Health
Next step for the fruitful collaboration between Makerere University and KI
One of KI’s largest international collaborations is with Makerere University in Uganda. In time for Makerere’s 100th anniversary, the partnership is to manifest itself in a Centre of Excellence for Sustainable Health. A delegation from KI travelled in May to Uganda to cement the relationship.
“The foundation of a virtual centre for sustainable health gives us a totally new way to build international collaborations,” says KI president, Ole Petter Ottersen. “Mutuality and far-sightedness will pervade all our projects with the aim of improving health for all. The centre will enable more international collaborations, not just in Uganda but also with more countries in Africa, such as Somalia, and other parts of the world. In today’s turbulent world, it is especially important to work on a global stage and stand up for responsible internationalisation.”
From research to extensive collaboration
The partnership between Makerere University and Karolinska Institutet was established back in 2000. At first it was mainly focused on research, but it was soon extended to everything from student and teacher exchanges to joint doctoral studies. There is now a related alumni network containing hundreds of researchers and healthcare workers in Sweden and Uganda.
One of the students who was quick to snap up the chance to change their study environment from Makerere University to Karolinska Institutet was Noeline Nakasujja. Today, she is a practising psychiatrist and departmental head at the Department of Psychiatry at the College of Health Sciences, Makerere University.
“I spent a month in Stockholm in 2005, which was a real eye-opening experience,” she says. “It opened a window onto our cultural differences and onto the differences in resources between universities. It made me realise how much we can achieve even with limited resources.”
Since the exchange programme began, some 300 students and teachers have participated.
“During my time in Sweden, I almost immediately saw a clear difference in student-teacher relations,” she continues. “We have a much more marked hierarchy. At Karolinska Institutet, I saw how it was even possible to have a more relaxed relationship without compromising the seriousness of the teaching.”
After her exchange, Noeline Nakasujja also took the opportunity to take a joint PhD at KI and Makerere.
“My time as a doctoral student led to me receiving a doctoral student from KI,” she says. “That personal contact was the key to creating a platform that has enabled others to successfully navigate a foreign university.”
Since then, Noeline Nakasujja and her department have accepted numerous students from KI, and she finds her first-hand experience of the Swedish study environment comes in very useful here. She now believes that the new Centre of Excellence for Sustainable Health can deepen the relationship between the two universities even more.
“We need to strengthen the preventative work we’re doing in Ugandan healthcare,” she says. “Patients with Alzheimer’s can particularly benefit from early intervention, such as physical exercise and social activities that help to slow the onset of disease.”
She goes on: “The only way to create truly sustainable health and social care services is by breaking the circle and offering prophylactic intervention.”
There are several partners attached to the Centre of Excellence for Sustainable Health, including universities in Congo, Somalia, Kenya, Malawi and Ethiopia.
“The collaboration enables us to create an environment for the exchange of knowledge and experience that will have a knock-on effect on other international partnerships,” she explains.
Innovation developed in Uganda now implemented in Sweden
Susanne Guidetti, professor of occupational therapy at the Department of Neurobiology, Care Sciences and Society has been involved in developing student and teacher exchanges between Makerere and KI since 2004. Back then, she had just come home from having lived with her family in Nairobi for a few years and was put straight in touch with Julius Kamwesiga, an affiliate of Makerere University.
The studies were conducted with Mulago National Specialised Hospital and gave the participants access to daily exercise with the help of their mobile phones. Stroke awareness is low in Uganda, where most people live in remote areas far from the nearest clinic.
“When we can work together to offer more people stroke rehabilitation, we give them a real possibility to live a better life,” Guidetti says. “After the project, one of the participants came up to me and said: ‘The surgeon helped me survive, but my contacts with the occupational therapist made life worth living again’.”
The study will now undergo a larger-scale follow-up in Uganda, and its findings have prompted further studies in Sweden.
“What made our study unique was that we brought knowledge and experience from Uganda to Sweden. Here, our innovation will make it possible to help stroke patients in remote parts of Sweden, too,” she says. “There are now several mobile phone-based rehab options, but in Uganda we helped to pioneer the technique.”
Today, Guidetti has an important part to play in the Centre of Excellence for Sustainable Health.
“Our project is a good example of how we can create an equivalent platform for sharing knowledge. Hopefully, we’ll be able to develop it further at the Centre and take new steps together towards sustainable health.”
The Centre of Excellence for Sustainable Health enables not only the sharing of knowledge and experiences, but also the development and spread of innovations that can bring the goal of sustainable global health closer to being achieved. The knowledge and the network that the centre possesses make it easier for us to take on today’s pressing societal challenges together, not only in Sweden and Uganda but globally, too.
“We have an incredible amount to learn from each other,” says Professor Ottersen. “Let us be inspired by each other’s solutions, big and small, and together find more ways to tackle global health challenges. With the founding of the Centre of Excellence for Sustainable Health, our partnership takes the step from aid funding to being a true partner-driven collaboration.”
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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