Health
72nd Graduation: Doctoral Citations – CHS
AGABA Bekiita Bosco
Molecular Epidemiological Surveillance of pfhrp2 and pfhrp3 gene deletions in Plasmodium falciparum parasite populations in Uganda
Mr. AGABA Bekiita Bosco investigated the biological and molecular changes in malaria parasites that make them difficult to be detected in malaria infected individuals. Once these parasites evade detection, individuals remain untreated leading to severe disease and risk of mortality. The results provide the first large-scale evidence reporting the presence of pfhrp2/3 gene deletions in P. falciparum parasites in Uganda and demonstrated that gene deletions are not confined but rather spread across regions. Further, the study showed that these parasites emerge independently and sponteneously. The findings inform national guidelines for malaria case management and policy for the introduction and deployment of new malaria diagnotic tests. The study was funded by the NIH-Fogarty Malaria training grant and the WHO collaborating center in Australia. The work was supervised by Prof. Moses R. Kamya, Prof. Chae Seung Lim, Dr. Adoke Yeka and Dr. Samuel Nsobya.
AMONGIN Dinah
Understanding Trends and Trajectories of Repeat Adolescent Birth in Uganda
Ms. AMONGIN Dinah studied the magnitude and explanation for repeat adolescent birth (i.e. a second or higher order live birth before age 20 years, following a first birth before age 18 years) and its later life consequences in Uganda. Her results revealed high repeat adolescent births (over 1 in 2) with slight decline in the 30 years of observation (1988/89-2016) although more women over the years wanted to have this repeat birth later. Results suggest life-long negative socio-economic and reproductive health outcomes among women with repeat adolescent births compared to those without. Further, escalation of the socio-economic distress following first birth, domestic violence, and partner coercion, predisposed adolescent girls to sexual exploitation and unwanted marriages. Interventions should focus on preventing repeat adolescent pregnancy and increasing opportunities for adolescent mothers, with a primary focus on: improving school retention/continuation, strengthening family planning services, and preventing early marriage. This study was funded by Training Health Researchers into Vocational Excellence (THRiVE-2) and was supervised by Assoc. Prof Annettee Nakimuli, Assoc. Prof Lenka Benova, Assoc. Prof Lynn Atuyambe, and Assoc. Prof Claudia Hanson.
KAPAATA ANDAMA Anne
Genotypic And Phenotypic Characterization Of Hiv-1 Transmitted/Founder Viruses And Their Effect On Cytokine Profiles And Disease Progression Among Acutely Infected Ugandans
Ms. KAPAATA ANDAMA Anne looked at Genotypic and Phenotypic Characterization of HIV-1 transmitted/founder viruses and their effect on cytokine profiles and disease progression among acutely infected Ugandans. Subtype analysis of inferred transmitted/founder viruses showed a high transmission rate of inter-subtype recombinants (69%) involving mainly A1/D, while pure subtype D variants accounted for one- third of infections (31%). The signal peptide-C1 region and gp41 transmembrane domain were hotspots for A1/D recombination events. She documented diversity in the functional protein domains across the Gag-Pol region of the HIV virus and identified differences in the Gag-p6 domain that were frequently associated with higher in vitro replication. She also found that HIV-1 subtype D infections had higher concentrations of different cytokines than subtype Ainfections. cytokines IL-12/23p40 and IL-1α were associated with faster CD4+T cell count decline while basic fibroblast growth factor was associated with maintenance of CD4+T cell count above 350cells/microliter. This work was funded by the International AIDS Vaccine initiative and supervised by Prof. Pontiano Kaleebu, Eric Hunter and Moses Joloba and Dr Jesus Salazar Gonzalez.
BAKESIIMA Ritah
Modern contraceptive use among female refugee adolescents in northern Uganda: prevalence, effect of peer counselling, adherence and experiences
Ms. BAKESIIMA Ritah studied modern contraceptive use among female refugee adolescents northern Uganda: the prevalence, effect of peer counselling, adherence, and experiences. She found that the use of modern contraceptives among sexually active adolescents was very low with less than 10% using a method, and yet they wanted to delay child birth. This highlights a high unmet need of contraceptives in this population. She also found that peer counselling had a positive effect on acceptance of modern contraceptives; participants who received peer counselling were more likely to accept a contraceptive method compared to those who received routine counselling. The commonest reasons for non-acceptance of a method were partner prohibition and fear of side effects. She recommends that refugee adolescents, together with their partners, are further sensitized of the dangers of teenage pregnancy, and the benefits of contraception in preventing teenage pregnancy and associated complications. This research was funded by SIDA and supervised by Assoc. Prof Elin Larsson, Dr. Jolly Beyeza-Kashesya, Prof. Kristina Gemzell-Danielsson, Dr. Amanda Cleeve, and Dr. Rose Chalo Nabirye.
BAYIGGA Lois
Role of Vaginal Microbiome in Host Susceptibility of HIV Infection in Pregnant Ugandan Women: Inflammatory Response and Epithelial Barrier Integrity
Mr. BAYIGGA Lois investigated the virginal microbial diversity and its immune-modulatory effects on host susceptibility to HIV among pregnant women in Uganda. In the results, the vaginal microbiome of pregnant women in the cross-sectional study was categorised into four distinct cervicotypes. In conclusion, African women had a more diverse vaginal microbiome relative to women in the America and Europe as observed in the literature. This work was supervised by Prof. Damalie Nakanjako, Dr. David Patrict Kateete, Dr. Musa Sekikubo and Prof. Deborah Anderson.
MIJUMBI Deve Rhona
Rapid Response Services to Support Policymaking in Uganda
Ms. MIJUMBI Deve Rhona evaluated the rapid response mechanisms aimed at providing evidence for policymaking in Uganda, including their feasibility and establishment, their uptake amongst the users along with these users’ experiences with them. She was able to determine and confirm the feasibility of an RRS in Uganda and map the establishment, growth, and evolution of the service. She was also able to document the important factors that led to the establishment of the service, then used this information to develop a theoretical framework combining the structural and temporal components of the development of an RRS and the factors important at each stage. She also established the important factors that influence the uptake of the RRS amongst its actual and potential users and also explored the users’ experience with the rapid response (RR) briefs produced by the RRS and used her findings to improve these briefs. The findings from this work are important to enable the use of evidence for decision-making at different levels of governance globally, especially in complex situations where time is barred. The work was funded by the International Development Research Center’s International Research Chairs Initiative and supervised by Prof. Nelson Sewankambo, Prof. John Lavis, and Dr. Andrew Oxman.
MUKURU Moses
An analysis of evolutions in maternal health policies and implementation adaptations in Uganda during the MDG period (2000-2015)
Mr. MUKURU Moses analysed Uganda’s maternal health policies introduced during the fifteen years of the Millennium Development Goals (MDG period) to understand policy failure. This followed the persistence of high preventable maternal mortality, which closed at a Maternal Mortality Ratio (MMR) of 368 deaths per 100,000 live births in 2015 below the target of 131 deaths per 100,000 live births. While most studies explain the failure to achieve maternal health policy targets from epidemiological, interventional and health systems perspectives, this study examined how elite interests underpinning maternal health policies, policy design and implementation influenced maternal health policy failure in Uganda. The study found that the failure to achieve policy targets and persistence of high maternal mortality despite introducing fourteen policy shifts emanated from a complex interplay of factors at the policy formulation, design and implementation levels. Policy elites developed policies which mainly served their selfish political and economic interests while paying limited attention to the goal of reducing maternal mortality. The policy instruments introduced were incoherent, inconsistent and incomprehensive to cover all the causes of maternal mortality rendering the policies ineffective in design. Consequently, maternal health policies could not be fully operationalised at the frontline to support timely response to all the emergencies that cause maternal death. The study was funded by DAAD, the Alliance for Health Policy and Systems Research, Switzerland, through the University of Cape Town, South Africa, the “Support Policy Engagements for Evidence informed (SPEED)” and was supervised by Professor Freddie Ssengooba and Dr Suzanne Kiwanuka.
MUSABA Milton
Obstructed labour in Eastern Uganda: risk factors, electrolyte derangements, and effect of bicarbonate on obstetric outcomes
Dr. MUSABA Milton studied the risk factors, electrolyte derangements, and effect of bicarbonate on obstetric outcomes among women with Obstructed labour (OL). Failure of a woman to give birth normally is called OL. It is often associated with poor outcomes for both the mother and baby, if the intervention (surgical) is not timely. In Uganda, one in five maternal deaths and two in five perinatal deaths are attributed to OL. The risk factors were being a first-time mother, using herbal medicines, and being referred in labour. While being married, having a delivery plan, and an educated partner were protective. Perioperatively, multiple electrolyte derangements were common. Perinatal death was four times higher than the national average, and the predictors were being referred and having a high maternal blood lactate level. Sodium bicarbonate infusion had no significant beneficial or harmful effect. Developing birth and complication readiness plans may help to minimize delays and multiple referrals in case of an emergency. To minimize the effects of metabolic and electrolyte derangements in OL, healthcare providers need to ensure that these patients are well rehydrated especially during transfer to a higher facility. This study was funded by NORHED/NORAD and was supervised by Prof. Grace Ndeezi, Prof. Julius N. Wandabwa, Dr. Justus K. Barageine, and Prof. Andrew D. Weeks
NAMAZZI Gertrude
Burden and risk factors for child developmental disability among infants in Busoga region, in Uganda
Dr. NAMAZZI Gertrude investigated the burden and risk factors for child developmental disability among infants in Busoga region, in Uganda. The study revealed a high burden of child developmental disability at population level and among preterm babies. The caretakers of children with developmental disability expressed emotional stress and an impoverishing experience with limited support from the community and the health system. The key risk factors included: birth asphyxia, malnutrition, newborn infections, and a mother having more than three children. The study findings indicate the need to improve the quality of care during delivery and the postnatal period to prevent birth asphyxia, neonatal infections and malnutrition so as to curb the burden of child developmental disability. In addition, parents should limit the number of children to those they are able to nurture and care for adequately. The study recommends to government to improve the health facility readiness to respond to caretakers’ needs and the needs of children with developmental disability so as to empower families, while respecting their beliefs, to cope with adversity. The study was funded by SIDA and was supervised by Prof. James Tumwine, Assoc. Prof. Peter Waiswa and Assoc. Prof. Helena.
NANKYA Mutyoba Eron Joan
Hepatitis B. Among Ugandan pregnant women: Studies on Epidemiology, knowledge, perceptions and behavioural intentions
Ms. NANKYA Mutyoba Eron Joan investigated the epidemiology, knowledge, perceptions and behavioural intentions associated with Hepatitis B among Ugandan pregnant women. The study was conducted among pregnant women attending routine Antenatal Care in public health facilities in Kampala, Wakiso and Arua Districts. In the results, the overall prevalence of Hepatitis B. Virus infection was 6.1%. Pregnant women in Uganda have a high burden of the virus with significant regional differences, low knowledge and inaccurate perceptions of the virus. This study was funded by SIDA and was supervised by Assoc Prof. Ponsiano Ocama, Asoc Prof. Fredrick Makumbi and Assoc Prof. Lynn Atuyambe.
ODEI OBENG-AMOAKO Gloria Adobea
Retrospective analysis of concurrently wasted and stunted children 6-59 months in the outpatient therapeutic feeding programme in Karamoja: burden, characteristics, detection, response to treatment and outcomes
Ms. ODEI Obeng-Amoako Gloria Adobea examined the burden, characteristics and detection of concurrently wasted and stunted among children under 5 years, and their response to treatment and outcomes in the outpatient therapeutic feeding programme in Karamoja. She found that 5% of children under-5 years in Karamoja were wasted and stunted concurrently. Concurrent wasting and stunting was common among children younger than 3 years and particularly males. She identified optimal weight for age z-score (WAZ) and mid upper arm circumference (MUAC) thresholds for detecting children with concurrent wasting and stunting. Nearly half (49%) of children with severe acute malnutrition receiving outpatient therapeutic care were concurrently wasted and stunted and had lower recovery rate. The study will inform decision-making on integrated wasting and stunting prevention and treatment policy and programme. This study was funded by Carnegie Corporation of New York through RUFORUM, UNICEF Uganda; and African Union and European Union-Intra-ACP Mobility Partnering for Health Professionals Training in African Universities (P4HPT) and supervised by Assoc. Prof Charles A. S. Karamagi and Dr. Henry Wamani.
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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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