate and the University Council for promoting and maintaining academic excellence, efficiency and order of the College.
Eligibility
The person eligible for appointment should possess the following minimum attributes:

  • Hold a PhD or other academic Doctorate in one or more of the disciplines taught at the College;
  • Be at least at the rank of Associate Professor at the time of application;
  • At least four ( 4) years managerial expenence as a Head of an academic Department, Programmes Coordinator or a Research Project Manager in a University, Tertiary Institution or a reputable National Research Institution
  • Teaching experience of at least Six ( 6) years in one of the disciplines offered in the College he/she intends to lead;
  • Applicants who are at the rank of Associate Professor should not be above 61 years at the time of application.
  • Applicants who are at the rank of Professor should not be above 66 years at the time of application
  • Applicants must have demonstrable expenence of networking, research and resource mobilization. Applicants must attach evidence of resource mobilization and research conducted in the last five years.
  • Be a citizen of Uganda.

Tenure
The Principal is appointed to hold office for a term of four years.
Salary: Scale PU3
Mode of application:

i) Interested individuals should submit a letter of application accompanied with Curriculum Vitae, copies of relevant Academic Credentials and naming three referees;

ii) Applicants should make sure that at least two of the three referees have forwarded references concerning their application and suitability by the stated deadline;

iii) The deadline for submission of applications is 7th October 2024 at 5:00p.m.
East African time.

Applications should be submitted to:

The University Secretary
Makerere University
Frank Kalimuzo Building, Study Room 4.1
P.O. Box 7062
Kampala, Uganda
Or search.principals@mak.ac. ug

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IMPACT Program Newsletter Sept. 2024

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A Screenshot of the IMPACT Program Newsletter September 2024. College of Health Sciences (CHS), Makerere University, Kampala Uganda, East Africa.

A very special welcome to the first edition of our newsletter of Makerere University’s Impact research capacity building program. The program is funded by a generous grant from the NIH Fogarty International Center to reduce the impact of rheumatic heart disease across all affected ages. For more than a decade Uganda has been at the fore front of rheumatic heart disease (RHD) research in sub-Saharan Africa. Building on that Foundation Makerere University College of Health Sciences decided it was opportune time to strengthen collaboration with Uganda Heart Institute and US partners: Cincinnati Children’s Hospital Medical Centre (CCHMC) and Children’s National Hospital (CNH) to uplift Uganda’s research capacity to innovate and generate knowledge critical for elimination of rheumatic fever and rheumatic heart disease in the long run.

Whereas doctoral training of doctors and nurses is the main focus of our capacity strengthening initiatives, other levels are not left behind. Training is concurrently ongoing at master’s degree level and in-service for health professionals to better their research careers. The training spots were nationally advertised publicly and recruitment of trainees was competitive. Major research activities are taking place in rural communities in which rheumatic fever is relatively common. The program puts emphasis on community engagement so that the public can understand the importance and centrality of their actions in the control and elimination of rheumatic fever and achieving better quality of life and survival of those having rheumatic heart disease and its complications. The program pays special attention to gender issues in the research we do.

Prof. Emeritus Nelson Sewankambo
PRINCIPAL INVESTIGATOR

Mark Wamai

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