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Former Grade III Teacher graduates with a PhD: NCDC approves her Study Intervention for Adolescent Care

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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.
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.

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.

Sarah Bunoti Nantono on the day of her PhD Defence. Davies Lecture Theatre, College of Health Sciences, Makerere University, Kampala Uganda, East Africa.
Sarah Bunoti Nantono on the day of her PhD Defence.

“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

Associate Professor Lynn Atuyambe, Dr. Sarah Bunoti's supervisor speaking during her defense. Davies Lecture Theatre, College of Health Sciences, Makerere University, Kampala Uganda, East Africa.
Associate Professor Lynn Atuyambe, Dr. Sarah Bunoti’s supervisor speaking during her defense.

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 (holding flowers) in a group photo with her PhD supervisors, examiners and family after her PhD defense. Davies Lecture Theatre, College of Health Sciences, Makerere University, Kampala Uganda, East Africa.
Dr. Sarah Bunoti (holding flowers) in a group photo with her PhD supervisors, examiners and family after her PhD defense.

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. 

Dr. Sarah Bunoti with her family. Davies Lecture Theatre, College of Health Sciences, Makerere University, Kampala Uganda, East Africa.
Dr. Sarah Bunoti with her family.

“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 CenterCollege 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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Makerere University Research shows challenges facing Forcibly Displaced Persons (FDPs) with Chronic Disease in Northern Uganda

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Left to Right: Dr. Esther Nanfuka Kalule, a postdoc fellow on this study; Emma Ikwara, a researcher at CHDC; PhD student Onesmus Kamacooko at CHDC and Dr. Ritah Nakanjako interacting after the colloquium.

By Agnes Namaganda

Preliminary findings from a study by Child Health and Development Centre (CHDC) -Makerere University have revealed several challenges faced by Forcibly Displaced Persons (FDPs) with chronic diseases like diabetes, hypertension and cardiovascular diseases. This study is specifically looking at FDPs in northern Uganda. Accessing food, water, medicine, clothing, toilet facilities, privacy and support is a challenge for healthy FDPs but for those with chronic diseases, these provisions may mean the difference between life and death.

According to Drs, Ritah Nakanjako and Esther Nanfuka Kalule, who are post-doc fellows at Makerere University, FDPs with chronic diseases are unable to access facilities with medicines. Speaking at the February monthly colloquium of CHDC, Dr. Nanfuka said, “Medicines and medical forms are sometimes forgotten by these patients yet some do not know the names of their medicines. For others, these medicines get finished along the way due to the abrupt movements.” These disturbances in the continuity of care affects their health and wellbeing.

Left to Right: Dr. Esther Nanfuka, Dr. Ritah Nakanjako, Dr. Godfrey Siu who is giving the presenters feedback about their presentation and Dr. Aggrey Dhabangi.
Left to Right: Dr. Esther Nanfuka, Dr. Ritah Nakanjako, Dr. Godfrey Siu who is giving the presenters feedback about their presentation and Dr. Aggrey Dhabangi.

As an example, she referred to the constant need to monitor blood pressure or blood sugar for these FDPs. “Even when facilities are available, you may not have the money to refill medicines or you may not remember the name of the medicine.” She added that the stress and trauma of this kind of situation usually exacerbates these conditions.

Speaking about the rationale for doing this research, Dr. Nakanjako said that non-communicable diseases (NCDs) are largely unrecognized and inadequately addressed in humanitarian settings, something which the Red Cross calls ‘a neglected crisis’.  Yet, studies conducted among refugees and asylum seekers across the world report a high burden of NCDs. Uganda hosts over 1.5m refugees, the highest proportion in sub-Saharan Africa with the majority comeing from South Sydan.

“The objective of this study is to examine the experiences of FDPs- which will contribute to knowledge on innovative ways of chronic disease care. This will also contribute to the management of NCDs in humanitarian, low resource settings,” Dr. Nakanjako explained.

Dr. Godfrey Siu (Left) and Dr. David Kyaddondo who is the Principal Investigator of this project interacting with other members of CHDC after the CHDC monthly colloquium which takes place every last Wednesday of the month.
Dr. Godfrey Siu (Left) and Dr. David Kyaddondo who is the Principal Investigator of this project interacting with other members of CHDC after the CHDC monthly colloquium which takes place every last Wednesday of the month.

This 5-year study that started in 2022 will run till 2026 and is funded by the Novo Nordisk Foundation under the Mobility-Global Medicine and Research Fund. It is a collaboration between three institutions; Makerere University, the University of Copenhagen, Denmark and the Sudan Centre for Strategic and Policy Studies in South Sudan. This research is taking place in Nyumanzi Reception Center in Adjumani district; Nyumanzi Refugee Settlement also in Adjumani district; IDP Settlements in South Sudan; and the Bidi Bidi Refugee Settlement in Yumbe District.

Other challenges revealed by the FDPs with chronic diseases include the fear of drinking recommended amounts of water before or during travel to manage urine and to avoid stop-overs for security reasons.

After arrival at Nyumanzi Reception Centre in Uganda, these FDPs with chronic diseases do not receive any special care. It is only those with communicable diseases like TB. Cholera or Covid19 that get special care. Other challenges include; “a limited range of drugs, maintenance of cold chains for insulin, rationed water, lack of drinking water, lack of sanitary facilities and the congestion.

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Water, Sanitation and Hygiene (WASH) Short Course 2024

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Some of the 22 participants that successfully completed the Water, Sanitation and Hygiene (WASH) certificate course joined by course facilitators and administrators show off their certificates in July 2022 at MakSPH. Makerere University School of Public Health, New Mulago Hospital Complex, Kampala Uganda, East Africa.

Did you know that with just a Uganda Advanced Certificate of Education (UACE) or its equivalent, along with at least 1 year of working experience in WASH, you qualify to join our Short Course in Water, Sanitation and Hygiene?

The Department of Disease Control and Environmental Health at Makerere University School of Public Health brings you yet another opportunity to enhance your skills and knowledge in Water, Sanitation, and Hygiene from for the 2024 intake, scheduled to run from 20th May to 12th July 2024.

Designed to equip practicing individuals with the necessary attitudes, skills, and scientific knowledge for effective WASH management, this course is open to officers with limited training in WASH and Environmental Health Practitioners seeking continuous professional development. For more details and application instructions, please refer to the attached course poster or visit the course website at https://sph.mak.ac.ug/academics/water-sanitation-and-hygiene-wash.

Apply before Thursday, 28th March 2024 for a rewarding learning experience!

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Call for Abstracts: Annual Health Professions Education Scientific Conference

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The Vice Chancellor, Prof. Barnabas Nawangwe (Centre Mak tie) with participants at the Health Professions Education Conference held 11th to 12th May 2023 at Hotel Africana, Kampala Uganda.

The Health Professions Education and Training for Strengthening the Health System and Services in Uganda Project (HEPI-SHSSU) at Makerere University College of Health Sciences (MakCHS) is organizing the Annual Health Professions Education Scientific Conference.

Venue: Hotel Africana, Kampala, Uganda

Conference Dates: 10th, 11th and 12th April 2024

Theme: Advances in Health Professions Education:  Research, Innovations in Teaching and Learning, Quality Assurance

Sub-Themes

  1. Quality Assurance and Accreditation
  2. Health Professions Education Research
  3. E-Learning 
  4. Innovations in teaching and learning
  5. Graduate Education
  6. Simulation-based Learning

Abstracts are welcome in any of the above areas for oral presentations, mini-workshops, thematic poster sessions, and didactic sessions.

We welcome abstracts from all people involved in the education and training of doctors, nurses, allied health professionals, students, health providers, and other stakeholders.

Abstract Submission:

Abstracts should be structured into:

Background, Objectives, Methods, Results, Conclusion

For Education innovations: What was the problem, What was done, Results, and Conclusion (300-word limit).

Include the details of the corresponding author, the author(s), their contacts, and Affiliation.

Send your abstract to: hepishssu@gmail.com

Deadline for Submission of abstracts: Saturday 23rd March 2024

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