Health
Mak and Karolinska to Continue Prioritising Sustainable Health
Makerere University and Karolinska Institutet Sweden have embarked on undertaking strategies aimed at ensuring that sustainable health becomes a priority on the global agenda. This was revealed during a high level meeting involving Makerere University Management and a delegation from the Karolinska Institutet Sweden, held on Tuesday 6th February 2024 at the Rotary Peace Centre Board Room, Frank Kalimuzo Central Teaching Facility.
The Vice Chancellor, Prof. Barnabas Nawangwe welcomed the Vice President of Karolinska Institutet Prof. Martin Bergö and his delegation to Makerere University. Reflecting on Makerere University’s 100 year journey (1922-2022), the Vice Chancellor pointed out that the institution has been at the forefront of training human resources who have been key in the identification and finding solutions to various development challenges.
“Makerere is a very collaborative university. We have collaborations within Africa of course, most of our external collaborations are in Europe and the United States. Times Higher Education (THE) considers Makerere the most collaborative university on their database,” said Professor Barnabas Nawangwe.
Adding that; “We publish jointly with a professor at another university, more than any other university in the world, 167 MOUs signed in one year and quite a number of them are very active and particularly in the College of Health Sciences.”
Professor Nawangwe also expressed the government of Uganda’s support to the Makerere University’s research agenda through its funding commitments under the Research and Innovation Fund.“When the SIDA support was due to end, I accompanied the Swedish Ambassador to go and see our Minister of Education and Sports, who is our First Lady as well, and he told her, ‘Swedish support is going to end in two years. Is the government going to take over?’ And she said, ‘yes we shall.’ For the first time, the government committed an equivalent of about $8 million dollars every year for research at Makerere University. A lot of projects have been funded. There are more than 1,250 since the project started four years that have been funded. 39% of all the grants are going to health,” shared Prof. Nawangwe.
As Makerere University embraces the next century, Prof. Nawangwe said that partnerships with Karolinska Institutet will be leveraged to ensure that research in sustainable health takes centre stage. “Global Health is a major issue. The Centre for Excellence for Sustainable Health, which is a collaboration between Makerere University in Uganda and Karolinska Institutet in Sweden will be central in addressing global issues.”
In this regard, the Vice Chancellor implored the researchers at Makerere and Karolinska to explore bringing more academic disciplines on board including those in agriculture, food security, gender, architecture, to mention but a few, for a holistic approach. In the same vein, the Director of Research and Graduate Training, Prof. Edward Bbaale proposed the need to include smart energy options, climate change, nutrition as well as the environment into sustainable health. For instance, how do nutritionists contribute to sustainable health?
Prof. Tobias Alfvén, a Pediatrician and Researcher at Karolinska Institutet, and Co-Chair of the CESH Working Group, underscored the fundamental role of the longstanding 20-year relationship between the two institutions and the dedicated teams involved in facilitating this work. Reflecting on the genesis of their collaboration, he explains, “We met just a month before the pandemic hit Sweden and Uganda, and we started collaboration; everything went online, and we started developing what became the Centre of Excellence for Sustainable Health (CESH). Without that long-term thinking and the good team already there, we would not have achieved that.”
Prof. Rhoda Wanyenze, the Dean, Makerere University School of Public Health (MakSPH) and Co-Chair of the Centre’s Working Group informed the University Management and the visiting delegation that sustainable health involves humans, animals, and the environment. In this regard, the CESH has embraced a multi-disciplinary approach towards research by involving students from different disciplines. She pointed out that CESH has identified students from the College of Agricultural and Environmental Sciences (studying climate change) and those from MakSPH (Environmental Health Sciences) to form research teams that will provide solutions to global health issues.
The CESH Working Group’s three-year commitment to promoting sustainable health practices was emphasized by Prof. Wanyenze who also reported a notable shift in focus toward sustainable health during sessions of the World Health Summit held last year.
“We can work together and learn from each other and we can bridge those gaps and the challenges that are leaving some of these vulnerable groups behind. It might be refugees’ issues in Uganda, it might be other disadvantaged groups within Sweden, but we can learn from one another and be able to reach out to them,” Professor Rhoda Wanyenze.
She added that; “When we are thinking about our health and wellbeing today, we should not have the health and well-being of future populations because there are many things we do today to keep ourselves happy and healthy that will affect those that are coming after us.”
Dr. Roy Mayega, an alumnus of Karolinska Institutet and a Senior Lecturer in the Department of Epidemiology and Biostatistics at MakSPH acknowledged Makerere University for valuing the partnership through funding research in sustainable health. He also pointed out that the research teams were discovering new issues such as gender and climate change in the realization of sustainable health.
On behalf of Karolinska Institutet, Prof. Martin Bergö thanked the Makerere University Management for the warm reception and the commitment to sustainable health. He mentioned that this was his first visit to Uganda and Makerere University. Acknowledging the partnership between both institutions for the last 22 years, Prof. Bergö who is the current Chairman of the Centre of Excellence for Sustainable Health expressed delight at being part of this collaboration.
He noted that all crises, whether caused by pandemics, poverty, conflicts, or climate change, have an impact on both physical and mental health. He further noted that the link between human, animal, and plant health, known as “One health” increases the importance of collaborating and working together across borders and between different sectors of society.
Prof. Bergö nevertheless acknowledged that people are at the heart of collaborations. “However, partnerships are foremost between people”, he noted, before adding “Building equitable personal relationships and learning from one another. This is perhaps the most important objective of this visit!”
He commended CESH, whose evaluation of the first three years of operation 2021-2023 revealed that the Centre was well on its way to achieving the set objectives. CESH has to date developed four out of planned five tools for working with sustainable health, while the last one is being finalized. “The tools are being used in education and research and I am happy to learn that we are making an impact.”
Prof. Bergö equally commended Prof. Barnabas Nawangwe and the former President of Karolinska Institutet, Prof. Ole Petter Ottersen on co-authoring a publication defining sustainable health. Other co-authors included Rhoda Wanyenze, Tobias Alfvén, Rawlance Njejjo, Nina Viberg, Roy William Mayega, and Stefan Swartling Peterson.
“I have read it with much interest and see myself as an ambassador for spreading the concept in different contexts. I am pleased to understand that this definition is the point of departure for all activities devised and carried out by the Centre of Excellence for Sustainable Health” he said, adding that the Karolinska Institutet President, Annika Östman Wernerson is looking forward to visiting Makerere University this November.
During this interactive meeting, both institutions underscored the role of the library in advancing research and preservation of knowledge. The Vice Chancellor, Prof. Barnabas Nawangwe pointed that the Makerere University Library serves as a national reference library as well as a legal and United Nations repository. He therefore acknowledged the support received from NORAD and Sida in the professionalization of library services and making it a model library in Africa. Prof. Bergö mentioned that libraries are the guardians of knowledge and thanked the Vice Chancellor for inviting the University Librarian to the discussion.
Makerere University Management Members who attended the meeting included: Deputy Vice Chancellor (Academic Affairs)-Assoc. Prof. Umar Kakumba, Director Research and Graduate Training-Prof. Edward Bbaale, Director of Quality Assurance-Dr. Cyprian Misinde, Academic Registrar-Prof. Buyinza Mukadasi, University Librarian-Assoc. Prof. Ruth Nalumaga, Deputy University Secretary-Mr. Simon Kizito, Head of Advancement Office- Mr. Awel Uwihanganye, and Principal Public Relations Officer-Ms Ritah Namisango
The Karolinska Institutet delegation included; Head of the International Office-Erika Dabhilkar, Co-chair of CESH-Tobias Alfvén, International Coordinator-Monika Berge-Thelander, Project Coordinator-Nina Viberg, Member of CESH Steering Committee-Stefan Peterson Swartling, and Communications Officer-Kseniya Hartvigsson.
Teams Visit the Swedish Ambassador’s residence
While hosting the two institutions, H.E. Maria Håkansson, the Ambassador of Sweden to Uganda, emphasized the significant ties between the two nations and their respective peoples as key drivers for this 22 year-old partnership.
“Collaboration between Karolinska and Makerere is still one of the most important international flagships. Which I think says a lot of what has been built and what the relations that have been creating between institutions but of course also between people. Also, we all know individually what role the university researchers play in the country’s policy development,” said Amb. Håkansson
Adam Kahsai-Rudebeck, First Secretary – Deputy Head of Cooperation Health and Social Protection at the Swedish Embassy added “We look forward to just building upon the already established relationships and initiatives that are ongoing.”
A Video Highlighting the Visit
Photography and Video by Davidson Ndyabahika
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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