Health
An Indigenous Community-Led Model to Address Type 2 Diabetes: Through Evidence Informed Cross-Cultural Learning and Adaptation in Uganda
By Joseph Odoi
Globally, an estimated 462 million individuals are affected by type 2 diabetes, corresponding to 6.28% of the world’s population. In high-income regions like Europe, of all persons with Type 2 Diabetes Mellitus (T2DM), 39.3% are undiagnosed. Low-income countries in Africa have the highest prevalence of undiagnosed diabetes, estimated at 66.7%. In Uganda alone, a steady increase in the number of diabetes cases has been observed in various regions
Despite the increasing burden of Type 2 diabetes in the country, there is hardly any Community-led Behavioral Science oriented change model to address the risky factors that increase chances of developing Non-Communicable Diseases including Type 2 diabetes among Rural Population in Uganda.
To counter this implementation science – practice gap, researchers from Makerere University led by Dr Juliet Kiguli have embarked on a journey to develop and pilot-test a community-led Behavioral Change Model in Teso, Lango, Busoga and among the Samia cultural groups in Uganda. This Development follows a study by Makerere University researchers with funding from Government of Uganda and Makerere University Research and Innovations Fund (Mak-RIF) who sought to understand the patterns of socio-cultural norms in two high incidence districts namely, Busia and Bugiri, in Eastern Uganda.
While facilitating at the cross-cultural learning event in late July 2023, Ramadhan Kirunda one of the Co-Principal Investigators noted that addressing Type 2 Diabetes requires a cross-cultural approach where communities take lead in identifying drivers of T2D and also share what works in context to their areas.
Ramadhan noted that the team is developing a behavioral change approach for type 2 diabetes risky factors because this condition is a behavioral and lifestyle disease. We are planning to engage religious leaders, cultural leaders, local leaders (LC1s), health workers, para-social workers, VHTs, husbands, wives, and in-laws in co-designing and co-implementing this change behavioral change approach. This intervention is designed to look at the community and the affected people as implementers as opposed to looking at them as beneficiaries of the intervention – hence the potential for sustainable change is high. In addition, it targets some duty bearers and thus social accountability for healthy behaviours can be enhanced. This study started as an “exploratory to co-design to pilot testing to implementation” study, making it one of the few that directly link research and practice.
At this event, Dr. Gerald Mutungi, Assistant Commissioner of Non-Communicable Diseases (NCDs) at the Ministry of Health, emphasized the seriousness of Type 2 Diabetes and its significant consequences. He highlighted the urgent need to address this issue effectively.
Dr. Mutungi further noted that ‘’While there are established interventions recommended by the World Health Organization (WHO) and other advising agencies, it is encouraging to see efforts being made to find local solutions for Type 2 Diabetes’’. He added that this study is of great importance as it will provide us with valuable insights into the factors contributing to the increase of Type 2 Diabetes in our local communities. Furthermore, it will enable us to understand the perspectives of local stakeholders and leaders, informing us about effective strategies specific to our context, rather than simply adopting approaches from countries like Switzerland or the USA.
Regarding the factors contributing to the rise of Type 2 Diabetes, Dr. Mutungi said, “Ugandans are continuously eating poorly. They say they are eating well but eating badly by consuming processed foods, fried foods, and fast foods.” He also highlighted the issue of physical inactivity, stating, “Ugandans are becoming physically inactive because they are using motorized transport even where they could have walked. They spend a lot of time in offices and go to sleep.”
On the significance of the study, Dr. Gerald noted, report from the study will inform programming and action around Type 2 Diabetes in Uganda.
Andrew Ochole, the Deputy Prime Minister of the TESO Cultural Union, expressed his sincere appreciation to Makerere University and the Fidelitas Scientific Execution Facility for their pioneering efforts in conducting the first-ever Type 2 Diabetes Study in the Teso Region.
’Despite Type TWO Diabetes being a killer, No Type TWO Diabetes Research has never been done in TESO and no one has been coming up to find local ways of lowering even when we have peculiar and shared norms that facilitate Type 2 Diabetes, I’m happy that Makerere University has taken up this initiative and we are ready to take it up as a community’’ explained Ochole.
He further reaffirmed TESO’s commitment to collaborate with researchers and development partners, such as Fedelitas, who are working alongside Makerere University in this study adding that Teso Cultural Union is prepared to actively disseminate the study’s innovations to educate and raise awareness among its community members in an effort to address Type 2 Diabetes.
In his remarks, the District Health Officer (DHO) of Busia District, Dr. Fredrick Ouma, emphasized the importance of recognizing that the world is a global village, with norms that cut across boundaries adding that there is an alarming prevalence of non-communicable diseases (NCDs) in Uganda which can’t be ignored.
To address these health challenges, the DHO stressed the need to develop and disseminate messages that can effectively raise awareness and educate the community about Type 2 Diabetes.
Additionally, Dr. Ouma emphasized the importance of sharing original and accurate information as reliable data is crucial for making informed decisions and designing effective interventions to address the health needs in the community.
In terms of Lifestyle, He urged participants to be role models by engaging in continuous exercise and adopting healthy lifestyles. By embodying these behaviors, health workers can inspire others in the community to follow suit and become agents of change according to him
According to Dr Juliet Kiguli – the Principal investigator, notes that this study is intended to change the implementation landscape for NCD programs. She underlined the importance of connecting research with indigenous local organizations like Fidelitas Scientific Execution Facility (Fidelitas), who can support research uptake, further resource mobilization and support scale-up of the innovations developed by researchers.
In his closing remarks at the Workshop, Mr John King Odolon, the CEO Fidelitas Scientific Execution Facility, emphasized the importance of active participation from all participants to drive change in addressing Type 2 Diabetes – noting that the participation and zeal should continue upto field level. He urged them to play their respective roles effectively, recognizing that collective efforts are needed to make a significant impact.
Looking ahead, Odolon mentioned that the valuable lessons learned from the Workshop would be disseminated across the four regions. This dissemination aims to ensure that the insights gained from the study reach a wider audience and contribute to addressing Type 2 Diabetes on a broader scale.
As part of the study, researchers actively engaged with various health stakeholders. These stakeholders shared their experiences and insights regarding the behavioral factors influencing Type 2 Diabetes. Their input and expertise added valuable perspectives to the study, enhancing its comprehensiveness and applicability.
More about the study
In the next phase, the team working with Fidelitas is going to pilot test the intervention, through piloting and spreading the type 2 diabetes desired future state messages for social norms change. This will be done through a quasi-experimental implementation research intervention in the four regions of Busoga, Teso, Lango and the Samia cultural groups. Stay tuned for the results, learning brief and a publication!
Health
Call for Abstracts: 2nd East African Symposium and Expo on Trauma, Injuries, and Emergency Care – 2025
At a ceremony held on 30th May 2025, themed ‘They taught us without saying a word’, the Makerere University College of Health Sciences (MakCHS) commemorated the silent teacher which are the cadavers (bodies) used in anatomy classes for medical students. In addition to a commemoration service, the event was used to create awareness and sensitise the public about the the importance of whole body donation.
The chief guest at the commemoration was Professor Mukadasi Buyinza, Deputy Vice Chancellor – Academic Affairs representing the Vice Chancellor, Professor Barnabas Nawangwe. The event attended by MakCHS students, staff and alumni was organised by students under Anatomy Society of MakCHS supported by Department of Anatomy and MakCHS leadership.
Welcoming guests to the event, Waziwu Mordecai–final year student of medicine and surgery who serves as President of the Anatomy Society, MakCHS explained that the reason for the gathering is three-pronged: to commemorate the silent teachers who make a profound contribution to medical education; to instill knowledge, compassion, and professionalism in future healthcare providers; and call on the community to support this noble act through awareness, advocacy, or future donation. ‘May the memory of our silent teachers live on in every life we will one day save’, he said.
The Anatomy society was founded in 2013 with aim of students providing peer mentorship to fellow students in lower years, such mentorship sessions help students appreciate better the anatomy of the human body. The society has supported:enhanced learning and mentorship; promoted academic participation including internal and external quizzes; and fostered connections including strengthen relationships between students across classes and with alumni.
Professor Elisa Mwaka, Head – Department of Human Anatomy welcomed all present for attending the ceremony. He thanked the College management led by the Principal, Professor Bruce Kirenga for the support provided in organizing the ceremony. He also expressed utmost appreciation to the Vice Chancellor for attending despite the competing priorities requiring his attention.
Professor Mwaka highlighted that we are here today, to pay our respect to the individuals whose bodies have been used for medical examination and research at MakCHS through offering prayers as well as sensitize people about willful/consented whole body donation.
Professor Mwaka explained that globally, sources of whole bodies for medical education and research are got through willed whole-body donation, unclaimed bodies in hospitals, imported bodies, executed persons among other means. In Uganda, unclaimed bodies in hospitals are used for medical as determined by the Uganda National Rules in the Penal Code Act of 1957.
In 2012 International Federation of Anatomy Associations (IFAA) recommended voluntary donation as the desirable and the only acceptable source for acquiring bodies. Almost all Africa countries and some European countries lack national body donation programs.
Speaking at the event, Professor Bruce Kirenga, Principal – MakCHS thanked Professor Mwaka for the insightful presentation. He welcomed Professor Buyinza to MakCHS and for accepting to attend despite the late invitation. He recognized the presence of the staff present and support towards the college activities.
Professor Kirenga underlined the importance of biomedical science under which human anatomy falls in medical education. ‘Biomedical sciences play a key role, once someone in grounded in the area, then he will be a good doctor’, he said.
The Principal also stressed that during his term of office operation efficiency will remain key ingredient for service delivery as well as rebuilding and rehabilitation of teaching and learning facilities. ‘Works to make the Biochemistry laboratory a model lab has commenced with a contract awarded to service provider; the refurbishment will be in phases’.
Professor Buyinza Mukadasi thanked the College, Human Anatomy department and the students for organizing the commemoration. ‘The amount of joy I have this morning, we should have done this a long time ago’, he said.
He expressed happiness at this commemoration for the silent teachers who unknowingly give so much to medical education and therefore mankind. He advised that community engagement to create awareness about the need for whole-body donation, regulatory compliance, and alignment to best practices.
He noted that disciplines like medicine is more like charity because medical practitioners give so much of themselves. ‘The number of people attending this ceremony is show of love for the discipline and commitment to the calling’ he said.
Professor Buyinza reiterated the commitment of Makerere University management to support MakCHS endeavours including this culture of commemorating the silent teacher. ‘Well-trained and season doctors are a result of the process explained here and the absence of bodies affects the quality of education provided and therefore the doctors produced’, he added.
Candles for the cadavers were lit and services representative of Anglican, Catholics and Muslims were conducted to remember the souls of the departed and wish them a peaceful rest. Ordinand Cosmas Ddembe for Anglican, Father Valentine Amuneke for Catholic and Dr. Haruna Kiryowa for Muslim preached the importance of respect for the dead and sacrifices of the dead for advancement of research and education in the medical field and health services.
Giving closing remarks, Professor Mwaka noted that setting up whole-body donation programs in Africa requires a holistic approach involving education, cultural sensitivity, legal structures, and partnerships with medical institutions.
Reasons why Africa has failed to establish body donation programs:
- Low awareness and willingness to donate bodies.
- Cultural and traditional beliefs
- Religious beliefs
- Fear of mishanding bodies
- Lack of legislation/ ambiguous regulations
- Lack of institutional policies and standard operating procedures
- Institutions should be encouraged to hold Services of thanksgiving or commemoration for those who have donated their bodies for medical education and research.
The following is required to change the current status:
- Cultural sensitivity and awareness
- Community engagement and awareness creation
- Educational campaigns
- Developing legal and ethical frameworks
- Building partnerships between hospitals and medical institutions
- Establishing local body donation systems i.e.,
- donation registration process,
- consent documentation,
- Logistical infrastructure necessary for the
- donation process.
- Effective communication, public trust,transparency.
- Training and professional development of healthcare providers.
- Global collaboration and funding: to share knowledge, best practices, and resources.
- Government support
- Funding and incentives
- Inclusion of body donation in national health strategies.
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