Health
Former Grade III Teacher graduates with a PhD: NCDC approves her Study Intervention for Adolescent Care
Sixty four-year-old Sarah Bunoti Nantono is a retired teacher and Lecturer of Psychology. She enrolled for a Ph.D. program at Makerere University School of Public Health (MakSPH) in 2013 with the goal of studying early adolescent reproductive health.
Having taught for more than thirty years, Dr. Sarah Bunoti Nantono had moved up the academic ladder from being a primary school teacher to a lecturer at Kyambogo University. She believed that earning a PhD would be her ultimate goal in life. While at Kyambogo University, the second largest of the now 13 public universities in Uganda, Dr. Sarah Bunoti devoted her professional life to training social scientists, teachers and teacher educators.
Eleven years later, Dr. Bunoti Sarah Nantono is one of the 46 females of the 132 PhD graduands in the #Mak74thGrad, which begins on Monday, January 29, 2024.
She successfully earns a Doctor of Philosophy ( PhD) in Public Health from Makerere University following her in-depth research titled; “Pubertal and Child Rights Awareness, Communication, and Child Protection against Sexual Abuse and Exploitation among 10–14-year-olds in Jinja Primary Schools: Opportunities, Challenges, and the Effectiveness of a School-Based Intervention.”
Dr. Sarah Bunoti is a seasoned lecturer with a proven track record in teacher training, social sciences, and psychology. Holding an MSc in Environment from Makerere University Institute of Environment, she also earned a Bachelor of Science in Zoology and Psychology from Makerere University in 1999, a Diploma in Teacher Education from ITEK in 1995, and a Grade III Primary School Teachers’ Certificate from the National Institute of Education. Beginning her career in 1981 as a primary school teacher, and later as a Teacher Trainer in the Ministry of Education in 1995, Sarah transitioned to Kyambogo University in 2000, where she currently serves as a part-time Lecturer, following her retirement. Sarah Bunoti Nantono is not only an educator but also an accomplished author, contributing to the development of the Child Rights Curriculum (CRED-PRO).
Dr. Sarah Bunoti’s PhD research examined how Jinja primary school children, aged 10 to 14, understood puberty and their rights related to sexual and reproductive health (SRH). The study looked at their knowledge sources, difficulties, and prospects for managing pubertal health effectively.
The 10-14 age group comprises 10% of the global population, with Uganda having a higher percentage at 16%. This period marks the onset of significant changes, known as the storm in Psychology, involving body transformations and social shifts.
According to Dr. Sarah Bunoti, timely support during these changes fosters a sense of achievement, but delays can lead to anxiety and unpreparedness. Uganda, aligning with international agreements, including the UN Convention on the Rights of the Child, works to uphold children’s sexual well-being through policies and partnerships.
Dr. Sarah Bunoti further notes in her research that the 10-14 age group in Uganda encounters puberty during primary school without appropriate information, support, protection, or preparation for the changes, leading to psychological challenges, sexual abuse, early marriages, unplanned pregnancies, and a rise in school dropouts.
![Dr. Sarah Bunoti's PhD Defense Panel [Professor Stella Neema, Associate Professor Joseph Ssenyonga, Dr. Siu E. Godfrey, Dr. Beyeza-Kashesya Jolly and supervisors Associate Professor Lynn Atuyambe, Prof. Nazarius Mbona Tumwesigye alongside the session chairperson Prof. Garimoi Orach] determining the verdict before she was declared to have passed her defense. Davies Lecture Theatre, College of Health Sciences, Makerere University, Kampala Uganda, East Africa.](https://news.mak.ac.ug/wp-content/uploads/2024/01/Makerere-CHS-SPH-74th-Graduation-Dr-Sarah-Bunoti-Jan2024-PhD-Defense-Panel-1024x683.jpg)
Busoga region, where the study was conducted faces particularly high rates of teenage pregnancies (7%) and school dropouts (91%). Children hold misconceptions driven by myths about puberty, emphasizing the lack of systematic guidance. Current Adolescent Sexual Reproductive Health programs focus on older children in secondary schools, neglecting the needs of those under 15.
Traditional sources, like family discussions, have diminished, placing the responsibility on schools, which often lack the necessary resources and teacher training. As a result, many 10-14-year olds are ill-prepared for changes and lack protection against sexual abuse, highlighting the necessity for evidence-based school interventions to address this information gap.
“Previously in our African traditional setting, the Aunties, Uncles and grandparents talked about puberty and prepared children for adulthood however with the breakdown of African traditional settings, schools are expected to do the role of talking to children about puberty.
Unfortunately, schools often look at puberty as an issue that is concerned with the family and expect the family to do that but also one possible problem is that the teachers themselves don’t know what to do when they are preparing these children for that,” observes Dr. Sarah Bunoti.
Unfortunately, some stakeholders use threatening language, warnings, and punishments, contributing to risk behaviors, including sexual abuse, mood swings, and trauma among children.
“We wanted to find out what these children know about puberty, challenges they face and the support they get. We also wanted to find out from key duty bearers, these are parents and teachers, what kind of support do they give to the children and to what extent do they fulfill their obligations to protect the children against sexual abuse,” said Dr. Sarah Bunoti.
The study covered 16 primary schools purposefully selected for their diverse characteristics, including boarding status, religious affiliations, gender specifications, and geographical locations. The investigators also engaged with government officials to understand their stance on current sexual and reproductive health issues among young adolescents.
The study exposed deficiencies in children’s understanding of puberty and child rights, along with teachers’ inadequate knowledge and skills in teaching puberty.
Findings for instance revealed that kids—particularly boys—don’t often get the chance to talk candidly about puberty with adults. In all focus group conversations, the study gave boys and girls a forum to openly address their experiences, difficulties, and rights related to sexual and reproductive health. This emphasizes how important it is for all people to become widely sensitive to the issues that face kids. Stepmothers were found not to communicate about puberty because of generalization and others.
“Surprisingly, discussions on pubertal challenges elicited more extensive responses from both boys and girls compared to other topics. Boys, although engaging in perceived anti-social behavior, demonstrated a level of conscience. It became evident that children, despite being sexually and biologically mature, require guidance on navigating the impact of hormones on their sexual feelings. The blame for communication gaps often falls on parents, who may be absent due to work, divorce, or being orphaned,” says Dr. Bunoti.
Subsequently, she developed, applied, and assessed two intervention books; A children’s Resource book and a Teachers’ guide. The Randomized Control Trial demonstrated improved pubertal knowledge among children and enhanced teaching capabilities in teachers, affirming the intervention’s effectiveness. These intervention books were approved by the National Curriculum Development Centre (NCDC) and approved for teaching pubertal health and safety in primary schools nationwide.
Dr. Bunoti has recommended empowering and involving young communicators to convey Sexual and Reproductive Health and Rights (SRHR) information to 10-14-year-olds, working collaboratively with parents and teachers, a strategy she believes will narrow the generation gap and enhance effective communication. Additionally, she calls for increased awareness and participation of male parents and teachers in SRH communication and child protection.
“Parents and adults should supplement school-based SRHR education by instilling age-appropriate individual, family, and community values and skills rooted in social, cultural, and religious contexts. Provide specialized training for Senior Women Teachers and Male Teachers, and reduce their teaching load to ensure dedicated attention to this critical aspect of education,” Dr. Bunoti expertly says.
Her study, funded by Sida and supervised by Dr. Lynn Atuyambe and Prof. Nazarius Mbona Tumwesigye, successfully attained this recognition.
During her PhD defense, Associate Professor Lynn Atuyambe remarked, “It was a very enjoyable defense. You truly and successfully defended your PhD—now, you own your PhD.”
“I want to thank most especially your family, they’ve been part of this journey I am not guessing, I know they’ve been and am excited to see them and I like the support they have offered to mum. The highest level of education in the world is a PhD, you can do no more than that. You have reached at the saddle of your life in academia, congratulations and I wish you good luck,” said Dr. Lynn Atuyambe.
How her PhD Journey started
About a decade ago, SIDA had been consistently supporting Makerere University. However, they decided to extend their support to other public universities. When the opportunity arose, she seized it.
“I have a habit of greeting, and my children often question why I greet so much. Sometimes, it turns out to be quite beneficial. One day, I walked into my Dean Dr. J Katigo – Kaheeru’s office and greeted, asking how he was. He said, ‘Sarah, I am glad you’ve come, read this but I said Doctor I am not ready for this, but he said, ‘Sarah, you can’t give any more excuses, this is a God given opportunity, they want a concept for the SIDA Scholarships, go ahead and write a concept.’ I later met Professor Mary N Okwakol, my undergraduate Lecturer of Zoology, and Professor Albert Lutalo Bbosa, the former Vice Chancellor of Kyambogo University, who too reassured me of my potential to attain a PhD. Out of 26 submissions from Kyambogo University, only three concepts were selected, and fortunately, mine was one of them,” Dr. Sarah Bunoti recalls.
Once her concept was ready, Dr. Bunoti came to Makerere University, but her research topic was broad. Unfortunately, her background did not align with the faculties that typically received sponsorship from SIDA. Zoology, Psychology, Education, and Environmental Studies were her strengths, but none fell within the supported areas.
Feeling disconsolate, she sought guidance from the then Director of Research and Graduate Studies at Makerere University, Professor Elly Katunguka. “He said, ‘why should you really struggle looking for a home, go and try School of Public Health. With your background, you’ll find a home,” she recalls.
Acting on his advice, Dr. Sarah Bunoti visited the School of Public Health one morning. However, the Dean, Prof. William Bazeyo, then, was away on leave; “I spoke with Assoc. Prof. Fred Wabwire-Mangen, the Acting Dean at the time. I explained my situation, highlighting my expertise in teaching, psychology, and environmental studies. He encouraged me to submit my concept, assuring me that these areas were valued in public health. This led to provisional admission, and I began refining my proposal with their guidance.”
As she exited Dr. Mangeni’s office, he promptly contacted Professor Anne Katahoire, who was by then the Director of Makerere University Child Health and Development Centre and Prof. Atuyambe, who was in Nairobi for a conference and told them; “We have a prospective student here, are you willing to take her up and without hesitation, Prof. Anne said yes and Prof. Lynn said, ‘I am in Nairobi but when I come back, I want to see that student,” Sarah recollects.
Subsequently, Prof. Mangeni reached out to Prof. Nazarius Mbona Tumwesigye upon recognizing the importance of the statistics component, he promptly invited her to discuss further details at the school. “In a short span, I found myself with a dedicated team of supervisors, a supportive Doctoral Committee chaired by Prof. Christopher Garimoi Orach with Prof Joseph Oonyu (RIP) and Dr. Christine K. Nalwadda, and a scholarly home in the Department of Community and Behavioral Sciences at the Makerere University School of Public Health,” Sarah Bunoti says.
Dr. Sarah Bunoti expresses gratitude to the MakSPH PhD Forum, the MakSPH family, the funder and her mother institution -Kyambogo University for the immeasurable support.
Dr. Sarah Bunoti expresses gratitude to the MakSPH PhD Forum, the MakSPH family, the funder and her mother institution -Kyambogo University for the inestimable support. She is also grateful to head teachers, teachers, children, and parents from her 16 project schools; Jinja City and District Education, Health and Community Development officers as well as the Family and Child Protection Unit of the Uganda Police Force and others for the information and support rendered to her.
“I can’t quantify the support I received from MakSPH, from PhD forum, from my supervisors you all did a good job to support me in this. In addition, SIDA did a good job because with our teaching salary, paying for my PhD would have been a problem but they paid all my tuition even when the scholarship was ending they said Sarah, we are paying for two years at ago and paid for the field’s activities,” she recalls.
She is equally grateful to everyone who provided her and her research team with useful information; Kyambogo University for assigning a teaching assistant to help her focus and her husband, Dr. Bunoti, who has promised to support her dream.
“I want to thank my family, my sister Mrs. Rebecca Lucy and her husband Eng. Dr James Muwuluke, my children. They have been there for me, my husband, Dr. Bunoti met me when I was a primary school teacher and he was a Doctor teach and told me, Sarah, I will support you until you are tired of reading and has kept his word, there are few empowered men who will want a woman to come up and get the title they hold,” she said.
“Given what I have gone through, am so excited about this achievement. My family is so excited about this. My husband is extremely excited. They have written short paragraphs about me about my resilience. I had decided not to hold any celebration but my sister and her husband says this could not pass since it is no mean achievement,” she says.
Dr. Godfrey Siu Etyang, her Ph.D. overseer, has invited her to collaborate on a parenting project at the Child Health and Development Center, College of Health Sciences, Makerere University. Over the past month, she has been actively contributing to the development of a comprehensive parenting curriculum for the unit.
Dr. Bunoti anticipates scaling up the approved intervention, particularly to additional primary schools in the Busoga region and beyond and has already began talks with Ministry of Education and Sports to support children’s understanding of puberty, a sine qua non for education and parenting.
Unexpected difficulties affected Dr. Sarah Bunoti Nantono’s journey to earning her Ph.D., resulting in longer than the expected four to six years. Midway through her studies, she developed insomnia, which was an unexpected health problem. In 2020 when it appeared that she would soon graduate, the Doctoral Committee insisted that she must publish her work, and was reluctant to accept a monograph, one of the options for one to graduate with a PhD at Makerere University. Further delays were due to lengthy processes to have her manuscripts published and clearances through the Institutional Review Board (IRB). Other than these challenges, Dr. Nantono also had to repeat the entire data collection process and deal with the untimely death of Assoc. Prof. Joseph Oonyu, a key member of her doctorate committee, in October 2020. Despite these challenges, Dr. Nantono feels proud to have completed her doctorate, demonstrating her incredible endurance in the face of adversity.
Congratulations Sarah!
As the funding to the higher education sector keeps on reducing due to competing priorities, universities are implored to come up with structures and strategies to attract and win research grants.
Key findings indicate that universities with institutionalized grant management offices, strong and coordinated research teams are better positioned to effectively compete for grants.
Makerere University, in partnership with Northwestern University, is spearheading the E-SMAC G11 Grants Administration and Management workshop from 14th to 17th July 2025, aimed at strengthening grant management offices and systems among the participating universities and entities.
It is envisioned that through this capacity building approach, the workshop which brings onboard over 130 participants from different universities and entities, will address the knowledge and skills gaps among faculty, grant managers, administrators and support staff.
The participating universities and entities include: Makerere University, Uganda Christian University-Mukono, Soroti University, Gulu University, Clarke International University, King Ceasor University, Kyambogo University, Muni University, Mother Kevin University, Uganda Martyrs’ University-Nkozi, Ernest Cook University, Mbarara University of Science and Technology, University of Kisubi, Kabale University, Busitema University, BRAC University, Infectious Diseases Institute, Ministry of Health, and among others.
Makerere University and Northwestern University have built a strong partnership over the past decade through academic exchange, collaborative research, and capacity building initiatives. “Since 2020, the institutions have deepened their collaboration in research administration through the UASP fellowship, sharing best practices and co-developing of sustainable systems to strengthen research management,” said Prof. Sylvia Antonia Nakimera Nannyonga-Tamusuza, Head of Grants Administration and Management Support Unit (GAMSU) at Makerere University.
She informed the participants that Northwestern University has been instrumental in building the capacity of staff at Makerere University in grants writing, management and administration.
Prof. Nannyonga-Tamusuza testified that when she was appointed to head GAMSU, she received comprehensive training from Northwestern University, which enhanced her competences and expertise in the field. She acknowledged Kate Klein from Northwestern University for the mentorship that empowered her with valuable knowledge and skills. She reported that five (5) members of staff from Makerere University had been trained by Northwestern University in grants and research management.
Filled with joy, she introduced the team of experts from Northwestern University namely Kate Klein, Bethany Ekesa and Elizabeth Christian to Makerere University, and applauded them for accepting to be facilitators. Prof. Nannyonga-Tamusuza assured the workshop participants that the team from Northwestern University would not only train them, but would share best practices in grants management and administration as well as networking opportunities.
The training workshop is part of the Expanded Strengthening of Makerere University’s Research Administration Capacity (E-SMAC) program, which focuses on enhancing research administrative systems and staff capacity at Makerere University and its partner institutions. Mordecai Tayebwa is the Program Director and Principal Investigator of the E-SMAC program being implemented from July 2024 to December 2025. The program is funded by the National Institute of Allergy and Infectious Diseases (NIAID).
The workshop provides a platform to build faculty, grant managers and administrators capacity in grant writing and management, foster cross-functional collaboration across departments, strengthen understanding of budget creation, biosketch and funder systems, encourage mentorship and peer to peer learning, and lay a foundation for regular support.
The training tackles four broader themes namely Grants Introduction and Systems, Proposal Development, Capacity Building, and Outcomes and Forward Planning. It covers vital areas such as grant writing, budgeting, funder systems, compliance, and overall grant administration. It features practical sessions, mentorship opportunities, and collaborative learning, with the goal of strengthening pre-award and post-award grant management and improving research productivity and compliance.
Opening the workshop, the Acting Deputy Vice Chancellor (Finance and Administration) at Makerere University, Prof. Winston Tumps Ireeta urged universities to institutionalize grant management offices and policies as well as strengthening research systems through collaborations.
Sharing his experience, Prof. Ireeta informed the participants that he was involved in the strategic discussion that led to the establishment of GAMSU at Makerere University. “We observed that Makerere University School of Public Health had established a grants office, which was instrumental in attracting and winning funds for research. We were inspired by this best practice. Thus, a comprehensive policy was developed to streamline and strengthen grants management across all colleges at the University,” he said.
Prof. Ireeta noted that Makerere University commits to being a research-driven institution, a strategic direction, that needs a strong funding base. ‘Research grants are therefore a key resource,” he said.
Stressing the importance of adhering to the technical details in the grants management processes, Prof. Ireeta appealed to the participants to be active listeners and maximally utilize the moment to learn from the experienced facilitators.
In the same vein, Prof. Nannyonga-Tamusuza, applauded the University Council and Management for the strategic direction undertaken to elevate GAMSU from a Unit to a Directorate. This points to the central role of the grants office in the life cycle of Makerere University. She pointed out that GAMSU reports to the Vice Chancellor through the Deputy Vice Chancellor (Finance and Administration).
Established by the University Council in 2020, GAMSU is a central office at Makerere University. It provides professional and coordinated services across the entire grant life-cycle-from identifying funding and developing proposals to ensuring compliance, project execution, financial oversight, and institutional capacity building. GAMSU works closely with academic and administrative staff to support competitive, well-managed and accountable research.
Focusing on the training workshop, Prof. Nannyonga-Tamusuza called upon the participants to utilize the golden opportunity to deepen their understanding of grants management in advancing research. She acknowledged the role of this collaboration in fostering mutual learning and the sharing of best practices, noting that such initiatives were key in ensuring that research conducted by universities aligns with global standards. She encouraged participants to engage fully in the workshop, collaborate with their peers, and build lasting connections to foster continuous learning.
The Administrative Director of the Havey Institute for Global Health at Northwestern University, Kate Klein, noted that grants administration goes beyond securing funding. She explained that grant administration is about building strong, sustainable systems that support researchers, facilitate collaboration, and ultimately contribute to solving global challenges.
Klein stated that grants administration and management require continuous learning, adaptability, and a strong foundation in regulatory and financial oversight.
“Collaborating and learning from one another is essential,” Klein stated. “When grants administration is effectively managed, it becomes a powerful catalyst for driving impactful change in research, ultimately advancing global initiatives that address the world’s most pressing challenges.”
She urged participants to critically analyze their current systems and identify areas where improvements could be made. By doing so, they would be better positioned to manage grants effectively and maximize their impact. She guided that a research grants administrator should be able to design monitoring frameworks, liaising with funders to address grant-specific issues, coordinating compliance, budgeting and reporting to ensure timely and effective implementation.
Presenting the Existing Support Systems and Principal Investigator (PI) agreements, Prof. Nannyonga-Tamusuza pointed out the critical role of GAMSU in maximizing Makerere University’s access to grants. This is particularly important in the context of limited financial resources, where GAMSU ensures that the university effectively leverages available funding opportunities.
Prof. Nannyonga-Tamusuza explained that GAMSU ensures research projects align with the priorities of funders and comply with both institutional and external regulations. She emphasized that this alignment is essential for securing and managing grants successfully. She stated that oversight offered by GAMSU, helps streamline the process for researchers. She pointed out that grant management is a collaborative process, involving multiple stakeholders across the university, which ensures that the necessary expertise and support are in place to manage grants effectively.
Underscoring the importance of grant negotiations, particularly with sub-award grants, Prof. Nannyonga-Tamusuza clarified that such negotiations are most successful when managed at the institutional level, where GAMSU oversees the entire lifecycle of a grant-from identifying funding opportunities to post-award activities.
Harriet Nambooze, the Project Coordinator at Makerere University School of Health Sciences, provided participants with a detailed guide on navigating the National Institutes of Health (NIH) grant application process. She introduced essential tools such as Grants.gov, eRA Commons, SAM.gov and the NATO Commercial and Government Entity (NCAGE), which are critical for applying and receiving an NIH award.
Nambooze stressed the importance of accurately setting up roles in the eRA Commons system, including Signing Official (SO), Principal Investigator (PI), Account Administrator (AA), and Administrative Official (AO), as well as ensuring that profiles are up-to-date across various systems.
She highlighted the necessity of adhering to NIH’s strict submission deadlines and maintaining active individual and institutional profiles to facilitate timely applications. She recommended that institutions should appoint multiple Signing Officials (SOs), to avoid any delays with the required submissions.
Presenting to the participants, Mordecai Tayebwa shared a detailed, step-by-step guide to starting a new grant application. He explained the key elements of the grant process, including the necessity of including a budget, adhering to specific formatting guidelines, and uploading required documents, such as the foreign justification for international projects.
He pointed out the need of thoroughly verifying the application before submission to ascertain that all required documents are included. “This step is crucial to avoid errors that could delay or jeopardize the submission,” he said.
The first day of the workshop set a strong foundation for enhancing grant administration capacity among the participating universities. Participants were equipped with knowledge and skills in grant systems at the national and global levels.
Day two, will focus on topics such as reading funding opportunity announcements, tailoring writing, budget development and justification, sub-contract management, sub-recipient monitoring, and Memoranda of Understanding (MoUs).
On Day three, the participants will gain a deeper understanding of the Grants Office, financial management, internal controls and reporting, peer review process overview and project closeout.
On Day four, the participants will witness the launch of the MakGAP (Makerere University Grants Professional Initiative), listen to a keynote speech on grants management from the Vice Chancellor of Makerere University, Prof. Barnabas Nawangwe, as well as presentations on professional growth through MakGAP, CRA Exam, and Global Research Administration Networks, and professional recognition of research managers and administrators in Africa and post evaluation.
The first day of the workshop set a strong foundation for enhancing grant administration capacity among the participating universities. Participants were equipped with knowledge and skills in grant systems at the national and global levels.
Day two, will focus on topics such as reading funding opportunity announcements, tailoring writing, budget development and justification, sub-contract management, sub-recipient monitoring, and Memoranda of Understanding (MoUs).
On Day three, the participants will gain a deeper understanding of the Grants Office, financial management, internal controls and reporting, peer review process overview and project closeout.
On Day four, the participants will witness the launch of the MakGAP (Makerere University Grants Professional Initiative), listen to a keynote speech on grants management from the Vice Chancellor of Makerere University, Prof. Barnabas Nawangwe, as well as presentations on professional growth through MakGAP, CRA Exam, and Global Research Administration Networks, and professional recognition of research managers and administrators in Africa and post evaluation.
Based on research led by Max Bobholz and colleagues from Makerere University in Uganda, Essentia Institute of Rural Health, and the Medical College of Wisconsin in the United States.
Adolescence is meant to be a time of holistic growth and self-discovery, but for many Ugandan teenagers, this period is becoming a season of silent mental health struggles. A new study published in PLOS Global Public Health has uncovered a silent but growing crisis: nearly one in five Ugandan secondary school students in the study areas have signs of an emotional disorder. These conditions included anxiety, depression, post-traumatic stress disorder (PTSD), and adjustment disorders often involving excessive worry, sadness, fear, or mood instability. Also, one in 20 adolescents exhibited behavioral issues ranging from attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder to substance use and other risky behaviors like alcohol use.
The study, led by Max Bobholz, a PhD candidate in Public and Community Health at the Medical College of Wisconsin, surveyed a sample of 1,953 students aged 10 to 18 years enrolled in eight secondary schools in Iganga district in Eastern Uganda and Mukono district in Central Uganda. This was one of the most comprehensive efforts yet to understand the prevalence and drivers of mental health challenges among school-going Ugandan adolescents.
“We are looking at a generation facing a complex blend of stressors, namely, academic, social, and emotional,” says Bobholz. “Our findings show that certain groups are especially vulnerable, and schools need to be equipped to respond.”
This study results, published on June 12, 2025 was funded by the Swedish International Development Cooperation Agency (SIDA), a government agency of the Swedish Ministry for Foreign Affairs, through the Makerere University Postdoctoral Fellowship to one of the investigators, Dr. Catherine Abbo. Other researchers included Julia Dickson-Gomez, Arthur Kiconco, Abdul R. Shour, Simon Kasasa, Laura D. Cassidy, and Ronald Anguzu.
According to the study, girls bear a higher emotional burden. Researchers found that female students had nearly two times higher odds of suffering from emotional disorders such as anxiety or depression than their male peers.
Dr. Catherine Abbo, an Adolescent Psychiatrist and Associate Professor at Makerere University, attributes this to both biological and socio-cultural factors. “Puberty brings hormonal shifts that can heighten emotional sensitivity,” she explains. “But just as importantly, Ugandan girls often face intense pressure to conform to gender roles while also navigating issues like body image, harassment, and future uncertainty.” The researchers are calling for gender-sensitive mental health interventions, particularly in schools, where early support could help mitigate long-term mental health issues.
Higher associations in older teens?
Age also emerged as a key associated factor, with each additional year increasing the odds of behavioral disorders by 20%. “As adolescents grow older, they are more prone to risk-taking, impulsivity, and resistance to authority,” explains Dr. Simon Kasasa, a senior lecturer and biostatistician at Makerere University School of Public Health.
“Combine that with academic pressure and identity-related stress, and it’s no surprise we’re seeing more conduct issues in late adolescence,” Dr. Ronald Anguzu, an Assistant Professor in the Institute for Health and Humanity at the Medical College of Wisconsin, added. This study raises critical questions about whether and how Ugandan secondary schools support older students as they transition toward adulthood.
The unseen influence of family mental health
The study also found that adolescents with a family history of mental illness had twice the odds of exhibiting behavioral problems compared to those without such a history.
“This speaks to the intersection of genetics and environment,” says Bobholz. “Living in a household with people affected by mental illness can mean instability, stigma, and lack of emotional support, all of which weigh heavily on a developing mind.”
The authors recommend that school mental health screening include family mental health history and advocate for greater collaboration between education and health sectors to support at-risk households.
Private schools: High marks, higher stress?
Interestingly, students in private schools had 1.4 times the odds of experiencing emotional disorders compared to those in public schools. Private schools, often seen as academic havens, may inadvertently be cultivating high-pressure environments. “There’s an assumption that better facilities mean better well-being,” says Dr. Abbo. “But intense academic competition, social isolation, and a lack of trained counselors can create emotional pressure cookers.”
Previous research in 47 secondary schools across five districts (Rakai, Kyotera, Masaka, Lwengo, and Kalungu) in southwestern Uganda found that economic and family support helped reduce absenteeism among adolescent girls in secondary schools. However, this support did not significantly improve behavior or reduce grade repetition. The region, which includes districts like Rakai and Masaka, also faces a higher burden of HIV, adding to the challenges young people experience.
Meanwhile, a review of data from 42 primary schools in Luwero District identified school-based mental health interventions such as cognitive behavioral therapy and mindset-building approaches as being particularly effective. Researchers now suggest that integrating these strategies, along with efforts to reduce school violence, could go a long way in improving the mental health of Ugandan adolescents.
A-Level pressure: Academic ambition meets mental health strain
The study also found a correlation between advanced (A’level) education and increased risk of emotional disorders. “We selected one school district from each region based on population and past academic performance. As these students prepare for university or the job market, the pressure to succeed becomes enormous,” says Kasasa. “They’re facing a future full of uncertainty, with very little structured mental health support to help them cope.”
A wake-up call for Uganda’s education and health systems
The authors of this study assert the urgent need for school-based mental health programs, especially in private and A-level institutions. These programs should offer routine screening, emotional support, and training for teachers to recognize warning signs of mental health disorders.
Importantly, this study adds weight to calls for a national adolescent mental health policy, tailored to Uganda’s context, with interventions that bridge health, education, and social services.
“Our data shows that mental health challenges are not a fringe issue,” says Bobholz. “They are widespread, significant, and deeply tied to school, home, and society.”
The COVID-19 school closures between 2020 and 2022 deepened feelings of isolation and financial strain, with out-of-school adolescents reporting depression rates as high as 21.5% to 50% higher than their peers who remained in class, according to research published in February 2025. Yet Uganda invests less than 1% of its health budget in mental health, with just one psychiatrist per million people, leaving many teens to cope through cheap alcohol used by 28% of urban youth or untrained healers, as reported by the government paper The New Vision in April 2025. With only 26% of students completing lower secondary school and 35% of the population under age 24, these mental health challenges now pose a serious threat to the country’s future.
Mercy Akankunda of Proven Foundation, a Ugandan NGO supporting vulnerable groups, warns that mental health struggles are quietly eroding the well-being of the country’s youth, over 12 million strong and making up 35% of the population. “These teens are not just statistics. They are the future of Uganda, she asserts. If Uganda hopes to reap the dividends of its young population, addressing adolescent mental health must become and remain a national priority, not just for treatment, but for prevention, resilience, and hope.
Reference:
Bobholz, M., Dickson-Gomez, J., Abbo, C., Kiconco, A., Shour, A.R., Kasasa, S., Cassidy, L.D., & Anguzu, R. (2025). Correlates of behavioral and emotional disorders among school-going adolescents in Uganda. PLOS Global Public Health. Read the study here
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