Health
Study to Address the Social drivers of Mental Illness Launched in Uganda by Kennesaw State University & Makerere University
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
At a ceremony held on 30th May 2025, themed ‘They taught us without saying a word’, the Makerere University College of Health Sciences (MakCHS) commemorated the silent teacher which are the cadavers (bodies) used in anatomy classes for medical students. In addition to a commemoration service, the event was used to create awareness and sensitise the public about the the importance of whole body donation.
The chief guest at the commemoration was Professor Mukadasi Buyinza, Deputy Vice Chancellor – Academic Affairs representing the Vice Chancellor, Professor Barnabas Nawangwe. The event attended by MakCHS students, staff and alumni was organised by students under Anatomy Society of MakCHS supported by Department of Anatomy and MakCHS leadership.
Welcoming guests to the event, Waziwu Mordecai–final year student of medicine and surgery who serves as President of the Anatomy Society, MakCHS explained that the reason for the gathering is three-pronged: to commemorate the silent teachers who make a profound contribution to medical education; to instill knowledge, compassion, and professionalism in future healthcare providers; and call on the community to support this noble act through awareness, advocacy, or future donation. ‘May the memory of our silent teachers live on in every life we will one day save’, he said.
The Anatomy society was founded in 2013 with aim of students providing peer mentorship to fellow students in lower years, such mentorship sessions help students appreciate better the anatomy of the human body. The society has supported:enhanced learning and mentorship; promoted academic participation including internal and external quizzes; and fostered connections including strengthen relationships between students across classes and with alumni.
Professor Elisa Mwaka, Head – Department of Human Anatomy welcomed all present for attending the ceremony. He thanked the College management led by the Principal, Professor Bruce Kirenga for the support provided in organizing the ceremony. He also expressed utmost appreciation to the Vice Chancellor for attending despite the competing priorities requiring his attention.
Professor Mwaka highlighted that we are here today, to pay our respect to the individuals whose bodies have been used for medical examination and research at MakCHS through offering prayers as well as sensitize people about willful/consented whole body donation.
Professor Mwaka explained that globally, sources of whole bodies for medical education and research are got through willed whole-body donation, unclaimed bodies in hospitals, imported bodies, executed persons among other means. In Uganda, unclaimed bodies in hospitals are used for medical as determined by the Uganda National Rules in the Penal Code Act of 1957.
In 2012 International Federation of Anatomy Associations (IFAA) recommended voluntary donation as the desirable and the only acceptable source for acquiring bodies. Almost all Africa countries and some European countries lack national body donation programs.
Speaking at the event, Professor Bruce Kirenga, Principal – MakCHS thanked Professor Mwaka for the insightful presentation. He welcomed Professor Buyinza to MakCHS and for accepting to attend despite the late invitation. He recognized the presence of the staff present and support towards the college activities.
Professor Kirenga underlined the importance of biomedical science under which human anatomy falls in medical education. ‘Biomedical sciences play a key role, once someone in grounded in the area, then he will be a good doctor’, he said.
The Principal also stressed that during his term of office operation efficiency will remain key ingredient for service delivery as well as rebuilding and rehabilitation of teaching and learning facilities. ‘Works to make the Biochemistry laboratory a model lab has commenced with a contract awarded to service provider; the refurbishment will be in phases’.
Professor Buyinza Mukadasi thanked the College, Human Anatomy department and the students for organizing the commemoration. ‘The amount of joy I have this morning, we should have done this a long time ago’, he said.
He expressed happiness at this commemoration for the silent teachers who unknowingly give so much to medical education and therefore mankind. He advised that community engagement to create awareness about the need for whole-body donation, regulatory compliance, and alignment to best practices.
He noted that disciplines like medicine is more like charity because medical practitioners give so much of themselves. ‘The number of people attending this ceremony is show of love for the discipline and commitment to the calling’ he said.
Professor Buyinza reiterated the commitment of Makerere University management to support MakCHS endeavours including this culture of commemorating the silent teacher. ‘Well-trained and season doctors are a result of the process explained here and the absence of bodies affects the quality of education provided and therefore the doctors produced’, he added.
Candles for the cadavers were lit and services representative of Anglican, Catholics and Muslims were conducted to remember the souls of the departed and wish them a peaceful rest. Ordinand Cosmas Ddembe for Anglican, Father Valentine Amuneke for Catholic and Dr. Haruna Kiryowa for Muslim preached the importance of respect for the dead and sacrifices of the dead for advancement of research and education in the medical field and health services.
Giving closing remarks, Professor Mwaka noted that setting up whole-body donation programs in Africa requires a holistic approach involving education, cultural sensitivity, legal structures, and partnerships with medical institutions.
Reasons why Africa has failed to establish body donation programs:
- Low awareness and willingness to donate bodies.
- Cultural and traditional beliefs
- Religious beliefs
- Fear of mishanding bodies
- Lack of legislation/ ambiguous regulations
- Lack of institutional policies and standard operating procedures
- Institutions should be encouraged to hold Services of thanksgiving or commemoration for those who have donated their bodies for medical education and research.
The following is required to change the current status:
- Cultural sensitivity and awareness
- Community engagement and awareness creation
- Educational campaigns
- Developing legal and ethical frameworks
- Building partnerships between hospitals and medical institutions
- Establishing local body donation systems i.e.,
- donation registration process,
- consent documentation,
- Logistical infrastructure necessary for the
- donation process.
- Effective communication, public trust,transparency.
- Training and professional development of healthcare providers.
- Global collaboration and funding: to share knowledge, best practices, and resources.
- Government support
- Funding and incentives
- Inclusion of body donation in national health strategies.
In a decisive step toward ending HIV as a public health threat by 2030, Uganda on Thursday, May 29, 2025, officially launched the third Uganda Population-based HIV Impact Assessment (UPHIA 2025) survey, a nationally representative household study expected to provide updated measurements on the status of the HIV epidemic by the end of the year.
The effort is led by Uganda’s Ministry of Health (MoH), with technical assistance from Makerere University School of Public Health (MakSPH), Uganda Bureau of Statistics (UBOS), Uganda Virus Research Institute (UVRI), and the U.S. Centers for Disease Control and Prevention (U.S. CDC), funded by the U.S. government through PEPFAR.
The Population-based HIV Impact Assessment (PHIA) surveys were first launched in 2014 as a global initiative at the International Center for AIDS Care and Treatment Programs (ICAP), based at Columbia University’s Mailman School of Public Health. Supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), through the U.S. CDC, the surveys have been conducted in at least 15 high-burden countries globally, including Uganda.
Led by national Ministries of Health, the PHIA surveys provide robust, population-level data on HIV prevalence, incidence, and viral suppression, offering a clear picture of epidemic trends and the effectiveness of national responses. They are designed to track progress, identify persistent gaps, and inform strategies to reach epidemic control, in line with global targets, including the fast-approaching goal of ending AIDS as a public health threat by 2030.
In Uganda, this survey was first rolled out between August 2016 and March 2017. The second followed in February 2020 but was disrupted by the COVID-19 outbreak, continuing through to March 2021. Both rounds were supported by ICAP at Columbia University, which provided technical assistance to strengthen data collection systems, improve laboratory infrastructure, and build national capacity to design, implement, and analyse the two national HIV surveys.
What sets UPHIA 2025 apart is the shift in technical leadership to Ugandan institutions for this third survey, reflecting local capacity to lead rigorous, high-quality public health research. For UPHIA 2025, Makerere University School of Public Health, in partnership with the Uganda Bureau of Statistics and the Uganda Virus Research Institute, is providing technical leadership to the Ministry of Health, alongside U.S. CDC. Implementation began with initial recruitment and training of over 300 field teams that begun on May 19, 2025, ahead of their nationwide deployment for data collection starting this June.
The first survey (UPHIA 2016) was an important milestone in informing Uganda’s national HIV response. This survey, concluded in 2017, measured, among things, the viral load suppression at the population level and provided household-based HIV testing and counselling, with results returned to participants and those who tested positive referred to care. The survey also assessed HIV incidence, HIV and syphilis prevalence, as well as hepatitis B infection rates. These findings would offer nationally representative data to track Uganda’s progress in controlling the HIV epidemic at both national and regional levels.
The next survey, UPHIA 2020, building on past success, was again executed with technical leadership from Columbia University’s ICAP, working with Uganda’s Ministry of Health alongside UVRI, UBOS, regional referral hospitals, local governments, and the U.S. CDC. It offered useful insights that showed encouraging progress, indicating that up to 88% of people living with HIV in Uganda at the time knew their status, 98% of them were on treatment, and 90% had achieved viral suppression. These results reflected momentum toward the UNAIDS global 95-95-95 targets, ensuring that most people living with HIV are diagnosed, treated, and have the virus under control, and advancing the broader goal of ending the epidemic by 2030.
Since the release of these findings nearly five years ago, which helped shape national HIV programming in Uganda, the country has made notable progress, but challenges remain. The UPHIA 2020 findings reported major gaps in testing coverage, particularly among young people and men. The results were also instrumental in identifying service delivery shortfalls and guiding decisions on resource allocation, program design, and policy. Yet today, Uganda remains one of the most heavily burdened countries in the world, with over 1.5 million people living with HIV and over 50,000 preventable new infections recorded per year.
It is this trend that Uganda’s Ministry of Health is working urgently to reverse. Launching UPHIA 2025 at the Ministry’s headquarters in Kampala on May 29, 2025, amidst great hope and expectation among the participants, Uganda’s Minister of Health, Dr. Jane Ruth Aceng Ocero, noted that the long-anticipated and previously delayed survey had arrived at such a critical moment. She welcomed UPHIA 2025 as both a measure of the country’s resilience and a guide for the final stretch toward ending AIDS by 2030, now just a few years away.
“The UPHIA 2025 survey comes at a strategic time to help us recalibrate and refocus our efforts,” the Health Minister said, underscoring the importance of its outcomes. “This will be Uganda’s final population-based HIV survey before 2030, the target year for ending AIDS as a public health threat. The findings will serve as a baseline for tracking our progress toward this national and global goal. They will also guide the next phase of strategic planning, ensuring that the final push toward 2030 is grounded in robust and reliable data.”
This third round of the survey will be carried out in 6,685 randomly selected households across the country. The exercise will involve interviews with approximately 15,000 individuals aged at least 15 and selected through a national household listing by UBOS. Of those, around 14,980 are expected to provide blood samples for HIV testing and analysis of viral suppression and other health indicators. The survey will also include interviews with 1,300 children and adolescents aged 10 to 14, though no blood draws will be taken from this group. Participation is voluntary, free of charge, and requires consent from the head of each household.
Dr. Aceng explained that beyond providing updated estimates of HIV prevalence, incidence, and viral load suppression, and examining regional and demographic disparities, the survey, which will cover the rest of the year, will include a qualitative post-survey assessment component to gather insights from people living with HIV, particularly those not virally suppressed, to understand their challenges and strengthen support services. Also, for the first time, this survey will assess the burden of non-communicable diseases among people living with HIV and include focused interviews with adolescents aged 10 to 14 in Mid-North and Mid-Eastern Uganda, where viral suppression was reported to be lowest in UPHIA 2020.
These activities are made possible thanks to the development support from the U.S. government, which invested $10 million (about UGX 37 billion) for this survey. Speaking at the UPHIA 2025 launch, U.S. Ambassador to Uganda William W. Popp noted that the United States has partnered with Uganda for over three decades to help people live longer, healthier lives;
“The bulk of our annual support, approximately $500 million this year, is dedicated to health programs, making the U.S. government the largest single provider of health assistance to Uganda,” the Ambassador said. He added, “Through PEPFAR, the United States has played a major role in Uganda’s progress toward ending HIV as a public health threat. Since 2003, when Uganda became one of the first countries to implement the program, we have invested nearly three billion dollars—almost 11 trillion Uganda shillings—in HIV prevention, care, and treatment services, saving millions of lives and making both our countries safer from HIV.”
With the benefit of hindsight, Uganda’s early encounter with HIV in the 1980s marked the beginning of one of the region’s most severe epidemics. But over the decades, a determined national response, driven by political leadership, community mobilisation, collaboration and global support, has delivered measurable progress. In the recent past, adult HIV prevalence fell from 7.2% in 2010 to 5.1% in 2023. Among women, it declined from 8.5% to 6.6%, and among men from 5.8% to 3.6%. AIDS-related deaths dropped from 53,000 to 20,000 over the same period, with female mortality declining by 66% and child deaths by 77%.
All these gains, amidst the challenge, go to show what is possible with sustained commitment. What is more, throughout this long journey of Uganda’s battle with eradicating HIV, Makerere University School of Public Health has played a pivotal role. From the early work of Prof. David Serwadda, whose ground-breaking research during the initial detection of HIV helped shape Uganda’s early response, to last year’s 2024 landmark Purpose 1 study on the twice-yearly injectable Lenacapavir that proved 100% efficacy in preventing HIV infection, MakSPH has remained at the forefront of innovation, evidence generation, and policy influence.
That legacy continues today, with the School providing technical leadership to the Ministry of Health in the implementation of UPHIA 2025. At the launch, MakSPH Dean Prof. Rhoda Wanyenze expressed pride in the School’s role as a trusted partner in Uganda’s fight against HIV and other public health challenges. She noted that for over 70 years, during which the School has existed, MakSPH has helped shape the country’s public health landscape through rigorous research, training, and policy support, anchored by a strong, long-standing partnership with the Ministry of Health and partners.
She also noted that the collaboration between Makerere University and the U.S. CDC has helped build national capacity in surveillance and epidemiology, while also strengthening Uganda’s ability to lead high-quality, large-scale national surveys, asserting that:
“The partnership between Makerere University and CDC has not only helped build national capacity in surveillance and epidemiology, but has also strengthened our ability to lead high-quality, large-scale national surveys. After two decades of joint work, we are proud that UPHIA 2024–2025 is now a fully Ugandan-led effort. This is critical to the sustainability of the skills and knowledge generation to inform our local response.”
The survey builds on MakSPH’s experience conducting similar national studies, including those on tuberculosis, prison health, family planning, schistosomiasis, and non-communicable diseases such as the STEPS survey. It will leverage the School’s strong capacity in research and impact evaluation, both in Uganda and across the African region, with a firm commitment to delivering high-quality data guided by the same rigour and integrity that have defined our work over the years, Prof. Wanyenze affirmed.
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