Health
Study to Address the Social drivers of Mental Illness Launched in Uganda by Kennesaw State University & Makerere University
Published
3 years agoon

A new 5-year study has been announced to determine the link between social drivers and mental health among young women who live in the slums of Kampala in Uganda. Kennesaw State University (KSU) received the five-year $3.3 million award from the National Institutes of Health (NIH) and has partnered with Makerere University to conduct this interdisciplinary project.
Mental illnesses are understudied, and scarce services lack evaluations, particularly in low-resource settings such as slums. In response to the vulnerable state of adolescent girls and young women in the urban slums, the team of researchers are implementing this five-year project named “TOPOWA” (The Onward Project On Well-being and Adversity), which means to “keep pushing forward and never giving up”, in the Luganda language.
Makerere University through the School of Public Health is teaming up with two U.S universities, Kennesaw State University (KSU) and Georgia State University (GSU) in the U.S. to implement the research component of the study. The Uganda Youth Development Link (UYDEL), a community-based organization in Kampala will lead the intervention components.

First of its kind, “the TOPOWA project will examine if a community-based intervention program comprised of vocational training, entrepreneurship and economic empowerment, team building through sports, and psychosocial support (“Socioeconomic Strengthening Targeted Training: “SeSTT”). leads to better mental health outcomes among disadvantaged women living in slums” said Dr. Monica Swahn, the Principal Investigator of the study.
The TOPOWA research project will focus on young women ages 18-24 years, the age period when most mental health symptoms are manifested and expressed. If the study shows that the intervention makes a difference in mental health outcomes (i.e., anxiety, depression, suicidality and substance use symptoms and disorders) for young women, it can address the tremendous unmet mental health needs in Uganda. The study will also increase the understanding of the community and neighborhood characteristics of the urban slums where the young women reside.
It was launched on Tuesday March 8, 2022, on International Women’s Day, a global holiday celebrating the social, economic, cultural, and political achievements of women. Speaking at the launch, Dr. Swahn, the Principal Investigator, and also Professor and Dean of the Wellstar College of Health and Human Services at KSU said “TOPOWA was in support of global action to advance gender equality and the empowerment of women and girls”

She also noted that this was a ground-breaking study, with investigators representing diverse expertise from three universities.
“Our TOPOWA project is ground-breaking because we look at the social drivers of mental illness and how to mitigate them. We conceived this project before the pandemic, but now with the pandemic, we know more than ever how mental health has been understudied and the growing scope of unmet need in the community,” she said. Dr. Swahn also added that, “We don’t have enough interventions for mental health in particularly among vulnerable populations in low-resource settings. So, what we have learnt post-COVID is that we need to find scalable interventions to better support mental health for women who live in poverty, particularly women who live in slums.”
Using a multicomponent 27-month, parallel prospective cohort design of young women, the study team will recruit 300 participants from three selected UYDEL study sites in Banda, Bwaise and Makindye to determine the pathways and mechanisms of mental health outcomes. The study will involve focus groups, a Photovoice project, community mapping, surveys, use of sleep wearables, saliva and stress reactivity to detect and determine stress levels of the young women.
The investigators will measure stress though threat reactivity in fear conditioning tests, ratio of salivary cortisol, dehydroepiandrosterone (DHEA) and α-amylase, and sleep quality by deploying Fitbit wearable sensors for each study participant as well measuring environmental stressors through geotrackers.
“We will ask these young women to wear these Fitbits. These will pick up on the measure of sleep. We know that when people are stressed, they have poor mental health, but also, they have poor sleep,” said Prof. Swahn. She adds that these Fitbit devices are worn just like a wrist watch. “They will give us a lot of insight to what happens at night when people are sleeping. The women may or may not be sleeping as well as they should. So again, it’s another marker of stress, their well-being and physical health. It really adds another important innovative component of the study. We looked for other studies across the sub-Saharan Africa and have not found any studies that use this technology in this type of setting so these gadgets will give us a lot of insight.”

Dr. Catherine Abbo, an Associate Professor of Psychiatry at Makerere University College of Health Sciences, and Co-Investigator of the TOPOWA study, says depression and other mental health issues are on the rise in Uganda, though they continue to go unrecognized.
“These women actually don’t even reach the clinic but people just suffer while they are in the communities. There are different anxiety disorders. So, the current estimates from the previous research shows about 1 in every 4 people have mental health issues,” Dr. Abbo says.
Asked about what could be the drivers of mental health in young adults, Dr. Abbo contends some of the drivers are psychosocial arising from the environment we live in while others maybe genetically predisposed.

“If you are going to live in an environment that is poverty stricken, you are going to live in an environment where you are not going to access education, you are not going to have support that you need to be mentally healthy, you become vulnerable to getting mental illness and that is the environmental aspect. And then we have individuals, who, because of their genetic makeup, may develop cause mental illness,” she said.
According to Dr. Abbo, the wearables are new technologies and that this is the first of its kind to be used in research in Uganda. “You know sometimes people go jogging and have phones that take the number of their steps, heart rate, so in the general population we have gadgets that can measure some aspects of body reactions but particularly in this case, it’s going to measure sleep patterns, that signify stress levels.”
Mr. Rogers Kasirye, UYDEL’s Executive Director, argues that many a time, intervention projects have been implemented among youth but they fail because of the inability to tackle underlying issues affecting the young people. He says this study to investigate the mental health status of the young women will go a long way in impacting the way such initiatives can be implemented to achieve greater success.

According to Mr. Kasirye, for over 25 years, UYDEL has worked with young people in the in the slums of Kampala and impacted many young people through their skilling and rehabilitation programs. He pointed out that that a majority of the young people in slums face a lot of challenges including poverty, lack of shelter while others have long lost contact with their families.
“But we don’t go beyond to investigate and support their psychosocial needs. From experience, some people who come to our facilities have alcohol and other problems. Many times, they are even failing to sleep. Some even come to the Centre and tell you that they have not had a meal. You know what it means to sleep on an empty stomach. Others say they lost contact with their families while others say they have been sexually abused and others raped. In other words, they have a mountain of psychosocial needs that must be addressed. With this project, we hope to track girls for several years to match the research findings with empowerment interventions,” said Mr. Kasirye.

Ms. Anna Kavuma, the Deputy Executive Director, UYDEL says the COVID-19 pandemic has had a toll on mental health issues among young women by increasing their vulnerability.
She notes that whereas the boys have equally been affected by the pandemic and could have pushed them to high stress levels, girls have a high level of vulnerability with responsibilities such as bringing up the children, dealing with pregnancies, accessing medical supplies as well as shelter.

“It’s quite difficult for the girls. It’s an understatement for me to say that they are not highly affected by mental issues in Uganda, that is why this project is coming in to understand that. For instance, if we gave young girls vocational skills and training in beauty and cosmetics, or any other vocational skilling, will it help reduce on these stresses that they have? Will it help address the underlying factors that they are facing? Will it help to improve the way they sleep? Will it help improve the stress levels? These are areas we are trying to study and we are hopeful that the results of the study will inform not only programming and practice but also inform policy environment as well,” said Nabulya.
The project’s intervention arm will look at skilling the adolescent girls and young women with the cost-effective beauty training, which the researchers say is also very easy to implement. Dr. Swahn, the PI noted, “We are hoping that if it’s shown to be effective, that is something that can be implemented in other communities and we know that many are offering vocational training but they have not been evaluated the way we are doing it with a very vigorous scientific protocol.

Dr. Rhoda Wanyenze, Professor and Dean, Makerere University School of Public Health thanked Prof. Swahn and UYDEL for partnering with MakSPH to implement this important project citing that the School was ready to work with the team.
“Mental health for young people is such an important area and very timely coming after the challenges and stress from the Coronavirus pandemic! We are excited to partner with you on this project,” said Prof. Wanyenze.
The TOPOWA Research Team is composed of nine investigators spanning two continents and three universities. The Project’s Principal Investigator (PI) is Dean and Professor Monica Swahn of Kennesaw State University. The Co-Investigators of the project include Dr. Cathy Abbo, Dr. Godfrey Bbosa, Dr. John Bosco Isunju, Charles Ssemugabo and Dr. Eddy Walakira from Makerere University, Dr. Ebony Glover from KSU and Dr. Rachel Culbreth and Dr. Karen Nielsen from GSU.

The Executive Director of UYDEL, Rogers Kasirye, leads the implementing partner whose mission is “to enhance socioeconomic transformation of disadvantaged young people through advocacy and skills development for self-reliance”.
The TOPOWA Project Advisory Board is composed of members from the Kampala City Government, the Ministry of Health, the Ministry of Gender Labour and Social Development as well as the Dean for the Makerere University School of Public Health.
Davidson Ndyabahika is the Communications Officer, MakSPH/TOPOWA Project
Article originally posted on MakSPH website
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Health
Ugandan Study Flags Girls and Senior Students as a Mental Health High-Risk Group
Published
2 days agoon
July 12, 2025
Based on research led by Max Bobholz and colleagues from Makerere University in Uganda, Essentia Institute of Rural Health, and the Medical College of Wisconsin in the United States.
Adolescence is meant to be a time of holistic growth and self-discovery, but for many Ugandan teenagers, this period is becoming a season of silent mental health struggles. A new study published in PLOS Global Public Health has uncovered a silent but growing crisis: nearly one in five Ugandan secondary school students in the study areas have signs of an emotional disorder. These conditions included anxiety, depression, post-traumatic stress disorder (PTSD), and adjustment disorders often involving excessive worry, sadness, fear, or mood instability. Also, one in 20 adolescents exhibited behavioral issues ranging from attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder to substance use and other risky behaviors like alcohol use.
The study, led by Max Bobholz, a PhD candidate in Public and Community Health at the Medical College of Wisconsin, surveyed a sample of 1,953 students aged 10 to 18 years enrolled in eight secondary schools in Iganga district in Eastern Uganda and Mukono district in Central Uganda. This was one of the most comprehensive efforts yet to understand the prevalence and drivers of mental health challenges among school-going Ugandan adolescents.
“We are looking at a generation facing a complex blend of stressors, namely, academic, social, and emotional,” says Bobholz. “Our findings show that certain groups are especially vulnerable, and schools need to be equipped to respond.”

This study results, published on June 12, 2025 was funded by the Swedish International Development Cooperation Agency (SIDA), a government agency of the Swedish Ministry for Foreign Affairs, through the Makerere University Postdoctoral Fellowship to one of the investigators, Dr. Catherine Abbo. Other researchers included Julia Dickson-Gomez, Arthur Kiconco, Abdul R. Shour, Simon Kasasa, Laura D. Cassidy, and Ronald Anguzu.
According to the study, girls bear a higher emotional burden. Researchers found that female students had nearly two times higher odds of suffering from emotional disorders such as anxiety or depression than their male peers.
Dr. Catherine Abbo, an Adolescent Psychiatrist and Associate Professor at Makerere University, attributes this to both biological and socio-cultural factors. “Puberty brings hormonal shifts that can heighten emotional sensitivity,” she explains. “But just as importantly, Ugandan girls often face intense pressure to conform to gender roles while also navigating issues like body image, harassment, and future uncertainty.” The researchers are calling for gender-sensitive mental health interventions, particularly in schools, where early support could help mitigate long-term mental health issues.

Higher associations in older teens?
Age also emerged as a key associated factor, with each additional year increasing the odds of behavioral disorders by 20%. “As adolescents grow older, they are more prone to risk-taking, impulsivity, and resistance to authority,” explains Dr. Simon Kasasa, a senior lecturer and biostatistician at Makerere University School of Public Health.

“Combine that with academic pressure and identity-related stress, and it’s no surprise we’re seeing more conduct issues in late adolescence,” Dr. Ronald Anguzu, an Assistant Professor in the Institute for Health and Humanity at the Medical College of Wisconsin, added. This study raises critical questions about whether and how Ugandan secondary schools support older students as they transition toward adulthood.
The unseen influence of family mental health
The study also found that adolescents with a family history of mental illness had twice the odds of exhibiting behavioral problems compared to those without such a history.
“This speaks to the intersection of genetics and environment,” says Bobholz. “Living in a household with people affected by mental illness can mean instability, stigma, and lack of emotional support, all of which weigh heavily on a developing mind.”
The authors recommend that school mental health screening include family mental health history and advocate for greater collaboration between education and health sectors to support at-risk households.

Private schools: High marks, higher stress?
Interestingly, students in private schools had 1.4 times the odds of experiencing emotional disorders compared to those in public schools. Private schools, often seen as academic havens, may inadvertently be cultivating high-pressure environments. “There’s an assumption that better facilities mean better well-being,” says Dr. Abbo. “But intense academic competition, social isolation, and a lack of trained counselors can create emotional pressure cookers.”
Previous research in 47 secondary schools across five districts (Rakai, Kyotera, Masaka, Lwengo, and Kalungu) in southwestern Uganda found that economic and family support helped reduce absenteeism among adolescent girls in secondary schools. However, this support did not significantly improve behavior or reduce grade repetition. The region, which includes districts like Rakai and Masaka, also faces a higher burden of HIV, adding to the challenges young people experience.
Meanwhile, a review of data from 42 primary schools in Luwero District identified school-based mental health interventions such as cognitive behavioral therapy and mindset-building approaches as being particularly effective. Researchers now suggest that integrating these strategies, along with efforts to reduce school violence, could go a long way in improving the mental health of Ugandan adolescents.
A-Level pressure: Academic ambition meets mental health strain
The study also found a correlation between advanced (A’level) education and increased risk of emotional disorders. “We selected one school district from each region based on population and past academic performance. As these students prepare for university or the job market, the pressure to succeed becomes enormous,” says Kasasa. “They’re facing a future full of uncertainty, with very little structured mental health support to help them cope.”

A wake-up call for Uganda’s education and health systems
The authors of this study assert the urgent need for school-based mental health programs, especially in private and A-level institutions. These programs should offer routine screening, emotional support, and training for teachers to recognize warning signs of mental health disorders.
Importantly, this study adds weight to calls for a national adolescent mental health policy, tailored to Uganda’s context, with interventions that bridge health, education, and social services.
“Our data shows that mental health challenges are not a fringe issue,” says Bobholz. “They are widespread, significant, and deeply tied to school, home, and society.”
The COVID-19 school closures between 2020 and 2022 deepened feelings of isolation and financial strain, with out-of-school adolescents reporting depression rates as high as 21.5% to 50% higher than their peers who remained in class, according to research published in February 2025. Yet Uganda invests less than 1% of its health budget in mental health, with just one psychiatrist per million people, leaving many teens to cope through cheap alcohol used by 28% of urban youth or untrained healers, as reported by the government paper The New Vision in April 2025. With only 26% of students completing lower secondary school and 35% of the population under age 24, these mental health challenges now pose a serious threat to the country’s future.
Mercy Akankunda of Proven Foundation, a Ugandan NGO supporting vulnerable groups, warns that mental health struggles are quietly eroding the well-being of the country’s youth, over 12 million strong and making up 35% of the population. “These teens are not just statistics. They are the future of Uganda, she asserts. If Uganda hopes to reap the dividends of its young population, addressing adolescent mental health must become and remain a national priority, not just for treatment, but for prevention, resilience, and hope.
Reference:
Bobholz, M., Dickson-Gomez, J., Abbo, C., Kiconco, A., Shour, A.R., Kasasa, S., Cassidy, L.D., & Anguzu, R. (2025). Correlates of behavioral and emotional disorders among school-going adolescents in Uganda. PLOS Global Public Health. Read the study here
Health
Call for Applications: Responsible Conduct of Research (RCR) Training Course
Published
3 days agoon
July 11, 2025By
Mak Editor
The Responsible Conduct of Research (RCR) Training Course, scheduled to take place from July 30th to August 1st, 2025, at the Makerere University College of Health Sciences’ Conference Room.
Background
The SUSTAIN: Advancing Makerere University Masters of Health Sciences in Bioethics program at Makerere University College of Health Sciences aims at developing and institutionalizing a mentorship program in research ethics that facilitates development of bioethics professionals and health researchers who are committed to the growth and application of research ethics in Uganda’s academic and research institutions to the highest possible degree. The Responsible Conduct of Research (RCR) course is one of the short courses that introduces trainees to a framework that involves application of established scientific, professional norms and ethical principles in the performance of all activities related to scientific research.
Course objectives
At the end of this course, trainees should be able to identify, manage and prevent research misconduct.
Course outline
Introduction to RCR; Introduction to Professionalism and Ethics; Human subject’s protection and regulatory framework in Uganda; Humane handling of animal research subjects; Conflict of interest;
Responsible laboratory practices; Mentor-mentee relationships; Collaborative research international, industry); Peer review; Research misconduct (including policies for handling misconduct); Community involvement during research in a low resource setting; Responsibility to society and environment; Responsible financial management; Data acquisition, management, sharing and ownership; Responsible authorship, publication and communication.
Target group
The Responsible Conduct of Research course is targeted at Researchers, Research administrators, Research assistants, Study coordinators, Graduate students and Student supervisors. Certificates will only be awarded to participants with 80% attendance.
Course fee: 205,000/=, or 56USD is payable.
The course fee will cater for meals and refreshments during the training period.
Payment & Registration procedure:
9030026194023, Stanbic Bank, Mulago, Makerere University Biomedical Research Center Limited
Dollar Currency:
9030026194147, Stanbic Bank, Mulago, Makerere University Biomedical Research Center Limited
Please Note: Share payment details on email/whatsup and a hardcopy deposit slip delivered on the first day of the training to Miriam Musazi, Department of anatomy, Bioethics Centre, Room C4,
Mob: +256 782 363 996/ +256 701 363 996, Email: mmusazi@gmail.com.
NB. Only those who will have paid by this date will be considered for the course
Venue: The training will take place at Makerere University College of Health Sciences’ Conference room
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Call For Applications: PhD Fellowship Training Position
Published
4 days agoon
July 10, 2025By
Mak Editor
Background:
Makerere University College of Health Sciences (MakCHS), Kampala, Uganda and Global Health Uganda (GHU); in collaboration with other research consortium partner institutions, including, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya; Training and Research Unit of Excellence (TRUE), Blantyre, Malawi; University of Bergen, Bergen, Norway; University of Amsterdam, The Netherlands; and Liverpool School of Tropical Medicine (LSTM), UK have been conducting clinical research on Malaria Chemoprevention. This research has focused on Malaria Chemoprevention in vulnerable patient populations, including children with severe anaemia, children with sickle cell anaemia and pregnant women. As an example, two of our recently completed studies are “The post-discharge malaria chemoprevention in children with severe anaemia [https://pubmed.ncbi.nlm.nih.gov/33264546/] and Malaria chemoprevention in children with sickle cell anaemia [https://pubmed.ncbi.nlm.nih.gov/39718172/]”.
With support from the UK Research and Innovation (UKRI) body, the consortium is expanding these studies to children with severe acute malnutrition, by conducting a large multi-centre randomized controlled trial entitled “Chemoprevention of malaria in the postdischarge management of children with severe acute malnutrition in Malawi and Uganda”.
In Uganda, the study will be conducted at one or two of their study sites in Jinja Regional Referral Hospital, Hoima Regional Referral Hospital or Kitgum General Hospital. Makerere University College of Health Sciences (MakCHS) and Uganda and Global Health Uganda (GHU) seek to appoint a full-time PhD Fellow, on this study. This will be a 4-year post, tenured at Makerere University and hosted at MakCHS.
Expectations of the PhD fellowship:
The PhD fellow will:
- Be a part of the main trial team, and participate fully in its implementation. However, he/she will be expected to design and develop his/her PhD research project, nested in the main trial.
- The area of study will be around “interactions between anaemia and severe acute malnutrition (SAM) in children or the interactions between malaria and severe acute malnutrition in children”.
- Conduct rigorous research, leading to high quality scientific publications.
- Submit a full research concept and obtain registration in the University by end of year-one. As such, there be an initial appointment for one year, renewable upon satisfactory performance.
- Academic mentorship and supervision will be provided by the research consortium (see above – composed of national and international researchers).
- Doctoral scholarly support and training environment, as well as didactic training in research methods and scientific writing skills will be provided by Makerere University.
- The funding support will cover tuition and a competitive monthly stipend for 4 years, scientific conferences fees/travel and other research-related costs.
Prospective candidates must:
- Hold Master’s of Medicine in Paediatrics and Child Health from a recognized university, and licensed to practice medicine in Uganda by the UMDPC.
- Possess undergraduate training in Medicine and Surgery (MBChB/MBBS/MD).
- Willingness to fully commit time and effort to their PhD studies, expected to start immediately
- Candidate should not hold other/concurrent fellowships
- Having publication experience will be an added advantage.
- Be highly motivated and willing to commit to a career in research and academia.
Application procedure:
Interested applicants should submit their application and supportive documents – listed here below, in one PDF document, in an email titled “PDMC-SAM–PhD Fellowship Application” to hr@globalhealthuganda.org [and cc – chdc.desk@mak.ac.ug] by 25th July 2025. The documents should include the following:
- An application letter (Max. 1 page)
- Motivation statement (Max. 500 words)
- CV (Max. 2 pages), including a list of publications
- Two (2) recommendation letters
- Academic transcripts and certificates for all university qualifications
- A synopsis focusing on the proposed PhD research work, describing briefly what is already known/burden, challenges, the gaps and potential interventions (include references) [Max. 800 words].
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