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I studied on Loans from Village Savings Group – Tabitha Audo, MakSPH First Class Graduand

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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.

Dr. Rhoda Wanyenze, MBChB, MPH, PhD, is a Professor and Dean of Makerere University School of Public Health (MakSPH) congratulates Ms. Audo Tabitha (Left).
Dr. Rhoda Wanyenze, MBChB, MPH, PhD, is a Professor and Dean of Makerere University School of Public Health (MakSPH) congratulates Ms. Audo Tabitha (Left).

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.

Some of the graduands of BEHS programme in a group photo with the Principal Registrar of MakSPH Ms. Gladys Khamili shortly after graduation.
Some of the graduands of BEHS programme in a group photo with the Principal Registrar of MakSPH Ms. Gladys Khamili shortly after graduation.

“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.

Ms. Audo Tabitha (Extreme Right) together with her colleagues L-R; Mike Wejuli, Irene Nakaziba and Arac Oscar all of whom obtained first Class Degrees in BEHS of Makerere University.
Ms. Audo Tabitha (Extreme Right) together with her colleagues L-R; Mike Wejuli, Irene Nakaziba and Arac Oscar all of whom obtained first Class Degrees in BEHS of Makerere University.

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.”

The College of Health Sciences (CHS) Leadership in a group photo at the 72nd Graduation Ceremony. Photo by Davidson Ndyabahika
The College of Health Sciences (CHS) Leadership in a group photo at the 72nd Graduation Ceremony. Photo by Davidson Ndyabahika

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Davidson Ndyabahika

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Holistic Retirement Planning includes Psychological, Emotional & Social well-being across all Career Stages

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The Chairperson MURBS Board of Trustees-Dr. Michael Kizito (8th Right) with Professor Seggane Musisi (7th Right) and Members after the session on 8th January 2026. Makerere University Retirement Benefits Scheme (MURBS) Member Sensitisation Session on "Understanding Identity Shifts; Developing Routines; Sustaining Motivation and Purpose", 8th January 2026, Yusuf Lule Central Teaching Facility Auditorium, Kampala Uganda, East Africa.

The Makerere University Retirement Benefits Scheme (MURBS) on Thursday, 8 January 2026 organised a Member Sensitisation Session on “Understanding Identity Shifts; Developing Routines; Sustaining Motivation and Purpose”. The session focused on holistic retirement planning, emphasising that readiness for life after work goes beyond finances to include psychological, emotional, and social well-being across all career stages—from early career to post-retirement.

The session featured a keynote presentation by Professor Seggane Musisi, who highlighted how work-related titles and roles often shape personal identity, and how retirement can trigger a sense of loss if individuals are unprepared to redefine themselves. Members were encouraged to consciously design a post-work identity grounded in values, purpose, and community contribution.

Participants learned practical strategies for:

  1. Preparing early for retirement at different career stages;
  2. Developing healthy, meaningful routines that support mental stability and productivity;
  3. Sustaining motivation and purpose beyond formal employment;
  4. Managing stress, maintaining physical and mental health, and nurturing social connections; and
  5. Balancing family responsibilities with personal well-being.

The discussion also addressed cultural realities of retirement in Uganda, including family expectations, social obligations, and financial pressures. Special attention was given to age-related challenges such as dementia, depression, and chronic illness, underscoring the importance of preventive health care, emotional resilience, and timely professional support.

Overall, the session reinforced the message that retirement is a lifelong transition, not a one-time event. Members were encouraged to plan early, adapt continuously, and intentionally design a fulfilling, purposeful life beyond work—psychologically, socially, and financially.

To view the session, please click the embedded video below. Further below is the presentation.


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Kampala at a Crossroads: What New Research Reveals About Mobility, Governance, and the City’s Public Health Risks

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Motorists navigate the Clock Tower Flyover intersection in Kampala. Uganda, East Africa

Every day in Kampala, millions of people inch through gridlock, dodge swarming boda-bodas threading through narrow gaps in traffic, inhale dangerously polluted air, and walk along streets rarely designed for pedestrians. These conditions, and more, are often dismissed as ordinary transport frustrations. Yet researchers at Makerere University School of Public Health (MakSPH) are examining how such everyday realities translate into public health outcomes, shaped not simply by congestion, but by governance, policy, and power. Their work forms part of a multi-country project investigating the political economy of urban mobility in three African cities.

A boda-boda rider navigates floodwaters alongside a car on a waterlogged road in Kampala’s Industrial Area in 2024, highlighting how rapid urban development, inadequate drainage, and car-oriented road design combine to heighten daily mobility risks for vulnerable road users. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.
A boda-boda rider navigates floodwaters alongside a car on a waterlogged road in Kampala’s Industrial Area in 2024, highlighting how rapid urban development, inadequate drainage, and car-oriented road design combine to heighten daily mobility risks for vulnerable road users.

Co-led by Dr. Aloysius Ssennyonjo, the Principal Investigator and health systems and governance researcher at MakSPH, together with Uganda’s Country Principal Investigator, Dr. Esther Bayiga-Zziwa, a road safety and injury epidemiologist, and Co-Principal Investigator Dr. Jimmy Osuret, an injury prevention researcher, the project titled The Political Economy of Urban Mobility Policies and Their Health Implications in African Cities (PUMA) applies a political economy lens to understand how political interests, institutional arrangements, and power dynamics shape mobility systems and their consequences for public health in Kampala, Kigali, and Lilongwe.

To note, political economy analysis examines how public decisions are shaped by the interplay of politics, interests, institutions, and resources, in short, who has influence, who controls what, and how money and power circulate within a system. In Kampala, a capital of nearly two million residents whose daytime population swells with commuters, this lens helps explain why some transport options attract funding and enforcement while others are tolerated, neglected, or contested. These choices are not just technical, but reflect competing interests and priorities, with consequences for safety, equity, and the everyday well-being of those moving through the city.

Illustration of the Index of Sustainable Urban Mobility (I_SUM) in a planned city, highlighting how transport, accessibility, environmental, social, infrastructure, and political factors jointly shape mobility outcomes. Source: Internet.
Illustration of the Index of Sustainable Urban Mobility (I_SUM) in a planned city, highlighting how transport, accessibility, environmental, social, infrastructure, and political factors jointly shape mobility outcomes. Source: Internet.

Now, through the NIHR-funded project, the Ugandan team is currently working with colleagues from the University of Rwanda, led by Professor David Tumusiime, and Kamuzu University of Health Sciences in Malawi, led by Dr. Dominic Nkhoma. The research partnership aims to generate evidence that can strengthen mobility governance and improve public health outcomes across the three African cities above, with advisory support for the research consortium from the University of Antwerp in Belgium and Canterbury Christ Church University in the UK.

Explaining the project’s rationale for the Politics of Urban Mobility, or PUMA, during the 2025 Universal Health Coverage Day webinar held on December 12 under the theme “Mobility, Costs, and Politics: How Urban Systems Shape Access and Progress Towards Universal Health Coverage in African Cities,” Principal Investigator Dr. Ssennyonjo said Africa is urbanising at an unprecedented pace. Projections show that by 2050, nearly 60% of the continent’s population will live in cities, a shift that is intensifying transport pressures and increasingly turning everyday mobility into a public health risk.

Participants at the PUMA Stakeholder Analysis Workshop held on November 21, 2025, where policymakers, practitioners, and researchers examined how political and governance dynamics shape urban mobility and public health outcomes in Kampala. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.
Participants at the PUMA Stakeholder Analysis Workshop held on November 21, 2025, where policymakers, practitioners, and researchers examined how political and governance dynamics shape urban mobility and public health outcomes in Kampala.

“Rapid urbanisation has created multiple challenges: transport systems are under strain, risks and vulnerabilities are rising, and opportunities for healthy behaviours such as walking are often limited. Access to livelihoods is also affected, with broad implications for health,” Ssennyonjo noted, adding: “Crucially, these issues are shaped by political and governance dynamics, yet few initiatives explicitly address them. This gap motivated our focus on the politics and governance of urban mobility.”

Dr. Aloysius Ssennyonjo, Principal Investigator of the PUMA project, speaks during the Stakeholder Analysis Workshop on November 21, 2025, highlighting the role of politics and governance in shaping urban mobility and public health outcomes in Kampala. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.
Dr. Aloysius Ssennyonjo, Principal Investigator of the PUMA project, speaks during the Stakeholder Analysis Workshop on November 21, 2025, highlighting the role of politics and governance in shaping urban mobility and public health outcomes in Kampala.

He mentioned that health outcomes are shaped by social, economic, and environmental factors, with transport costs, risks, and stress often posing greater barriers than medical fees alone to achieving affordable health for all. He noted that the PUMA project brings together multidisciplinary teams to study how governance and political dynamics shape urban mobility, public health, and development, a perspective reflected in Prof. Julius Kiiza’s observation that effective urban development relies on coordinated action by diverse stakeholders across sectors to improve health outcomes, though emphasising the primacy of politics.


“Uganda and Singapore had comparable levels of underdevelopment in the 1960s. Under Lee Kuan Yew, Singapore embarked on a deliberate nation-building project. Today, it is among the smartest cities globally, outperforming many Western cities in clean government, mobility, and liveability. Why are we lagging behind? The answer, I argue, lies largely in the nature of our politics,” Prof. Julius Kiiza cogently argued.


He intimated that the result has been cities that are “unreliable, unsafe, unsmart, and chaotic,” noting that claims of inclusive urban development often ring hollow. “I have argued, and repeat here, that boda bodas as a symbol of inclusivity represent a false model of inclusion. We must interrogate this and invest in better urban transport systems and wider, well-planned highways,” he affirmed.


Prof. Julius Kiiza, Professor of Political Science, speaking during a PUMA team–organised Universal Health Coverage Day webinar, highlighted how politics and governance shape urban mobility and public health outcomes. December 12, 2025. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.
Prof. Julius Kiiza, Professor of Political Science, speaking during a PUMA team–organised Universal Health Coverage Day webinar, highlighted how politics and governance shape urban mobility and public health outcomes. December 12, 2025.

Prof. Kiiza urged policymakers and practitioners to move beyond piecemeal technical fixes and instead treat urban mobility as a governance challenge requiring coordinated, cross-sector action. He stressed the importance of aligning transport planning with public health, housing, employment, and skills development, arguing that safer, more liveable cities depend on institutions that work together and are accountable to the public. Such reforms, he noted, demand sustained political commitment and inclusive dialogue across government, academia, civil society, and the private sector, precisely the terrain the PUMA project is engaging, by convening stakeholders and shaping a shared research agenda around Uganda and the continent’s urban mobility challenge.

Students cross a busy road in Kampala, Uganda, navigating traffic dominated by cars and motorcycles—an everyday reality that highlights the public health and safety risks shaping urban mobility in the city. 2024. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.
Students cross a busy road in Kampala, Uganda, navigating traffic dominated by cars and motorcycles—an everyday reality that highlights the public health and safety risks shaping urban mobility in the city. 2024.

Indeed, on November 21, 2025, the Ugandan team convened a national stakeholder workshop in Kampala, bringing together a wide range of stakeholders. Opening the workshop, Assoc. Prof. Suzanne Kiwanuka, Head of the Department of Health Policy, Planning and Management (HPPM) at MakSPH, commended the team for highlighting what she described as a long-underexplored dimension of Uganda’s urban health landscape: mobility and its governance.

Reflecting on her own experience, she noted how boda-bodas have become increasingly indispensable for millions seeking quick, flexible transport, but also carry complex health, safety, and economic implications that demand multisectoral attention, calling for a balanced, evidence-driven dialogue that recognises their value while also addressing the infrastructural and policy gaps that shape mobility systems in Uganda’s rapidly growing cities.


“I sometimes use boda-bodas,” Assoc. Prof. Suzanne Kiwanuka said. “They are necessary when you need to move quickly during heavy traffic. Yet we all know how unsafe they can be. This PUMA initiative is timely to generate evidence not only on the politics of urban mobility and its health implications, but also its economic consequences.”


Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa. Prof. Suzanne Kiwanuka, Head of the Department of Health Policy, Planning and Management, addresses participants during a PUMA stakeholder workshop, emphasising the need for evidence-informed, multisectoral approaches to urban mobility and public health governance in Kampala.
Prof. Suzanne Kiwanuka, Head of the Department of Health Policy, Planning and Management, addresses participants during a PUMA stakeholder workshop, emphasising the need for evidence-informed, multisectoral approaches to urban mobility and public health governance in Kampala.

Notably, road traffic crashes remain one of Uganda’s most urgent public health threats today. The recent Uganda Police Force Annual Crime Report 2024 recorded 5,144 road deaths, a seven per cent rise from 2023, with motorcyclists accounting for nearly half of all fatalities. In Kampala, pedestrians, cyclists, and motorcycle riders constitute 94 per cent of all fatal crashes, according to the Kampala Capital City Authority. Thousands more suffer life-altering injuries each year.

Still, evidence from MakSPH, through its Centre for Trauma, Injury and Disability Prevention (C-TRIAD) and the Johns Hopkins International Injury Research Unit (JH-IIRU) under the Bloomberg Philanthropies Initiative for Global Road Safety (BIGRS), shows that the design and use of city roads are worsening the risk environment. Between 2021 and 2023, the team conducted more than one million roadside observations across Kampala, finding that while only five per cent of vehicles are officially recorded as speeding, those that do travel at an average of 57 km/h, well above safe limits for dense urban corridors, making city roads increasingly unsafe.

Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa. The motorcycle rider at the centre of the image is travelling against the flow of traffic in Kampala, highlighting everyday road-use practices that increase safety risks in the city. 2024.
The motorcycle rider at the centre of the image is travelling against the flow of traffic in Kampala, highlighting everyday road-use practices that increase safety risks in the city. 2024.

The World Health Organization (WHO) guidelines, cited in the report, recommend speed limits of 30 km/h on community roads and in urban areas where pedestrians, cyclists, and other vulnerable road users share space with motorised traffic, and 50 km/h on major urban roads. Yet the findings show that six in ten vehicles on community roads exceed these limits, heightening risks for those least protected and underscoring the need for lower-speed zones, traffic-calming measures such as speed humps and raised crossings, and consistent enforcement of traffic regulations.

For the PUMA team in Uganda, the writing on the wall shows that these rising injuries coincide with worsening congestion and rapid urbanisation, yet city mobility policies within Kampala remain heavily oriented toward road expansion and vehicular flow, with limited attention to safety, health protection, or non-motorised transport. This policy imbalance, then, explains why daily commuting remains hazardous and why progress on safer streets has been slow.

Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa. A designated non-motorised transport corridor on Namirembe Road, Kampala, intended for pedestrians, is partially occupied by parked motorcycles and roadside trading. The scene highlights how everyday encroachment weakens urban mobility interventions aimed at improving safety and walkability. November 2025.
A designated non-motorised transport corridor on Namirembe Road, Kampala, intended for pedestrians, is partially occupied by parked motorcycles and roadside trading. The scene highlights how everyday encroachment weakens urban mobility interventions aimed at improving safety and walkability. November 2025.

The study uses a three-tiered approach that combines policy analysis, regional evidence, and local experiences to examine how mobility decisions are made in Kampala, Kigali, and Lilongwe, who holds authority, and how these processes affect public health and equity. This is strengthened by structured co-creation workshops with practitioners, policymakers, and community actors, which reveal how governance functions in practice, often diverging from what is written on paper.

In parallel, the research team is conducting a continent-wide review of academic and grey literature to map regional trends, gaps, and the broader forces shaping African mobility systems. Together, these streams enable the researchers to compare cities, identify shared challenges, and build a grounded analytical framework for improving mobility governance across Africa.

In Kampala, preliminary findings by the MakSPH PUMA research team show a city governed by many mobility policies but marked by weak mobility governance. The team shared that Kampala operates under a dense mix of frameworks, from the National Integrated Transport Master Plan and National Urban Policy to road safety, climate, and KCCA development plans. While these documents acknowledge congestion, urbanisation, and road injury risks, they also reveal overlapping mandates, blurred institutional roles, and limited coordination authority.

Minibuses crowd a busy transport hub in Kampala, reflecting the scale and intensity of the city’s paratransit-based transport system and the planning challenges shaping everyday mobility. 2024. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.
Minibuses crowd a busy transport hub in Kampala, reflecting the scale and intensity of the city’s paratransit-based transport system and the planning challenges shaping everyday mobility. 2024.

Key government Ministries, Departments, and Agencies (MDAs) actors include the Ministry of Works and Transport, KCCA, the Ministry of Lands, the Office of the Prime Minister, and the Ministry of Finance, with the Ministry of Health conspicuously absent despite clear health implications. Policy attention, according to the early findings, remains heavily skewed toward road transport, leaving non-motorised mobility and major health pathways, noise exposure, psychosocial stress, community severance, heat, and mobility independence largely unaddressed.

Governance realities are further shaped by political processes, including electoral cycles, informal negotiations with transport unions, selective regulation of boda-bodas, and heavy reliance on development partners that often influence what is prioritised and implemented. Together, these dynamics help explain stalled master plans, inconsistent enforcement, and resistance to progressive interventions. While the PUMA research remains at a preliminary stage currently, the emerging findings underscore the need for an integrated, multisectoral mobility agenda that places health at the centre of Kampala’s transport policy and practice.

Motorcycle riders travel alongside a heavy truck emitting exhaust fumes on a road in Kampala, illustrating how daily urban transport exposes road users to air pollution and related public health risks. 2024. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.
Motorcycle riders travel alongside a heavy truck emitting exhaust fumes on a road in Kampala, illustrating how daily urban transport exposes road users to air pollution and related public health risks. 2024.

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John Okeya

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How People Earn a Living is Contributing to Malaria Risk in Uganda, Study Finds

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How People Earn a Living is Contributing to Malaria Risk in Uganda, Study Finds. Photo: ImageFX

Livelihood activities such as farming, livestock keeping, construction, and night-time work significantly increase malaria risk in Uganda, according to new research by Dr Kevin Deane, a development economist at The Open University, UK, and Dr Edwinah Atusingwize and Dr David Musoke, a Research Associate and Associate Professor of Environmental Health at Makerere University School of Public Health, respectively.

The study, Livelihoods as a key social determinant of malaria: Qualitative evidence from Uganda, published on December 2, 2025, in the journal Global Public Health, examines how everyday economic activities shape exposure to malaria, often undermining conventional prevention measures such as insecticide-treated nets and indoor residual spraying. The findings are based on qualitative fieldwork conducted in June 2024 in Busiro County, Wakiso District, a peri-urban area with persistently high malaria transmission in Uganda.

Using a qualitative design, the researchers conducted 14 key informant interviews, 10 focus group discussions, and 11 in-depth interviews with households recently affected by malaria, engaging 100 participants from communities, health services, local government, and civil society across Kajjansi, Kasanje, and Katabi Town Councils, as well as Bussi Sub-County, in Busiro South. Their analysis, guided by the Dahlgren–Whitehead social determinants of health model, enabled the researchers to situate malaria risk within the broader social, economic, and environmental conditions shaping how people live and work.

Dahlgren and Whitehead model of the social determinants of health. Source: internet.
Dahlgren and Whitehead model of the social determinants of health. Source: internet.

In their findings, participants linked malaria exposure to agricultural practices, among which is maize cultivation near homes, which was associated with increased mosquito density during the rainy season. “One of the most common crops cultivated in Uganda, which many rely on as staple foods, creates environments in which mosquitoes are attracted to and thrive, often in settings where maize is grown near homes in rural areas and urban areas. This increases mosquito density around homes and contributes to increased outdoor biting and the number of mosquitoes entering houses,” the study argues.

Its authors say this poses a difficult policy challenge because maize is central to household food security, leaving few practical options for reducing exposure. They argue that proposals to keep maize away from homes are often unrealistic for families with limited land or those farming in urban areas, while targeted control during flowering periods may have limited impact given mosquitoes’ ability to travel beyond cultivation sites.

Screenshot of the open-access research article “Livelihoods as a key social determinant of malaria: Qualitative evidence from Uganda,” published in Global Public Health on December 2, 2025.
Screenshot of the open-access research article “Livelihoods as a key social determinant of malaria: Qualitative evidence from Uganda,” published in Global Public Health on December 2, 2025.

Beyond crop farming, the study reports that livestock rearing, especially zero-grazing cattle kept close to houses, attracts mosquitoes into household compounds. Other livelihood activities, including construction and brick-making, created stagnant water-filled pits that served as breeding sites, while night-time livelihoods, such as street vending, guarding, fishing, bar work, and brick burning, among others, prolonged outdoor exposure during peak mosquito biting hours. Gender further shaped risk, with women’s livelihoods and caregiving responsibilities frequently exposing young children alongside them.

“The evidence we present illustrates the unintended health consequences of development strategies intended to promote key livelihood activities, food security, and poverty reduction. There are no straightforward solutions given the complexity of these relationships and the importance of these livelihoods for many households,” the authors assert.

They conclude that malaria elimination efforts will fall short unless livelihoods and development activities are explicitly integrated into malaria prevention strategies, calling for stronger alignment between public health, agriculture, urban development, and economic policy.

Please see below for the study:

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John Okeya

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