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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 Kirunda one of the Project Co-Principal Investigators at the Workshop. MakSPH, Mak-RIF, Uganda, East Africa.
Ramadhan Kirunda one of the Project Co-Principal Investigators at the Workshop.

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. Gerald Mutungi, Assistant Commissioner of Non-Communicable Diseases (NCDs) at the Ministry of Health (MoH) giving remarks at the event. MakSPH, Mak-RIF, Uganda, East Africa.
Dr. Gerald Mutungi, Assistant Commissioner of Non-Communicable Diseases (NCDs) at the Ministry of Health (MoH) giving remarks at the event.

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.

Andrew Ochole, the Deputy Prime Minister of the TESO Cultural Union giving his remarks. MakSPH, Mak-RIF, Uganda, East Africa.
Andrew Ochole, the Deputy Prime Minister of the TESO Cultural Union giving his remarks.

’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.

Mr. John King Odolon, the CEO Fidelitas Scientific Execution at the Workshop. MakSPH, Mak-RIF, Uganda, East Africa.
Mr. John King Odolon, the CEO Fidelitas Scientific Execution at the Workshop.

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!


CHS Annual Report 2023



Professor Damalie Nakanjako, Principal, Makerere University College of Health Sciences (MakCHS). Kampala Uganda, East Africa.

With pleasure I present to you the Makerere University College of Health Sciences (MakCHS) annual report for the year 2023. This report provides only a snapshot of activities at MakCHS, as we went about executing our mandates of teaching and learning, research, and service delivery throughout 2023.

Through our mission to provide transformational education and research to improve service delivery and wellbeing of the communities, MakCHS exhibited admirable performance through its five constituent schools; School of Medicine, School of Biomedical Sciences, School of Public Health, School of Health Sciences and School of Dentistry. I wish to congratulate all our staff, students, and stakeholders upon completion of a very productive 2023, as we struggled to return to the pre-COVID University calendar. Special thanks go to each one of you for your individual and cooperate contributions to offering our students, staff and partners memorable learning experiences at MakCHS.

Our major challenge is keeping with the current and emerging needs of the society we serve nationally and globally. This year MakCHS had a systematic review of the 2011 college research agenda to create the 2023-2040 research agenda that is responsive to the third national development plan (NDP III) and global sustainable development goals (SDGs). In addition to key priorities of the 2011 research priorities that are still relevant, the revised research agenda has adopted key pressing societal challenges that include Translational Science, Biomedical Research & Discovery (including pre-clinical studies, genomics, product development & commercialization), Population Health, Climate change, health systems research, urbanization and their impact on health, pollution, food security and immigration. In addition, mental health as wells as Digital Health, Artificial Intelligence and Big Data applications were included as priority areas to improve health outcomes for the 21st century society.

We continue to be spurred on by our mission to provide transformative education to health professionals that will transform health care in Uganda, Africa and globally. We are encouraged by the great words of Jon Gordon, an American author and speaker on leadership who said, “We don’t get burned out because of what we do. We do get burned out because we forget why we do it”. At MakCHS, remembering our vision to be a leading and transformational institution for academic excellence and innovation in Health sciences in Africa keeps us going strong.

I extend my sincere gratitude to all our stakeholders including but not limited to all MakCHS staff, students, alumni, partners, funders, patients and health care providers for your unwavering commitment to serve humanity.

On behalf MakCHS leadership I wish you a happy holiday season and a blessed productive 2024.

Prof. Damalie Nakanjako

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Call for 2024 Applications: Eastern Africa FAIMER Regional Institute (EAFRI)



Prof. Damalie Nakanjako (L) presents the EAFRI Director-Prof. Sarah Kiguli to participants at the launch of the Institute on 10th May 2023, Davies Lecture Theatre, CHS, Makerere University, Mulago Hill, Kampala Uganda.

The Eastern Africa FAIMER Regional Institute (EAFRI) invites applications for the 2024 intake of participants. EAFRI will welcome its second class of Fellows on 30th July 2024. Makerere University College of Health Sciences in Kampala, Uganda, is the EAFRI host institution, and Mbarara University of Science and Technology Faculty of Medicine in Mbarara, Uganda, is the regional partner.

Who can Apply

Applications for EAFRI are open to health professions educators throughout East Africa including Burundi, the Comoros, the Democratic Republic of Congo, Djibouti, Eritrea, Ethiopia, Kenya, Mauritius, Rwanda, Seychelles, Somalia, South Sudan, Tanzania, and Uganda. EAFRI will also consider applicants from other regions of Africa.

Interested Applicants should submit their application using the link below

Deadline: 12th March 2024


EAFRI is a two-year, part-time online fellowship program. The curriculum is based on the core curriculum of the International FAIMER Institute, and it is adapted to the local context. It is designed to teach education methods, leadership and management, education scholarship and research, and project management and evaluation. Each participant is required to propose and implement an education innovation project that is supported by their home institution. EAFRI participants, known as FAIMER Fellows, become part of an international network of more than 2,000 FAIMER Fellows, developing strong professional bonds with other health professions educators around the world.


A mix of international faculty and senior health professional Educators from East Africa design courses, teach, provide support for EAFRI, and serve as project advisors for Fellows’ innovation project design and implementation.

Free Tuition

Tuition for EAFRI is free, and the application process is competitive.

Contact EAFRI

For more information, please visit the FAIMER Regional Institutes webpage at or contact the EAFRI Leadership Prof. Kiguli at and Prof. Maling at

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Mak and Karolinska to Continue Prioritising Sustainable Health



Seated: The Vice Chancellor-Prof. Barnabas Nawangwe (Centre) and the VP Karolinska Institutet-Prof. Martin Bergö (2nd Right) with Left to Right: Prof. Tobias Alfvén, Prof. Rhoda Wanyenze and Ms. Erika Dabhilkar after the meeting on 6th February 2024. Rotary Peace Centre Board Room, Frank Kalimuzo Central Teaching Facility, Makerere University, Kampala Uganda, East Africa.

Makerere University and Karolinska Institutet Sweden have embarked on undertaking strategies aimed at ensuring that sustainable health becomes a priority on the global agenda. This was revealed during a high level meeting involving Makerere University Management and a delegation from the Karolinska Institutet Sweden, held on Tuesday 6th February 2024 at the Rotary Peace Centre Board Room, Frank Kalimuzo Central Teaching Facility.

The Vice Chancellor, Prof. Barnabas Nawangwe welcomed the Vice President of Karolinska Institutet Prof. Martin Bergö and his delegation to Makerere University. Reflecting on Makerere University’s 100 year journey (1922-2022), the Vice Chancellor pointed out that the institution has been at the forefront of training human resources who have been key in the identification and finding solutions to various development challenges.

Makerere is a very collaborative university. We have collaborations within Africa of course, most of our external collaborations are in Europe and the United States. Times Higher Education (THE) considers Makerere the most collaborative university on their database,” said Professor Barnabas Nawangwe.

Adding that; “We publish jointly with a professor at another university, more than any other university in the world, 167 MOUs signed in one year and quite a number of them are very active and particularly in the College of Health Sciences.”

Professor Nawangwe also expressed the government of Uganda’s support to the Makerere University’s research agenda through its funding commitments under the Research and Innovation Fund.“When the SIDA support was due to end, I accompanied the Swedish Ambassador to go and see our Minister of Education and Sports, who is our First Lady as well, and he told her, ‘Swedish support is going to end in two years. Is the government going to take over?’ And she said, ‘yes we shall.’ For the first time, the government committed an equivalent of about $8 million dollars every year for research at Makerere University. A lot of projects have been funded. There are more than 1,250 since the project started four years that have been funded. 39% of all the grants are going to health,” shared Prof. Nawangwe.

Prof. Barnabas Nawangwe (Right) and Prof. Martin Bergö (Left) during the courtesy call prior to the meeting. Frank Kalimuzo Central Teaching Facility, Makerere University, Kampala Uganda, East Africa.
Prof. Barnabas Nawangwe (Right) and Prof. Martin Bergö (Left) during the courtesy call prior to the meeting.

As Makerere University embraces the next century, Prof. Nawangwe said that partnerships with Karolinska Institutet will be leveraged to ensure that research in sustainable health takes centre stage.  “Global Health is a major issue. The Centre for Excellence for Sustainable Health, which is a collaboration between Makerere University in Uganda and Karolinska Institutet in Sweden will be central in addressing global issues.”

In this regard, the Vice Chancellor implored the researchers at Makerere and Karolinska to explore bringing more academic disciplines on board including those in agriculture, food security, gender, architecture, to mention but a few, for a holistic approach.  In the same vein, the Director of Research and Graduate Training, Prof. Edward Bbaale proposed the need to include smart energy options, climate change, nutrition as well as the environment into sustainable health. For instance, how do nutritionists contribute to sustainable health?

Prof. Tobias Alfvén, a Pediatrician and Researcher at Karolinska Institutet, and Co-Chair of the CESH Working Group, underscored the fundamental role of the longstanding 20-year relationship between the two institutions and the dedicated teams involved in facilitating this work. Reflecting on the genesis of their collaboration, he explains, “We met just a month before the pandemic hit Sweden and Uganda, and we started collaboration; everything went online, and we started developing what became the Centre of Excellence for Sustainable Health (CESH). Without that long-term thinking and the good team already there, we would not have achieved that.”

Prof. Rhoda Wanyenze, the Dean, Makerere University School of Public Health (MakSPH) and Co-Chair of the Centre’s Working Group informed the University Management and the visiting delegation that sustainable health involves humans, animals, and the environment. In this regard, the CESH has embraced a multi-disciplinary approach towards research by involving students from different disciplines. She pointed out that CESH has identified students from the College of Agricultural and Environmental Sciences (studying climate change) and those from MakSPH (Environmental Health Sciences) to form research teams that will provide solutions to global health issues.

Left to Right: Prof. Umar Kakumba, Prof. Martin Bergö, Prof. Rhoda Wanyenze and Ms. Monika Berge-Thelander during a courtesy call on the DVCAA in his office. Senate Building, Makerere University, Kampala Uganda, East Africa.
Left to Right: Prof. Umar Kakumba, Prof. Martin Bergö, Prof. Rhoda Wanyenze and Ms. Monika Berge-Thelander during a courtesy call on the DVCAA in his office.

The CESH Working Group’s three-year commitment to promoting sustainable health practices was emphasized by Prof. Wanyenze who also reported a notable shift in focus toward sustainable health during sessions of the World Health Summit held last year.

“We can work together and learn from each other and we can bridge those gaps and the challenges that are leaving some of these vulnerable groups behind. It might be refugees’ issues in Uganda, it might be other disadvantaged groups within Sweden, but we can learn from one another and be able to reach out to them,” Professor Rhoda Wanyenze.

She added that; “When we are thinking about our health and wellbeing today, we should not have the health and well-being of future populations because there are many things we do today to keep ourselves happy and healthy that will affect those that are coming after us.”

Dr. Roy Mayega, an alumnus of Karolinska Institutet and a Senior Lecturer in the Department of Epidemiology and Biostatistics at MakSPH acknowledged Makerere University for valuing the partnership through funding research in sustainable health.  He also pointed out that the research teams were discovering new issues such as gender and climate change in the realization of sustainable health.

Left to Right: Prof. Roy Mayega, Prof. Stefan Peterson Swartling and Prof. Tobias Alfvén during the courtesy call on the DVCAA in his office. Senate Building, Makerere University, Kampala Uganda, East Africa.
Left to Right: Prof. Roy Mayega, Prof. Stefan Peterson Swartling and Prof. Tobias Alfvén during the courtesy call on the DVCAA in his office.

On behalf of Karolinska Institutet, Prof. Martin Bergö thanked the Makerere University Management for the warm reception and the commitment to sustainable health. He mentioned that this was his first visit to Uganda and Makerere University. Acknowledging the partnership between both institutions for the last 22 years, Prof. Bergö who is the current Chairman of the Centre of Excellence for Sustainable Health expressed delight at being part of this collaboration.

He noted that all crises, whether caused by pandemics, poverty, conflicts, or climate change, have an impact on both physical and mental health. He further noted that the link between human, animal, and plant health, known as “One health” increases the importance of collaborating and working together across borders and between different sectors of society.

Prof. Bergö nevertheless acknowledged that people are at the heart of collaborations. “However, partnerships are foremost between people”, he noted, before adding “Building equitable personal relationships and learning from one another. This is perhaps the most important objective of this visit!”

He commended CESH, whose evaluation of the first three years of operation 2021-2023 revealed that the Centre was well on its way to achieving the set objectives. CESH has to date developed four out of planned five tools for working with sustainable health, while the last one is being finalized. “The tools are being used in education and research and I am happy to learn that we are making an impact.”

Prof. Martin Bergö (Left) and Prof. Rhoda Wanyenze (Right) during the courtesy call on the DVCAA in his office. Senate Building, Makerere University, Kampala Uganda, East Africa.
Prof. Martin Bergö (Left) and Prof. Rhoda Wanyenze (Right) during the courtesy call on the DVCAA in his office.

Prof. Bergö equally commended Prof. Barnabas Nawangwe and the former President of Karolinska Institutet, Prof. Ole Petter Ottersen on co-authoring a publication defining sustainable health. Other co-authors included Rhoda Wanyenze, Tobias Alfvén, Rawlance Njejjo, Nina Viberg, Roy William Mayega, and Stefan Swartling Peterson.

“I have read it with much interest and see myself as an ambassador for spreading the concept in different contexts. I am pleased to understand that this definition is the point of departure for all activities devised and carried out by the Centre of Excellence for Sustainable Health” he said, adding that the Karolinska Institutet President, Annika Östman Wernerson is looking forward to visiting Makerere University this November.

During this interactive meeting, both institutions underscored the role of the library in advancing research and preservation of knowledge. The Vice Chancellor, Prof. Barnabas Nawangwe pointed that the Makerere University Library serves as a national reference library as well as a legal and United Nations repository. He therefore acknowledged the support received from NORAD and Sida in the professionalization of library services and making it a model library in Africa.  Prof. Bergö mentioned that libraries are the guardians of knowledge and thanked the Vice Chancellor for inviting the University Librarian to the discussion.

Makerere University Management Members who attended the meeting included: Deputy Vice Chancellor (Academic Affairs)-Assoc. Prof. Umar Kakumba, Director Research and Graduate Training-Prof. Edward Bbaale, Director of Quality Assurance-Dr. Cyprian Misinde, Academic Registrar-Prof. Buyinza Mukadasi, University Librarian-Assoc. Prof. Ruth Nalumaga, Deputy University Secretary-Mr. Simon Kizito, Head of Advancement Office- Mr. Awel Uwihanganye, and Principal Public Relations Officer-Ms Ritah Namisango

Prof. Barnabas Nawangwe (Left) and Prof. Martin Bergö (right) interact with staff from Makerere and Karolinska during the meeting. Rotary Peace Centre Board Room, Frank Kalimuzo Central Teaching Facility, Makerere University, Kampala Uganda, East Africa.
Prof. Barnabas Nawangwe (Left) and Prof. Martin Bergö (right) interact with staff from Makerere and Karolinska during the meeting.

The Karolinska Institutet delegation included; Head of the International Office-Erika Dabhilkar, Co-chair of CESH-Tobias Alfvén, International Coordinator-Monika Berge-Thelander, Project Coordinator-Nina Viberg, Member of CESH Steering Committee-Stefan Peterson Swartling, and Communications Officer-Kseniya Hartvigsson.

Teams Visit the Swedish Ambassador’s residence

While hosting the two institutions, H.E. Maria Håkansson, the Ambassador of Sweden to Uganda, emphasized the significant ties between the two nations and their respective peoples as key drivers for this 22 year-old partnership.

“Collaboration between Karolinska and Makerere is still one of the most important international flagships. Which I think says a lot of what has been built and what the relations that have been creating between institutions but of course also between people. Also, we all know individually what role the university researchers play in the country’s policy development,” said Amb. Håkansson

Adam Kahsai-Rudebeck, First Secretary – Deputy Head of Cooperation Health and Social Protection at the Swedish Embassy added “We look forward to just building upon the already established relationships and initiatives that are ongoing.”

A Video Highlighting the Visit

Highlights of KI- Mak #CESH Working group Engagements in Kampala, February 2024

Photography and Video by Davidson Ndyabahika

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