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New Uganda study shows Oxygen Access increase among neonates & children in Hospitals

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A new study in Uganda has shown a significant increase in oxygen access and pulse oximetry among neonates and children in health facilities.

Preliminary findings published in The Lancet, the world’s highest-impact medical and academic journal show the positive impact of a diverse oxygen systems strengthening intervention on diagnosis, oxygen therapy use, and mortality rates.

Titled; “Improving Effective Coverage of Medical Oxygen Services for Neonates and Children in Health Facilities in Uganda: A Before-After Interventional Study,” the study shows that large-scale improvements in hospital oxygen services are achievable in a relatively short timeframe and have great potential for impact.

The study was led by Dr. Freddie Ssengooba, an Associate Professor of Health Policy Planning and Management, at the School of Public Health and Dr. Freddy Eric Kitutu, a Senior Lecturer of Health Systems Pharmacy both co-chairs of the Lancet Global Health Commission on Medical Security. Other researchers on the study include Hamish Graham from the University of Melbourne, Yewande Kamuntu, Blasio Kunihira, Santa Engol, Jasmine Miller, Absolom Zisanhi, Dorcas Kemigisha, Lorraine Kabunga and Felix Lam all from Clinton Health Access Initiative, Dr. Charles Olaro from Uganda’s Ministry of Health and Dr. Harriet Ajilong from the Uganda Paediatric Association.

From June 2020 to June 2022, an intervention study assessed neonates and children at 31 government health facilities in Uganda’s Busoga and North Buganda regions, located at altitudes of 1100-1400 meters. The primary outcome measured the proportion of patients with documented pulse oximetry on admission.

Secondary outcomes included patients with severe hypoxaemia (SpO2 < 90%) receiving oxygen, overall oxygen usage, and appropriate oxygen usage. The study’s primary effectiveness analysis compared pulse oximetry coverage before and after the intervention, incorporating a 4-month washout period. The analysis utilized mixed-effects logistic regression, adjusting for clustering at individual facilities, age (child versus neonate), and sex (male versus female).

Pulse oximetry and oxygen coverage over time with major intervention timings.
Pulse oximetry and oxygen coverage over time with major intervention timings.

Researchers analyzed 64,562 patients (25% neonates) and observed a significant rise in pulse oximetry coverage during the intervention period, increasing from 24% to 88% with an adjusted odds ratio of 40.1 (95% confidence interval: 37.4 to 42.9).

They also observed better oxygen coverage for children and neonates with low oxygen levels, increasing from 40% to 71%, with an adjusted odds ratio of 3.81 (95% confidence interval: 3.26 to 4.46).

Additionally, there was a slight increase in overall oxygen usage, rising from 8% to 11%, with an adjusted odds ratio of 1.95 (95% confidence interval: 1.79 to 2.13).

“Improvements were relatively greater in smaller facilities and for children (versus neonates). We estimated additional patients served and lives saved in the post-intervention period using observed effect estimates in this and other studies,” reads the study.

With these findings, researchers are calling on governments in low-income and middle-income countries to create oxygen plans and invest in proven solutions, like incorporating pulse oximetry in regular hospital care, and providing clinical as well as biomedical mentorship and support.

For all age groups, medical oxygen is essential for both acute and chronic health problems. Scientific evidence suggests access to medical oxygen services that are safe, economical, and appropriate is essential for improving overall health and achieving Sustainable Development Goals. Unfortunately, inadequate or inconsistent oxygen supplies present challenges for many low- and middle-income nations, particularly for small medical facilities in underserved areas.

WHO Representative to Uganda, Dr Yonas (blue tie) and the Danish Ambasador to Uganda H.E Nicolaj Petersen (black mask) hand the cylinders over to the Minister of Health Dr Jane Ruth Aceng ©WHOUganda 2022/Edmond Mwebembezi
WHO Representative to Uganda, Dr Yonas (blue tie) and the Danish Ambasador to Uganda H.E Nicolaj Petersen (black mask) hand the cylinders over to the Minister of Health Dr Jane Ruth Aceng ©WHOUganda 2022/Edmond Mwebembezi

Disruptions in the oxygen supply during the COVID-19 pandemic caused excessive deaths, which predominantly affected countries with low to middle incomes. According to a 2021 study, half of the COVID-19 patients who died in 64 critical care units across ten African countries did not receive the required medical oxygen.

The study was funded by a grant from the Bill and Melinda Gates Foundation (BMGF) and ELMA Philanthropies to the Clinton Health Access Initiative (CHAI) and approval from Makerere University School of Health Sciences Research and Ethics Committee, and the Uganda National Council of Science and Technology.

Available at SSRN: https://ssrn.com/abstract=4676954 or http://dx.doi.org/10.2139/ssrn.4676954

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Davidson Ndyabahika

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Makerere University Public Health students recount hands-on experience in Ebola case finding in Uganda

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By AFENET

The first day of the case-finding activity began with an orientation session at the Emergency Operations Center (EOC) offices at the Ministry of Health (MoH). The briefing was led by Dr. Wenani Daniel, Lubwaama Bernard, and Mr. Daniel Kadobera, who provided an overview of the current status of the Ebola Virus Disease (EVD) outbreak caused by Sudan ebolavirus (SEBV) in central Uganda. A key focus of the session was adherence to strict infection prevention and control (IPC) measures including maintaining a safe distance, avoiding direct contact, refraining from entering homes, and not eating or drinking in the field.

To enhance efficiency, the team was divided into three groups, ensuring that each group included at least one clinician for proper assessment of inpatient department (IPD) registers and patient files. The groups were then deployed to their respective sites: Saidinah Abubakar Islamic Hospital, Mulago National Referral Hospital, and a buffer zone within a 2km radius around Saidinah Hospital.

Read full article on AFENET

About AFENET

The African Field Epidemiology Network (AFENET) is a not-for-profit networking and service alliance of FE(L)TPs, and other applied epidemiology training programs in Africa. Makerere University School of Public Health (MakSPH) is one of four founder members of the network that has since grown to 40 members spanning Anglophone, Francophone, and Lusophone Africa.

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Meet Laura Silovsky, a Makerere University Graduate with Refugee Roots Bridging Continents

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Laura Silovsky (Right) at the graduation ceremony alongside fellow graduands Juma Said Tusubila and Ssali Abdallah Yahya on Day 2 of the 75th Graduation Ceremony. 75th Graduation Ceremony, Day 2, CoBAMS, CHS and CoNAS. 14th January 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa.

On Tuesday January 14, 2025, under the radiant rays of the Ugandan sun, Laura Silovsky crossed the stage at Makerere University’s 75th Graduation Ceremony to receive her master’s degree in Public Health Disaster Management (MDM). Hers is a story of passion, dedication, and curiosity to rewrite the narrative of global education. Among 1,813 master’s graduates, Laura’s story stood out, as a blend of refugee roots, firefighting bravery, and a drive to decolonize learning.

Laura’s journey began long before her arrival in Kampala. Born in the UK to a father who fled from Czechoslovakia’s dictatorship in the 1970s, she grew up understanding displacement intimately. “My father was a refugee. Why would I fear refugees?” she once asked during her research fieldwork in Uganda’s West Nile, where her empathy bridged divides.

“People in Uganda may not expect that a muzungu could be the child of a refugee, but my family experienced displacement from (what was then) Czechoslovakia as well as the effects of the protracted conflict in Northern Ireland. Fortunate to have been born in the UK, I was raised to appreciate that disasters can affect anyone, anywhere, anytime.

After studying Sustainable Development at the University of Edinburgh, I worked on a behavior change project tackling non-communicable diseases in Scotland,” Laura says.

Laura Silovsky outside MakSPH on graduation day. 75th Graduation Ceremony, Day 2, CoBAMS, CHS and CoNAS. 14th January 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa.
Laura Silovsky outside MakSPH on graduation day.

Her journey twisted through battling Australia’s bushfires and volunteering in a COVID pandemic, but it was Uganda’s welcoming refugee policies and Makerere University’s academic excellence that pulled her in next.

“In 2020, I relocated to Australia, just after the worst bushfires since records began and before the COVID-19 pandemic. The following two years, I qualified as a firefighter and supported bushfire recovery by volunteering with a community-based organization. After gaining some insight into these different disasters, I made the decision to return to higher education, and so I applied for the MDM programme at Makerere in 2022,” says Laura.

Armed with experience in emergency response, Laura was drawn to the field’s multidisciplinary nature and was convinced she needed to expand her expertise beyond immediate recovery efforts. She aimed to explore the full disaster management cycle and the intricate connection between health and environment.

“I needed to combine gaining academic knowledge with developing practical skills, so the field placement offered within the master’s degree in Public Health Disaster Management programme was a major motivator for me,” she shared.

The love for Uganda

Studying at the University of Edinburgh, Laura took a class in Kiswahili, that included a field-based short course on the Tanzanian shores of Lake Victoria. This experience sparked a desire to spend more time in the region, but she knew she needed to expand her skill set in order to genuinely add value to an organisation, if she was on the continent.

“I hoped studying at an East African university would teach me invaluable soft skills needed to work more effectively as an international team member. Makerere University School of Public Health (MakSPH) has a strong reputation, and I wanted to study somewhere that was locally grounded but globally recognized. Uganda’s progressive refugee policies were an added incentive to learn from experts here,” Laura says.

Laura’s intentional choice to decolonize her education

“I came to Uganda to learn from the experts here,” Laura declared, rejecting Eurocentric frameworks. “A big factor for me wanting to study at Makerere University was to decolonize my education, to recognize that the knowledge about responding to public health disasters and supporting refugees is here in Uganda,” she says.

She adds, “When I first arrived, I was quite vocal with my classmates about wanting to challenge that bias and truly acknowledge the wealth of knowledge within institutions like Makerere. The expertise here is invaluable, and I was intentional about decolonizing my education.”

Laura Silovsky with some of the 2022 MDM cohort outside MakSPH building after an exam. 75th Graduation Ceremony, Day 2, CoBAMS, CHS and CoNAS. 14th January 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa.
Laura Silovsky with some of the 2022 MDM cohort outside MakSPH building after an exam.

At MakSPH, Laura immersed herself in courses like epidemiology, struggled briefly with statistics, but thrived on critical discussion groups and consultation with lecturers.

Collaborating with classmates from Uganda and across East Africa, she learned Luganda phrases and Somali proverbs, and built a “family” united by late-night study sessions and shared ambitions.

Beyond expectations

For Laura, studying at MakSPH was the best decision she could have made. She is still struck by the faculties’ wealth of academic and professional experience in public health and disaster management.

“I anticipated the programme would focus on applying the knowledge we gain to real-world scenarios. Of course, there were cultural differences that took me time to adjust to. I am grateful to faculty members such as Prof. Christopher Garimoi Orach, for his dedication and support, Prof. Elizeus Rutembemberwa for leading by example and valuing students’ time, and Dr. Justine Bukenya and Dr. Simon Kibira for offering their extensive support as my dissertation supervisors.”

The Fieldwork Attachment that Transformed Laura’s Research Experience

At Rhino Camp refugee settlement in West Nile, Laura’s work took on new meaning. Partnering with the Uganda Red Cross Society, she helped digitize data tools and walked long distances through Tika Zone, inspecting latrines and speaking with South Sudanese girls about their challenges in managing their menstrual health through their project that focused on schools.

Laura Silovsky conducting focus group discussions in a school in Rhino Camp in Northern Uganda with a team from the Uganda Red Cross Society. 75th Graduation Ceremony, Day 2, CoBAMS, CHS and CoNAS. 14th January 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa.
Laura Silovsky conducting focus group discussions in a school in Rhino Camp in Northern Uganda with a team from the Uganda Red Cross Society.

“That experience in West Nile influenced my own research ideas, and it was a privilege to later return to Rhino Camp for data collection. I will always remember the long days walking with my research assistants through villages and being graciously welcomed by so many respondents,” she recalls, noting that the experiences crystallized her resolve to advocate for refugee dignity globally.

Life in Kampala  

Life in Kampala, with its vibrant energy and unique challenges, was truly a ‘full sensory experience’ for Laura. “My parents live in a small village, so Edinburgh felt like a big city when I moved there. And Edinburgh is much smaller and quieter than Kampala! But on weekends, I loved going downtown to shop at Owino Market or heading to Kyadondo Rugby Club for some pork.”

These spaces were perfect for Laura, offering new cultural experiences, including matooke, a starchy dish not found in the UK, which is mainly eaten in Uganda as a local delicacy and staple meal. Despite the differences in culture, sharing meals with classmates provided Laura with a comforting sense of connection.

Back to academics, navigating the university administrative processes wasn’t seamless initially for Laura, though. She says administrative hurdles such as paper-based systems, could change for the university to comfortably enjoy its strong reputation.

She recalls, right at the beginning, when she couldn’t find sufficient information online to support her to complete her application to join Makerere University. However, she later received support from the University’s International Office that deals with the welfare of international students.

Other university officials, from finance, librarians, program administrators, to academic registrars, played a key role in supporting her in her research and postgraduate training. “The system relies on dedicated individuals,” she noted, calling for digital reforms while praising MakSPH’s “atmosphere of innovation.”

“From my experience, such as when obtaining my transcript, the system relies heavily on individual staff members working around these administrative challenges. I’m grateful for those who helped me navigate this, and I’m interested to see how the university continues its digital transition, as it could greatly streamline processes in the future,” says Laura.

A Bittersweet Graduation Day

On graduation day, Laura’s pride mingled with melancholy. Watching families cheer on graduates, she reflected on classmates sidelined by finances or family crises.

Having gone through the course and interacted with Ugandan students, Laura hints on the common financial and personal challenges preventing many from graduating: family illness, new children, sponsorship falling through.

“I know so many of my classmates had worked so hard and were almost over the finish line but, due to financial challenges or other commitments at home, it wasn’t possible for them to graduate this year,” she says.

“For me, I was able to make the choice to pursue this program before having children, so I had fewer responsibilities at home, and I had also been saving for many years to get the money to pay tuition. Because I knew I had the money for tuition before I started, I could focus on studying. As you know, the reality for many people is that that’s not always possible.

“Small supports can transform student experiences,” Laura emphasized, advocating for systemic empathy. She sees great potential for more pastoral support at the university, citing peers from UCU and Kyambogo who benefited from accommodations like private breastfeeding spaces and flexible deadlines in special circumstances. Such initiatives, alongside financial aid, could significantly improve student welfare.

Still, the ceremony’s electric energy—watched via livestream by her parents in Europe—symbolized hope. “Uganda taught me that collaboration transcends borders,” she reflected.

Laura Silovsky (Right) at the graduation ceremony alongside fellow graduands Juma Said Tusubila and Ssali Abdallah Yahya. 75th Graduation Ceremony, Day 2, CoBAMS, CHS and CoNAS. 14th January 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa.
Laura Silovsky (Right) at the graduation ceremony alongside fellow graduands Juma Said Tusubila and Ssali Abdallah Yahya.

“You could feel this sense of how hard everyone had worked to reach up to that point and that this was really an opportunity for them to celebrate, particularly by having family and friends around to be able to see. I love the PhD awards, when you see the PhD students coming out and their families rushing up to greet them. To me, that’s the best part of the ceremony, because a PhD requires so much work and commitment, and I think it’s really emotional to see everyone share this moment with their support networks,” she says.

Adding that; “…I was so grateful that the ceremony was streamed online. My family were watching live at home in Europe and it was so special that they could see me on camera and participate in the ceremony that way as well.”

Laura noted striking similarities between Makerere and Edinburgh’s ceremonies, especially the moment when students were asked to turn and thank their families, an emotional and powerful tradition.

Looking Ahead

Now in Tanzania, Laura eyes roles with international NGOs, armed with Ugandan-taught pragmatism and a zeal to challenge Europe’s refugee policies. “MakSPH gifted me more than a degree—it reshaped my worldview,” she says.

“As a muzungu with a Ugandan postgraduate education, I feel privileged to have benefitted from different educational perspectives, and I hope that the skills and knowledge I acquired during my time at Makerere will help me to secure a role with an international NGO. After witnessing the incredible support that Uganda provides to refugees, I also hope to advocate for more dignified policies concerning refugees in Europe,” she shares.

“There’s a spirit of innovation and dedication at Makerere, particularly when passionate lecturers like Prof. Orach, Dr. Roy Mayega, or Dr. Victoria Nankabirwa engaged students through discussion and sharing lived experiences. You could really see a different level of engagement within the students as well. Overall, I’ve had such a fantastic experience at Makerere University.”

“I wouldn’t change a thing,” she smiles.“Except maybe convince more Europeans to study here. Africa’s wisdom is the future.”

Davidson Ndyabahika

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Exciting PhD Opportunity in Health Innovation – Starting 2025

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The NTU-Mak delegation posing with some of the community health workers at the field office in Nakawuka, Wakiso district.

We are happy to share this exciting PhD studentship opportunity through the NTU-Makerere University partnership under the theme Health Innovation. Starting in 2025, this project will focus on One Health drivers of antibiotic-resistant bacterial infections in rural Ugandan communities.

The research will combine microbiological and public health approaches to explore the prevalence, transmission, and contributing factors of antibiotic-resistant bacteria in these communities. Key research questions include:

  • What human, animal, and environmental factors contribute to the spread of antibiotic-resistant bacteria?
  • How can Community Health Workers (CHWs) help mitigate their spread?

Requirements:

  • Essential: Willingness to spend time in both Uganda and the UK during the project and proficiency in Luganda.
  • Desirable: Wet lab microbiology skills.

For full details, visit:
<https://www.ntu.ac.uk/study-and-courses/postgraduate/phd/phd-opportunities/
studentships/health-innovation-phd-studentships/one-health-drivers-of-antibi
otic-resistant-bacterial-infections-in-rural-ugandan-communities
> NTU Health Innovation PhD Studentships.

Application Deadline: Friday, 14 February 2025.

For inquiries, contact Dr. David Musoke at dmusoke@musph.ac.ug or Jody Winter at jody.winter@ntu.ac.uk.

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