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
Makerere-Incubated Safe Bangle Technologies Wins Prestigious World Summit Award for Innovation Against GBV
By Joseph Odoi
In a groundbreaking achievement, SafeBangle Technologies, an innovation incubated at Makerere University, has won the prestigious World Summit Award 2025 for its groundbreaking contribution to the fight against gender-based violence (GBV) in Africa. This remarkable honor comes in recognition of the development and implementation of a real-time domestic violence reporting bracelet.
The award was presented to the SafeBangle team that was represented by Saul Kabali, Messach Luminsa, and Janet Christine Nabaloga from SafeBangle Technologies at the WSA Global Congress in Hyderabad, India, where Uganda’s innovation potential was proudly showcased on a global stage.
The award was conferred in the Inclusion & Empowerment category for Safe Bangle’s cutting-edge solution; a wearable safety bracelet designed to address the pressing challenge of gender-based violence (GBV) across Africa.
The SafeBangle is a smartwatch-like, real-time domestic violence reporting bracelet that allows users to send SMS alerts via a single button press. Its core mission is to create a safer, more secure environment for women and children in Africa through innovative, affordable tech solutions.
According to Saul Kabali and Messach Luminsa, the innovators behind SafeBangle from SafeBangle Technologies, hosted at the Resilient African Network Lab. This award is very timely and a recognition that cements the importance of community rooted technology.
The team further stated that ‘’This award is a powerful affirmation of our mission and refuels our commitment to empowering Ugandan women and girls through innovation and technology. It influences our next steps by opening doors to new partnerships, increasing our credibility, and accelerating efforts to scale the SafeBangle nationally. We’re now more equipped to positively impact the daily lives of Ugandan women and girls through our SafeBangle bracelet.
To further the innovation, the team has called upon government to support the Safe Bangle Innovation
‘’Governments can support us by providing funding, facilitating policy support, and creating collaborative platforms for innovation. NGOs can help with grassroots outreach, and connect us to potential donors and funders interested in solving Sexual and Gender Based Violence amongst vulnerable communities; and tech partners can enhance scalability through infrastructure, data insights, and capacity building.
Moving forward, the team emphasized the importance of uniting innovation, partnership, and purpose to scale impact. “As we empower communities, invest in local solutions, and promote collaboration, we can transform how technology protects and uplifts women and girls across Uganda,” added the award-winning team.
The Story Behind the Safe Bangle Bracelet Innovation
According to the Safe Bangle innovators Saul Kabali and Messach Luminsa , ‘’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’’
To Makerere University School of Public Health’s Dr. Juliet Kiguli, who collaborated closely with the team during the rollout of the bracelet, this award is a vote of confidence in the work of Makerere University, whose core function focuses on teaching, learning, community engagement, research, and innovation, all contributing to the university’s efforts in addressing domestic violence.
‘’The award-winning innovation stems from the findings of a longitudinal study led by the Makerere University School of Public Health.
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 to incorporate 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
We’re excited about the progress so far, and with this recognition, we hope that more like-minded partners will join us to scale this initiative and ultimately help make the world a safer place for all.” Added Dr Kiguli of the Safe Bangle innovation potential
The research team, comprising Dr. Juliet Kiguli (Principal Investigator), Dr. Roy Mayega (Deputy Chief of Party, RAN), and Dr. Agnes Nyabigambo (Study Coordinator), piloted the bracelet under the PEER (Partnerships for Enhanced Engagement in Research) program with support from USAID and the National Academies of Sciences.
A consortium of partners, including SafeBangle Technologies, Makerere School of Public Health/RAN , the Medical College of Wisconsin, and Somero Uganda, implemented the rollout of the Domestic Violence Real-Time Reporting Bracelet. The initiative was supported by USAID and the National Academy of Sciences in Washington, DC. Key contributors to the project included Dr Juliet Kiguli Roy Mayega from Makerere University School of Public Health, Dr. Kelly Robbins, Dr. Lina Stankute-Alexander, Dr. Brent Wells, Dr. Melissa Trimble, and Uganda’s Dr. Gloria Kasozi at USAID. Wisconsin Madison Medical University’s Prof. Julia Dickson-Gomez was also a collaborator.
In terms of the acceptability of the SafeBangle innovation as a solution to GBV, the team has piloted the technology with more than 1,000 users, resulting in a 63% reduction in response times
During the event, SafeBangle Team participated in the “Equity by Design” panel, sharing insights on inclusive technology development with global experts including Dorothy Gordon, Abhishek Singh from India’s Ministry of Electronics and IT, Baroness Beeban Kidron, and representatives from UNESCO and WE Hub.
About SafeBangle Technologies
SafeBangle Technologies is a Ugandan social enterprise hosted at Resilient African Network Lab focused on addressing gender-based violence through innovative safety solutions. The company combines wearable technology with an interactive web platform to provide real-time reporting of violence and physical assaults, even in areas without internet connectivity. Founded in 2018, SafeBangle operates with a mission to make safety accessible and affordable for vulnerable populations, especially women and children.
Health
A Humble Petition from the Marabou Storks of Kampala to His Excellency, President Yoweri Kaguta Museveni
Your Excellency,
We send you warm greetings from the skies above Kampala — from your old, bald-headed friends, the Marabou Storks, or as we are fondly called, the Kalooli. We are not the prettiest of birds, with our wrinkled faces, hunched shoulders, and sharp beaks, but we carry an important duty. Where others see waste and decay, we see purpose. We are nature’s cleaners, recycling what would otherwise rot and cause harm.
Some count us among Africa’s “Ugly Five,” alongside hyenas, vultures, wildebeests, and warthogs, but we take no offense. Beauty was never the Creator’s mission for our mission, but service was. We glide quietly between life and death, keeping the balance, cleaning the mess, and doing the work that must be done.
Today, we come to you not with complaints, but with a plea for partnership, to protect our shared home and ensure a cleaner, healthier Uganda for all. We still remember the day in 2008, Mr. President, when you gave the Uganda Wildlife Authority and the Kampala Capital City Authority instructions to “kindly relocate us” from the esteemed grounds of State House, Nakasero. We don’t harbor angry feelings. Truly. We realized back then, as we do now, that not everyone finds our odd looks or the noble scent that naturally results from a lifetime of cleaning your lovely nation appealing.
Your Excellency, we are modest. And forgiving. We maintained our composure even when we were discussed in Parliament in 2020, when honorable members referred to us as “health threats” and asked that we leave the Parliament gardens. We birds, after all, literally have thicker skin!
We are better citizens now. Thanks to Makerere University‘s kind hospitality, we have discovered a new haven. We express our deep thanks to Vice Chancellor Professor Barnabas Nawangwe for preserving the ancient trees, the very canopies that now provide us with protection, generation after generation. Students here lovingly refer to us as “the real professors of Makerere,” observing us as we keep a watchful eye on campus life with our sage, steady gaze. Some people think it’s a blessing to see a Kalooli before an exam. We take selfies with other people. We have kind of turned into little celebrities, sir. We appreciate the tranquility, love and peace you provided, with your comrade freedom fighters. They bring uhuru to these trees, and our kids pray for you every day for more life.
However, we come before you today not just to reminisce, but to raise important concerns not for ourselves alone, but for the survival of Uganda’s fragile ecosystem.
We are concerned about the growing crisis in waste, plastics, and environmental decay.
Your Excellency, you are a man who loves numbers. Allow us to present some:
- 768 metric tons — that is the amount of food waste produced DAILY in Kampala alone.
- 65% to 79% of solid waste in Kampala landfills consists of food waste.
- The dairy industry in Uganda loses $23 million annually from waste alone, according to the Food Rights Alliance.
- 135,804 tons of plastic waste generated in the Kampala Metropolitan Area recently.
- 42% of that waste remains uncollected, leading to clogged drains, flood risks, pollution of wetlands, and of course, diseases.
- Shockingly, 10% of this waste ends up in Uganda’s precious water systems!
Your Excellency,
It might surprise you but it’s true. Between 2018 and 2021, Uganda produced 12,330 tons of recycled polyethylene (rPET). And that’s not all conservative estimates predict a 91% increase in production between 2022 and 2025, should imports stay the same.
Mr. President, we Marabou Storks have served loyally as your unpaid, unsung environmental officers. While your citizens discard waste carelessly, we fly across the city, scavenging, sorting, and managing organic decay. We are your frontline solid waste managers, yet without uniforms, pensions, or even a simple “thank you.”
We join you in mourning the tragic loss of life that occurred at Kiteezi Landfill. We experienced devastation because the birds that live there consider that place their territory. We directly observed your people’s struggle to survive while they navigated hazardous unstable waste piles. Our deepest condolences go out to the families who lost loved ones and to every Ugandan citizen. The disaster served as a harsh reminder that waste mismanagement impacts people directly beyond just environmental concerns. Working together as environmental custodians we ask you to take action to prevent more deaths from occurring beneath waste mountain piles.
Just for context, Mr. President, since you fondly like science, here is the scientific truth about us
You may recall Dr. Derek Pomeroy and Mr. Michael Kibuule, distinguished researchers at Makerere University, who in 2021 published the history of our kind in Uganda. They noted:
- Over 1,200 nesting pairs once graced Kampala city alone.
- Over 800 Marabous nested at Makerere University.
- Uganda likely hosts the largest urban colony of Marabou Storks in the world.
Dr. Pomeroy and Kibuule should receive Katonga medals because we recognize their devotion to us. They have loved us. Dr. Pomeroy first came to Uganda in 1969 to work in Makerere University‘s Department of Zoology. He developed deep affection for us and demonstrated excellent understanding. He has written affectionately about us. He knows we are innocent. Dr. Pomeroy maintains his affiliation to Makerere University while conducting independent research as both a Zoologist and an ecologist.
Mr. President, in the beginning, our existence was in the untamed savanna. We transitioned to urban areas alongside human development to assist with cleanup duties rather than to create any disturbance. We came to clean up the areas where you discarded bones and waste. Ronald Norman Magill stated that despite being part of Africa’s “Ugly Five,” we remain crucial to ecosystems because our simple and gritty nature is what makes us indispensable. Our role includes feeding on dead animals and decomposing matter to prevent diseases and sustain soil health through silent and selfless recycling of life.
Your Excellency, here are our humble pleas to you, Our President
- Please urge your people to plant trees.
Our homes are disappearing completely. Sky scrapers are popping up everywhere we used to patch. Your Excellency, we merely ask that you recognize our role and protect our habitats; we are not opposed to development. In order to locate nesting sites, we now have to travel a considerable distance between Kiteezi, Lubigi, and the University. For all creatures, feathery, four-legged, and two-legged—healthy trees translate into richer soils, cleaner air, better rainfall, and cooler cities. - Please strengthen plastic waste management.
Your laws Mr. President, the 10-Year Restoration Plan, the National Environment Act 2019, and the Extended Producer Responsibility rules are all positive steps, but laws that do nothing are just as useful as wings on a tortoise. Please advocate for implementation, particularly in the areas of public education on responsible dumping and enforcement. We implore you to encourage your people to stop illegal dumping, sort their waste, recycle, and treat the environment as a gift rather than a trash can. - Please invest boldly in waste infrastructure.
Your Excellency, - If Parliament can enjoy a small patriotic “thank you” of the legendary “100 silver coins” for safeguarding peace, surely a few crumbs can reach us, the Marabou Storks; Kampala’s tireless, unpaid sanitation workers, as a token of national gratitude. Imagine what a few billion shillings for KCCA, for trucks, bins, and civic education could achieve. A cleaner Kampala would mean less wandering for us and less embarrassment for you when tourists meet our noble, bald-headed selves. At least then, we would feast in dignity, not after cross-country marathons over scattered rubbish.
- Support Community Environmental Heroes.
Students, youth, schools, churches, and communities are already doing cleanup drives. Support them with grants, incentives, recognition, and encouragement. Empower a new generation of eco-warriors.
Mr. President, we, Marabou Storks are no longer the nuisance you once sought to relocate.
We are living proof that resilience, adaptation, and hard work can co-exist even in a changing, urbanized world.
All we ask now is for you and your government to join wings with us, birds and humans alike to clean up Kampala, to green Uganda, and to create a legacy that future generations will bless you for.
Let us work together, so that Uganda shines not under mounds of waste, but under canopies of trees, rivers flowing freely, and skies where even the humble Kalooli can soar proudly.
Yours sincerely,
The Marabou Storks of Kampala
The writer is a science and health communicator
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