Health
I studied on Loans from Village Savings Group – Tabitha Audo, MakSPH First Class Graduand
Motivated to beat the statistic that none of the Irarak-Iworoi clan and her entire family has ever gone to university and obtained a degree, Ms. Tabitha Audo is graduating from Makerere Universiy, top of her class with a 4.63 CGPA in Bachelor of Environmental Health Sciences —BEHS.
Ms. Audo is overjoyed about accomplishing a major milestone of becoming the best performing undergraduate student at Makerere’s School of Public Health and setting the pace for her siblings.
She was born to Ms. Mary Immaculate Kiria and the late John Peter Ameu in April 1992 in Opiin village, Atiira Subcounty, in the Eastern Uganda District of Serere.
At the age of 6, Audo lost her father and that meant that the burden of raising her was left to her peasant mother. She was lucky that her step-mother Apio Angella, a VHT of Atiira Subcounty stood hand-in-glove with her mother to support her through her studies.
She sailed through her Primary education between 1998 and 2004 with the support of both mothers and obtained 19 aggregates at Apokor Primary School, Serere.
In 2005, she joined Rhema High School and sat her Uganda Certificate of Education in 2008 and obtained 43. But she would persist.
She had no hopes of joining A ‘level until a good Samaritan, Ms. Akwi Christine, the now the Assistant District Health Officer Serere District Local Government, currently acting ADHO- Environmental Health identified her and encouraged her to join Mbale School of Hygiene. “She encouraged me to join the Course after seeing my conditions in our home. She also helped me to get a sponsorship under Mvule Trust Fund to pay for the certificate Course,” recalls Audo.
Between 2009 and 2011, Ms. Audo concentrated on acquiring a Certificate in Environmental Health which she excelled with a Distinction at Mbale School of Hygiene before upgrading to a Diploma in 2014-2016 which she equally scored highly with CGPA of 4.62.
Upon completing her certificate course, she was employed by Serere District Local Government as Health Assistant in 2012.
“The institution had motivated us that when you would pass a certificate, they would give you a government scholarship. However, when I passed with a distinction, I learnt that the government scholarship had been scrapped for upgraders. God blessed me to get a job immediately where I got money to pay for my Diploma.”
Audo says studying her Diploma was the hardest because it was a full-time study program that required a lot from her. Yet, additionally, she was paying fees for two of her siblings, one in Secondary School and another in a Tertiary Institution.
“I also had to pay for myself and I had just got a loan to support my tuition needs. It also happened that I had a baby who was just 8 months old. It was tough on me to pull of that Diploma. It was very tight to balance but I had to keep moving,” says Audo.
She recalls her low moments in School to manage family, work, and School. She said the initial loan cleared her two semesters and also paid for her siblings’ fees but it wasn’t sustainable in the long run.
“I was with Atai Faith in the same class. They knew my situation and supported me through discussion groups and with their help, I was also able to concentrate like any other person. I learnt that if you keep focused, even when challenges come, you still find ways. You can’t just sit down and say; ‘now, I can’t do anything’,” Audo recollects.
Her family background played a huge role in shaping her views on education and her desire to change her destiny. She says the pain her mother suffered in search of money to pay for her fees was an eye opener to her.
“My mother is a peasant. She stopped in S.2 and she didn’t have any job with her. She used to get weekly loans in village groups. I used to see all that suffering she was going through. Even feeding, everything was difficult. It gave me a motivation that ‘I don’t want to live in this kind of life again. So, even after I got a job, I wanted to relieve her from that suffering and that is why I had to carry the responsibility to pay fees for my siblings,” Audo reveals.
Joining MakSPH
In 2014, while Audo was still studying at the School of Hygiene -Mbale, the School held a careers session where a one Abel Wilson, then a Student at MakSPH spoke to them about the opportunities to advance their career through a Bachelor of Environmental Health. She was on the look-out until an advert for diploma entry-government admissions came out.
“Of course it was following Abel’s visit to School of Hygiene. So, I kept on waiting for the time of the advert and when it came, the first person who forwarded it to me was my supervisor, by then, the Serere District Town Council Clerk,” recounts Audo.
Mukula Max Martin, the former Serere Town Clerk, who is now the Deputy Chief Administrative Officer Buvuma, a Central Uganda District coterminous with the Buvuma Islands scattered in Lake Victoria pushed Audo to study and further advance her career in 2018.
“Mukula motivated me and told me that he was sure I could make it. He told me I should study when I was still young and finish. He cautioned me against being comfortable and assured me that if I get admitted, I would get a study leave,” Ms. Audo says.
Her admission in 2018 was the proudest moments of her life but more to parents, she recalls. “The family didn’t know what government sponsorship means. But for them, they were overjoyed that I was going to study from Makerere University. They were happy for me because for the first time, I was going to stay in Kampala.”
Her admission however came on the heels of her promotion to Health Inspector of Serere District that had been affected in March 2018. She thought given that she had just been promoted, it would be difficult to secure a study leave; “My immediate boss, Mr. Mukula called me to his office and congratulated me. He straight away started processing for my study leave. When my study leave was approved by the district service commission in November 2018, it was with pay and this was a serious relief.
Her appeal to bosses is to never seat on employees’ opportunities to study and believes any employee with interest and opportunity to study should be given a chance. She is passionate about changing the health situation in her current employment station. Although she dreams of working with the Ministry of Health, international organisation such as the United Nations, UNICEF.
Audo says she is interested in improving water and waste management situation in Uganda’s towns/cities. “When you look at our towns, both liquid and solid waste is a serious gap that we have to work on. Waste is everywhere, people are not sorting waste, it’s not being well managed I should say. Look at the towns, small or big. I expected Kampala to be better. Even liquid waste, over floors are everywhere every time and we need to surely improve!”
He key take away from the course is the diversity of knowledge in all fields. “Being a preventive medicine course, that involves working directly with the community to address problems, the course is one of those that involves you and builds your research capacity. I admire the level of research and quality of researchers at School.”
Health
Mak Staff Receive Prestigious International “Future of the Field” Recognition in Global Research Administration Class of 2026.
Prof. David Guwatudde, Principal Investigator (centre), and Dr. Justine Bukenya with researchers and stakeholders at the ARISE-NUTRINT dissemination meeting in Iganga, 1 October 2026.
Adolescence is a consequential period for health, when diets, behaviours and other risks can form and persist into adulthood. In Mayuge District, new evidence from Makerere University School of Public Health is showing how some of these early vulnerabilities could contribute to the later risk of non-communicable diseases (NCDs), and what can change when interventions begin early.
The evidence comes from the ARISE-NUTRINT project, a three-year EU-funded study led by Prof. David Guwatudde and Dr. Justine Bukenya. The project examines health and behavioural risks among adolescents and young adults, with a particular focus on nutrition-related NCD risks, and tests interventions designed to improve nutrition fluency and diet quality.
The work comes against a substantial NCD burden in a country where 73.2% of the population is below 30. WHO estimates that NCDs accounted for 42.2% of deaths in Uganda in 2023, while the country’s latest national NCD risk-factor survey found significant risk factors persisting in the population, with little overall change from the previous survey in 2014. Together, the evidence strengthens the case for prevention much earlier in life.
“There is strong evidence from literature demonstrating that most behavioral NCD risk factors, including nutrition-related, are established during childhood, persisting into adulthood. This may lead to development of actual NCDs if such risks are not reversed early,” Prof. Guwatudde said.
The study, he explained, linked assessment of young people’s health risks with developing responses suited to their circumstances. Since enrolling 1,206 participants aged 10–24 in Mayuge District in March 2024, the team has conducted three annual rounds of data collection, with young people and local stakeholders also helping evaluate interventions to reduce the risks identified.
A problem that starts early
The findings, shared with community and district stakeholders in Iganga on October 1, 2026, show that some vulnerabilities were already evident at baseline. Nearly one in three participants had anaemia, 49% had low nutrition literacy, while about one in ten reported symptoms of anxiety and a similar proportion reported depressive symptoms.
Anaemia, a condition in which the blood does not have enough healthy red blood cells or haemoglobin to carry adequate oxygen around the body, was highest among the youngest participants. Overall, 375, or 31%, had anaemia, rising to 35.7 per cent among 10–14-year-olds, compared with 18.9% among those aged 15–19 and 10.6 per cent among young adults aged 20–24.
Nutrition presented another challenge. At baseline, 49% of participants had low nutrition literacy and 13% had poor overall diet quality. Low nutrition literacy was associated with more than four times the odds of poor diet quality.
Gaps also emerged in sexual and reproductive health knowledge and behaviour. About 14 per cent of participants did not know that HIV cannot be transmitted by sharing food with a person living with HIV, 10% believed a condom could be used more than once, and 13 per cent did not know pregnancy could occur during first sexual intercourse. Among 168 participants who reported having had sex, more than half reported using no method to prevent pregnancy during their first or most recent sexual intercourse.
Mental health findings added another dimension. Anxiety symptoms were reported by 10 per cent of participants, depressive symptoms by 9.5% and loneliness by 6.3 per cent. Among 534 participants aged 13–24 assessed for suicidal ideation, 1.9% reported suicidal thoughts.
Together, the baseline findings show that vulnerabilities extended beyond any single health issue. For nutrition, the study went further to examine what shaped everyday food choices and whether those influences could be changed.
Nutrition literacy goes beyond knowing which foods are healthy. It includes understanding nutrition information and applying it to everyday choices. The study found those choices were also shaped by parents, peers, food vendors, culture, prices, seasons, and what was available locally. Improving diets, therefore, required reaching beyond individual knowledge to the households and communities where food choices are made.
What early action changed
The baseline evidence informed the Adolescent Nutrition Fluency Intervention. Working with adolescents and young adults, caregivers, Community Health Workers (CHWs), district teams and other stakeholders, the project adapted nutrition messages to local foods, language and household realities. Ten trained CHWs delivered nine monthly household sessions covering balanced diets, physical activity, vitamins and minerals, meal planning and anaemia prevention.
The household approach reached young people in and out of school. The nutrition literacy, diet-quality and intervention analyses form part of the PhD research of Mr. Thomas Buyinza, supported through ARISE-NUTRINT. At endline, participants who received the sessions recorded higher nutrition literacy and overall diet-quality scores.
“The improvement in nutrition literacy and diet quality suggests that practical education, grounded in local foods and household realities, can support healthier choices among adolescents and young adults. In addition, involving parents and caregivers is important because they influence what families buy, prepare, and eat,” Dr. Bukenya said.
She stressed that nutrition education needed to be complemented by better access to affordable, nutritious foods. Dr. Bukenya also called for continued follow-up, including the use of nutrition and dietary data from DHIS2, to assess whether improvements were maintained and guide district planning.
Changes in other outcomes were mixed. Participants reporting no physical activity fell from 22.6% to 7.4%, while those active on four to seven days a week increased from 46% to 54.8%. But activity duration did not improve: those reporting more than 60 minutes a day declined from 28.2% to 21.1%. Underweight fell modestly from 6.2% to 5%, while overweight and obesity did not change significantly.
Anaemia recorded the largest change, falling from 31.1% before the intervention to 9.9% afterwards. During the intervention period, participants received weekly iron and folic acid supplementation and deworming alongside nutrition education on iron-rich foods, dietary diversity and practices that improve iron absorption.
Mayuge District’s Assistant District Health Officer, Ms. Elizabeth Kawaala, said the findings reflected problems recognised locally and highlighted the need for a response involving families and other stakeholders.
“There is a serious challenge that needs to be tackled with many stakeholders, with parents at the centre because these are children. We also learnt that many parents, I think, lack the skills to communicate with their adolescents,” she said.
She said the findings had been shared with colleagues and described integrating health education and sensitisation into services. She also called for departments to use the evidence when planning activities in their workplans.
Beyond Mayuge
Seen alongside Uganda’s 2023 STEPS survey, the Mayuge findings add an earlier-life dimension to the national evidence. Makerere University School of Public Health contributed to both studies, with Prof. Guwatudde contributing to the national STEPS survey and now leading ARISE-NUTRINT. While STEPS found significant NCD risk factors persisting among adults, ARISE-NUTRINT shows that some behaviours and vulnerabilities relevant to later NCD risk are already evident during adolescence and young adulthood. The Mayuge research goes further by testing what can change when interventions begin during this period.
The findings leave Mayuge with more than a measure of the problem. They show where vulnerabilities are emerging, what changed when interventions were introduced and where challenges remain. For ARISE-NUTRINT, the evidence now turns attention to which approaches can be sustained and how lessons from Mayuge can inform efforts to support healthier transitions from adolescence into adulthood.
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