Health
Former Grade III Teacher graduates with a PhD: NCDC approves her Study Intervention for Adolescent Care
Published
2 years agoon

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!
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Holistic Retirement Planning includes Psychological, Emotional & Social well-being across all Career Stages
Published
1 week agoon
January 12, 2026By
Mak Editor
The Makerere University Retirement Benefits Scheme (MURBS) on Thursday, 8 January 2026 organised a Member Sensitisation Session on “Understanding Identity Shifts; Developing Routines; Sustaining Motivation and Purpose”. The session focused on holistic retirement planning, emphasising that readiness for life after work goes beyond finances to include psychological, emotional, and social well-being across all career stages—from early career to post-retirement.
The session featured a keynote presentation by Professor Seggane Musisi, who highlighted how work-related titles and roles often shape personal identity, and how retirement can trigger a sense of loss if individuals are unprepared to redefine themselves. Members were encouraged to consciously design a post-work identity grounded in values, purpose, and community contribution.
Participants learned practical strategies for:
- Preparing early for retirement at different career stages;
- Developing healthy, meaningful routines that support mental stability and productivity;
- Sustaining motivation and purpose beyond formal employment;
- Managing stress, maintaining physical and mental health, and nurturing social connections; and
- Balancing family responsibilities with personal well-being.
The discussion also addressed cultural realities of retirement in Uganda, including family expectations, social obligations, and financial pressures. Special attention was given to age-related challenges such as dementia, depression, and chronic illness, underscoring the importance of preventive health care, emotional resilience, and timely professional support.
Overall, the session reinforced the message that retirement is a lifelong transition, not a one-time event. Members were encouraged to plan early, adapt continuously, and intentionally design a fulfilling, purposeful life beyond work—psychologically, socially, and financially.
To view the session, please click the embedded video below. Further below is the presentation.
Health
Kampala at a Crossroads: What New Research Reveals About Mobility, Governance, and the City’s Public Health Risks
Published
2 weeks agoon
January 8, 2026
Every day in Kampala, millions of people inch through gridlock, dodge swarming boda-bodas threading through narrow gaps in traffic, inhale dangerously polluted air, and walk along streets rarely designed for pedestrians. These conditions, and more, are often dismissed as ordinary transport frustrations. Yet researchers at Makerere University School of Public Health (MakSPH) are examining how such everyday realities translate into public health outcomes, shaped not simply by congestion, but by governance, policy, and power. Their work forms part of a multi-country project investigating the political economy of urban mobility in three African cities.

Co-led by Dr. Aloysius Ssennyonjo, the Principal Investigator and health systems and governance researcher at MakSPH, together with Uganda’s Country Principal Investigator, Dr. Esther Bayiga-Zziwa, a road safety and injury epidemiologist, and Co-Principal Investigator Dr. Jimmy Osuret, an injury prevention researcher, the project titled The Political Economy of Urban Mobility Policies and Their Health Implications in African Cities (PUMA) applies a political economy lens to understand how political interests, institutional arrangements, and power dynamics shape mobility systems and their consequences for public health in Kampala, Kigali, and Lilongwe.
To note, political economy analysis examines how public decisions are shaped by the interplay of politics, interests, institutions, and resources, in short, who has influence, who controls what, and how money and power circulate within a system. In Kampala, a capital of nearly two million residents whose daytime population swells with commuters, this lens helps explain why some transport options attract funding and enforcement while others are tolerated, neglected, or contested. These choices are not just technical, but reflect competing interests and priorities, with consequences for safety, equity, and the everyday well-being of those moving through the city.

Now, through the NIHR-funded project, the Ugandan team is currently working with colleagues from the University of Rwanda, led by Professor David Tumusiime, and Kamuzu University of Health Sciences in Malawi, led by Dr. Dominic Nkhoma. The research partnership aims to generate evidence that can strengthen mobility governance and improve public health outcomes across the three African cities above, with advisory support for the research consortium from the University of Antwerp in Belgium and Canterbury Christ Church University in the UK.
Explaining the project’s rationale for the Politics of Urban Mobility, or PUMA, during the 2025 Universal Health Coverage Day webinar held on December 12 under the theme “Mobility, Costs, and Politics: How Urban Systems Shape Access and Progress Towards Universal Health Coverage in African Cities,” Principal Investigator Dr. Ssennyonjo said Africa is urbanising at an unprecedented pace. Projections show that by 2050, nearly 60% of the continent’s population will live in cities, a shift that is intensifying transport pressures and increasingly turning everyday mobility into a public health risk.

“Rapid urbanisation has created multiple challenges: transport systems are under strain, risks and vulnerabilities are rising, and opportunities for healthy behaviours such as walking are often limited. Access to livelihoods is also affected, with broad implications for health,” Ssennyonjo noted, adding: “Crucially, these issues are shaped by political and governance dynamics, yet few initiatives explicitly address them. This gap motivated our focus on the politics and governance of urban mobility.”

He mentioned that health outcomes are shaped by social, economic, and environmental factors, with transport costs, risks, and stress often posing greater barriers than medical fees alone to achieving affordable health for all. He noted that the PUMA project brings together multidisciplinary teams to study how governance and political dynamics shape urban mobility, public health, and development, a perspective reflected in Prof. Julius Kiiza’s observation that effective urban development relies on coordinated action by diverse stakeholders across sectors to improve health outcomes, though emphasising the primacy of politics.
“Uganda and Singapore had comparable levels of underdevelopment in the 1960s. Under Lee Kuan Yew, Singapore embarked on a deliberate nation-building project. Today, it is among the smartest cities globally, outperforming many Western cities in clean government, mobility, and liveability. Why are we lagging behind? The answer, I argue, lies largely in the nature of our politics,” Prof. Julius Kiiza cogently argued.
He intimated that the result has been cities that are “unreliable, unsafe, unsmart, and chaotic,” noting that claims of inclusive urban development often ring hollow. “I have argued, and repeat here, that boda bodas as a symbol of inclusivity represent a false model of inclusion. We must interrogate this and invest in better urban transport systems and wider, well-planned highways,” he affirmed.

Prof. Kiiza urged policymakers and practitioners to move beyond piecemeal technical fixes and instead treat urban mobility as a governance challenge requiring coordinated, cross-sector action. He stressed the importance of aligning transport planning with public health, housing, employment, and skills development, arguing that safer, more liveable cities depend on institutions that work together and are accountable to the public. Such reforms, he noted, demand sustained political commitment and inclusive dialogue across government, academia, civil society, and the private sector, precisely the terrain the PUMA project is engaging, by convening stakeholders and shaping a shared research agenda around Uganda and the continent’s urban mobility challenge.

Indeed, on November 21, 2025, the Ugandan team convened a national stakeholder workshop in Kampala, bringing together a wide range of stakeholders. Opening the workshop, Assoc. Prof. Suzanne Kiwanuka, Head of the Department of Health Policy, Planning and Management (HPPM) at MakSPH, commended the team for highlighting what she described as a long-underexplored dimension of Uganda’s urban health landscape: mobility and its governance.
Reflecting on her own experience, she noted how boda-bodas have become increasingly indispensable for millions seeking quick, flexible transport, but also carry complex health, safety, and economic implications that demand multisectoral attention, calling for a balanced, evidence-driven dialogue that recognises their value while also addressing the infrastructural and policy gaps that shape mobility systems in Uganda’s rapidly growing cities.
“I sometimes use boda-bodas,” Assoc. Prof. Suzanne Kiwanuka said. “They are necessary when you need to move quickly during heavy traffic. Yet we all know how unsafe they can be. This PUMA initiative is timely to generate evidence not only on the politics of urban mobility and its health implications, but also its economic consequences.”

Notably, road traffic crashes remain one of Uganda’s most urgent public health threats today. The recent Uganda Police Force Annual Crime Report 2024 recorded 5,144 road deaths, a seven per cent rise from 2023, with motorcyclists accounting for nearly half of all fatalities. In Kampala, pedestrians, cyclists, and motorcycle riders constitute 94 per cent of all fatal crashes, according to the Kampala Capital City Authority. Thousands more suffer life-altering injuries each year.
Still, evidence from MakSPH, through its Centre for Trauma, Injury and Disability Prevention (C-TRIAD) and the Johns Hopkins International Injury Research Unit (JH-IIRU) under the Bloomberg Philanthropies Initiative for Global Road Safety (BIGRS), shows that the design and use of city roads are worsening the risk environment. Between 2021 and 2023, the team conducted more than one million roadside observations across Kampala, finding that while only five per cent of vehicles are officially recorded as speeding, those that do travel at an average of 57 km/h, well above safe limits for dense urban corridors, making city roads increasingly unsafe.

The World Health Organization (WHO) guidelines, cited in the report, recommend speed limits of 30 km/h on community roads and in urban areas where pedestrians, cyclists, and other vulnerable road users share space with motorised traffic, and 50 km/h on major urban roads. Yet the findings show that six in ten vehicles on community roads exceed these limits, heightening risks for those least protected and underscoring the need for lower-speed zones, traffic-calming measures such as speed humps and raised crossings, and consistent enforcement of traffic regulations.
For the PUMA team in Uganda, the writing on the wall shows that these rising injuries coincide with worsening congestion and rapid urbanisation, yet city mobility policies within Kampala remain heavily oriented toward road expansion and vehicular flow, with limited attention to safety, health protection, or non-motorised transport. This policy imbalance, then, explains why daily commuting remains hazardous and why progress on safer streets has been slow.

The study uses a three-tiered approach that combines policy analysis, regional evidence, and local experiences to examine how mobility decisions are made in Kampala, Kigali, and Lilongwe, who holds authority, and how these processes affect public health and equity. This is strengthened by structured co-creation workshops with practitioners, policymakers, and community actors, which reveal how governance functions in practice, often diverging from what is written on paper.
In parallel, the research team is conducting a continent-wide review of academic and grey literature to map regional trends, gaps, and the broader forces shaping African mobility systems. Together, these streams enable the researchers to compare cities, identify shared challenges, and build a grounded analytical framework for improving mobility governance across Africa.
In Kampala, preliminary findings by the MakSPH PUMA research team show a city governed by many mobility policies but marked by weak mobility governance. The team shared that Kampala operates under a dense mix of frameworks, from the National Integrated Transport Master Plan and National Urban Policy to road safety, climate, and KCCA development plans. While these documents acknowledge congestion, urbanisation, and road injury risks, they also reveal overlapping mandates, blurred institutional roles, and limited coordination authority.

Key government Ministries, Departments, and Agencies (MDAs) actors include the Ministry of Works and Transport, KCCA, the Ministry of Lands, the Office of the Prime Minister, and the Ministry of Finance, with the Ministry of Health conspicuously absent despite clear health implications. Policy attention, according to the early findings, remains heavily skewed toward road transport, leaving non-motorised mobility and major health pathways, noise exposure, psychosocial stress, community severance, heat, and mobility independence largely unaddressed.
Governance realities are further shaped by political processes, including electoral cycles, informal negotiations with transport unions, selective regulation of boda-bodas, and heavy reliance on development partners that often influence what is prioritised and implemented. Together, these dynamics help explain stalled master plans, inconsistent enforcement, and resistance to progressive interventions. While the PUMA research remains at a preliminary stage currently, the emerging findings underscore the need for an integrated, multisectoral mobility agenda that places health at the centre of Kampala’s transport policy and practice.

Health
How People Earn a Living is Contributing to Malaria Risk in Uganda, Study Finds
Published
2 weeks agoon
January 5, 2026
Livelihood activities such as farming, livestock keeping, construction, and night-time work significantly increase malaria risk in Uganda, according to new research by Dr Kevin Deane, a development economist at The Open University, UK, and Dr Edwinah Atusingwize and Dr David Musoke, a Research Associate and Associate Professor of Environmental Health at Makerere University School of Public Health, respectively.
The study, Livelihoods as a key social determinant of malaria: Qualitative evidence from Uganda, published on December 2, 2025, in the journal Global Public Health, examines how everyday economic activities shape exposure to malaria, often undermining conventional prevention measures such as insecticide-treated nets and indoor residual spraying. The findings are based on qualitative fieldwork conducted in June 2024 in Busiro County, Wakiso District, a peri-urban area with persistently high malaria transmission in Uganda.
Using a qualitative design, the researchers conducted 14 key informant interviews, 10 focus group discussions, and 11 in-depth interviews with households recently affected by malaria, engaging 100 participants from communities, health services, local government, and civil society across Kajjansi, Kasanje, and Katabi Town Councils, as well as Bussi Sub-County, in Busiro South. Their analysis, guided by the Dahlgren–Whitehead social determinants of health model, enabled the researchers to situate malaria risk within the broader social, economic, and environmental conditions shaping how people live and work.

In their findings, participants linked malaria exposure to agricultural practices, among which is maize cultivation near homes, which was associated with increased mosquito density during the rainy season. “One of the most common crops cultivated in Uganda, which many rely on as staple foods, creates environments in which mosquitoes are attracted to and thrive, often in settings where maize is grown near homes in rural areas and urban areas. This increases mosquito density around homes and contributes to increased outdoor biting and the number of mosquitoes entering houses,” the study argues.
Its authors say this poses a difficult policy challenge because maize is central to household food security, leaving few practical options for reducing exposure. They argue that proposals to keep maize away from homes are often unrealistic for families with limited land or those farming in urban areas, while targeted control during flowering periods may have limited impact given mosquitoes’ ability to travel beyond cultivation sites.

Beyond crop farming, the study reports that livestock rearing, especially zero-grazing cattle kept close to houses, attracts mosquitoes into household compounds. Other livelihood activities, including construction and brick-making, created stagnant water-filled pits that served as breeding sites, while night-time livelihoods, such as street vending, guarding, fishing, bar work, and brick burning, among others, prolonged outdoor exposure during peak mosquito biting hours. Gender further shaped risk, with women’s livelihoods and caregiving responsibilities frequently exposing young children alongside them.
“The evidence we present illustrates the unintended health consequences of development strategies intended to promote key livelihood activities, food security, and poverty reduction. There are no straightforward solutions given the complexity of these relationships and the importance of these livelihoods for many households,” the authors assert.
They conclude that malaria elimination efforts will fall short unless livelihoods and development activities are explicitly integrated into malaria prevention strategies, calling for stronger alignment between public health, agriculture, urban development, and economic policy.
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