A consortium of Seven Sub-Saharan countries is implementing a 5-year intervention aimed at building the capacity of improved, sustainable, and locally–led management of antimicrobial resistance (AMR) and Neglected Tropical Diseases (NTDs).

AMR is a public health problem that poses the largest threat to human health, causes death, and threatens economies especially those of developing countries in sub-Saharan Africa and South Asia.

In Uganda, the project is implemented by Makerere University in the College of Health Sciences (CHS) and the College of Veterinary Medicine, Animal Resources and Biosecurity (CoVAB).  Prof. Dr. Damalie Nakanjako, the Principal CHS, and CoVAB’s Assoc. Prof. Julius Okuni are the Principal investigators.

The other sub-Saharan African states in the consortium include Senegal, Ghana, Nigeria, the Democratic Republic of the Congo, Ethiopia, and Sudan, while the other participants like Leipzig University are drawn from Germany.

At the project kickoff event held at Protea Hotel in Entebbe on Monday 12^th May 2024 attended by all implementing partners, it was explained that the five-year project will investigate and sustainably develop the local capacity to identify and intervene with a diverse range of biomedical and sociocultural factors impacting human, animal, and environmental health in sub-Saharan African settings to better control AMR and NTDs.

Through a One Health Approach, the project will work with several stakeholders including Behavior scientists, Data scientists, veterinarians, Human health workers, and policymakers in developing the capacity of anti-microbial stewardship in Sub-Saharan Africa.

The project’s main tasks will include screening of AMR in humans, livestock, and poultry using surveillance and genetic mapping; investigating the relationship between helminthic infection and drug resistance bacteria to better understand the co-infection between pathogens; developing capacities for point of need diagnostics on AMR and NTDs using mobile tests for field use; identifying any changes in antimicrobial use and AMR incidences; controlling communicable disease transmission and building capacity for sustainable leadership.

The kickoff meeting was addressed by stakeholders from different sectors who made proposals aimed at ensuring a successful project implementation. Hon. Dr. Charles Ayume, the Chair of the parliamentary health committee, while addressing the forum urged the implementers to consider involving the political wings of the respective countries and to ensure that the politicians get to appreciate the concerns on Anti-Microbial Resistance and the Neglected Tropical Diseases.   He said that in the case of Uganda, the process of the formation of the Parliamentary Forum on AMR was in the initial stages and observed that several politicians were not well informed about the challenges of AMR.  He said bringing the politicians on board would help the project implementers and stakeholders lobby for financial allocations towards AMR or else refer to it as unfunded priorities because they do not appreciate its magnitude. Dr. Ayume regretted noting that although innovations were game changers, Research and development were underfunded and mostly anchored in the hands of the donors.  He said regarding the success of the project, research was important because of the need to domesticate AMR, by taking it down lower to the communities.

Dr. Ayume said he was cognizant of the fact that there was a lot to do citing the example of the poor state of abattoirs regarding lack of adherence to public health regulations, poor sanitation as well and non-adherence to public health regulations. Legislation is important because several laws like the Public Health Act although amended do not cover AMR, he observed. He cited the recently enacted Animal Feeds Bill, as one example through which the Government can be held accountable.  He expressed commitment to further spread the AMR message through the Parliamentary Committees of Health from Africa, where he is a member.  For most of the issues that affect the region, he said there was a need to get together, and that this can be a way of domestication of AMR.

The Deputy Principal, CoVAB, Prof James Acai – Okwee who spoke on behalf of the Principal Prof. Frank Nobert Mwiine acknowledged and welcomed the partners from other countries and the German Federal Ministry of Education for the project support. He said Makerere University aspires to translate into a research-led institution including research in AMR.  He explained that there was a significant animal factor in AMR, where infection in animals will always be shared in the human population because of the extensive microbial use in animal production.  Anti-microbial use is becoming the normal practice in production and therefore 75% of the infections originate from the animals that’s why we appreciate the one health approach in addressing AMR, the environment, food production, and public health he said, while appreciating the need for a multi-sectoral approach in addressing the challenge at hand. He expressed the colleges’ commitment and readiness to work with the project team led by Assoc. Prof. Julius Okuni.

Other presenters at the meeting included a representative of the Director General of Health Services, the Ministry of Health, and the Ministry of Water and Environment, among others.

Later on Wednesday 15^th May 2024, the project team visited the College of Veterinary Medicine, Animal Resources, and Biosecurity where they interacted with the leadership and staff and took a guided tour of some of the laboratories.

The Monitoring and Evaluation Technical Support (METS) Program is a 5-year CDC-supported collaboration of Makerere University School of Public Health (MakSPH), the University of California San Francisco (UCSF) and Health Information Systems Program (HISP Uganda).

Highlights of the METS April 2024 Newsletter

• Development of the National Health Data Warehouse
  • MoH, with support from partners like Makerere University School of Public Health METS Program, CDC Uganda, JHPIEGO, Infectious Diseases Institute (IDI) and the Uganda Strengthening Supply Chain Systems (SSCS) is developing a National Data Warehouse to transform the siloed healthcare data into a well-organised and efficient system that gives aggregated information with insights.
  • The national data warehouse project consists of Project management, Business requirements, Developers, Analysts, and Documentation teams.
• Mortality surveillance for healthier communities
  • METS has supported the MoH to digitalise and scale up use of the Health Information System (HMIS) form 100 for notification and certification of medical cause of death using the EMR. The initiative currently being rolled out to 76 health facilities, involves staff orientation on correct form-filling and reporting procedures and working closely with regional implementing partners.
  • This process is aimed at linking information in the EMR to DHIS2. This information will subsequently be transmitted to National Identification and Registration Authority (NIRA), to improve death notification and registration rates in the country.
• DREAMS Program GBV Portfolio Review
  • METS, in collaboration with Ministry of Health and supported by CDC, conducted a GBV portfolio review in the districts of Masaka, Lyantonde, Sembabule, and Kalangala. The review focused on assessing the DREAMS program’s efforts in addressing gender-based violence in these central region districts, particularly concerning adolescent girls and young women (AGYW)s’ enrollment, prompt service delivery post-enrollment, and referrals to additional support services where needed.
  • As a result of the review, plans are underway to increase the number of mentors within the program to provide enhanced support for AGYWs, aiding in their transition towards sustainability. Furthermore, a peer-led employment program will be initiated to provide opportunities for trained beneficiaries. Local government officials, implementing partners, staff, and beneficiaries all participated in the review process, which included focus group discussions to assess the program’s progress.
• Gallery
  • National Health Data Warehouse working meeting – 12^th April 2024
  • METS MoH AIDS Control Program Meeting – 11^th April 2024
  • UCSF and OpenMRS Team courtesy visit to METS
  • METS mortality surveillance site activation at Komamboga HC III

View on METS

Makerere University students, staff and the general public will have easy and free access to Reproductive Tract Infection (RTI) health services courtesy of a new mobile application developed by Makerere University Hospital.

The Mak RTI mobile App launched on Friday 3^rd May 2024 can be downloaded free of charge from the Google Play Store. The App enables users to learn more about reproductive tract infections, chat with the health care providers, book an appointment with a doctor as well as access other health services.

Makerere University Hospital has also established the RTI Information Centre dedicated to addressing matters pertaining to reproductive tract infections among Ugandans. To supplement the RTI App, Mak hospital has established an RTI clinic which will be open every Monday to provide services to those in need.

In Uganda, a number of people from the age of 15 to 49 years suffer from Reproductive Tract Infections (RTIs). RTIs are defined as infections of the genital organs and include Sexually Transmitted Infections (STIs), endogenous infections and iatrogenic infections. Endogenous infections such as vaginal candidiasis and bacterial vaginosis are not sexually transmitted and can occur among people who have never had a sexual relationship. On the other hand, iatrogenic infections are caused by organisms introduced into the genital tract while doing improper medical procedures for instance unsafe abortions. Research at all levels indicates that if left untreated, RTIs are harmful to a person’s body and can lead to complications some of which may manifest later in life.

According to Prof. Josaphat Byamugisha, Director of Makerere University Hospital and the Principal Investigator of this research project, some of the symptoms of RTIs such as itching in the private body parts and/or experiencing pain when urinating, and/or severe pain during one’s menstrual cycle seem minor, but once left untreated, they advance into health complications such as blocking the fallopian tubes, affecting the ovary and womb, infertility among women, failure of the urinary system and in some cases cancer.

Prof. Byamugisha revealed that the Mak RTI App was developed to address the information gap on RTIs among the community. He observed that some Ugandans (15-49 years), do not have access to the right information about RTIs while others fear to talk about these types of infections because they affect reproductive organs or private body parts. He also mentioned the stigma associated with such diseases for instance referring to them as Sexually Transmitted Diseases (STDs) or Sexually Transmitted Infections (STIs), and yet some of them even attack young people who have never had sexual relations. For example, Syphilis can be transmitted from the mother to the unborn child. Prof. Byamugisha pointed out that to avoid the stigmatization, such infections are better classified as Reproductive Tract Infections (RTIs).

To address the information gap on RTIs, the Principal Investigator Prof. Byamugisha together with a team of researchers from other disciplines at Makerere University wrote a concept which they submitted to the Makerere University Research and Innovations Fund (Mak-RIF) funded by the Government of Uganda. Upon receipt of the funding, the research project team embarked on the development of the Mak RTI App and Mak RTI Information Centre. The Project Research team consists of:  Prof. Josaphat Byamugisha, Prof. Sarah Ssali, Dr. Edith Nakku Joloba, Mr. Rogers Kamulegeya, Ms. Ritah Namisango, Dr. Solomon Aleper, Dr. Mukasa David Christopher and Dr. Hassan Mulema.

“We developed the app mainly to help the public access information about these infections. We feel this information should reach many people and that is why we found it wise to have the Mak RTIs Information Centre,’’ the Principal Investigator said.

Prof. Byamugisha emphasized the need for individuals to seek medical care and treatment as soon as any symptom related to RTIs is detected. He thanked the Directorate for ICT Support (DICTS) led by Mr. Samuel Paul Mugabi for playing a central role in the development of the Mak RIT App.

The Mak RTI Information Centre and Mobile App were officially launched by the Deputy Vice Chancellor (Academic Affairs)-DVCAA, Prof. Umar Kakumba represented by the Principal of the College of Health Sciences (CHS), Prof. Damalie Nakanjako.

The DVCAA commended the Director, Makerere University Hospital for bringing on board a multi-disciplinary research team to address the information gap on RTIs and health services in general. He also applauded the University Hospital for continuously coming up with health products and innovations in line with the University’s digitalization agenda. He underscored that the Mak RTI App and Mak RTI Information Centre would enable students, staff and the public to access the right information on RTIs and health services in general from any part of the country.

“As I launch the Mak RTI Information Centre and Mak RTI App, I am pleased to note that most disciplines such as health, social sciences, gender, communication and the media have participated in the processes leading to this research output. Matters of health should not be left to the doctors alone. Health should be a matter of concern for all of us. We can never have perfect health if we do not collaborate and bring different teams together,” said the Principal.

Prof. Nakanjako said the College of Health Sciences takes the lead in the utilisation of government funds to support research and innovation at Makerere University.  She congratulated the Mak Hospital, which is under the College of Health Sciences, for conducting the research and coming up with the Mak RTI App.

She further highlighted that the College of Health Sciences exists to provide transformative education and research to meet societal needs. “Research is mainly to solve problems in the community, therefore, the Mak RTI App and Information Centre is an example of research that supports the community,” she elaborated. She appreciated the Ministry of Health for continually working with the College of Health Sciences to advance research in Uganda and beyond.

On behalf of the Ministry of Health, Dr. Richard Mugahi, Assistant Commissioner Reproductive and Infant Health, applauded the Makerere University Hospital, the research team and DICTS for developing the Mak RTI App. “In this digital era, this is what is expected. The young people are more digitally oriented. I also commend the shift from the term STI (Sexually Transmitted Infections) to RTI (Reproductive Tract Infections),” he said.

Dr. Mugahi expressed the readiness of the Ministry of Health to integrate the Mak RTI App into its digital products and services. He indicated that the Ministry of Health already has a hotline, and this would be linked with the University Hospital RTI App.

Ms. Ritah Namisango, the Principal Public Relations Officer, and a Member of the Research team re-affirmed that the Mak RTI App presents a convenient and user friendly approach for students, staff and general hospital to access health services at the University Hospital. She urged all attendees to share information about the Mak RTI app widely so that it can reach everyone in need of RTI services.

On behalf of DICTS, Mr. Juma Katongole, the Principal Information Systems Administrator said that the development of the Mak RTI App is anchored in the DICTS mandate of working with the different units at the University to optimize and automate all university business processes/services. Mr. Katongole also assured the student leaders who attended the launch that the information received through the Mak RTI App will be treated with confidentiality and accessed by only the University Medical Team with the mandate to attend to students, staff and the public in general.

Responding to questions from student leaders from the respective Colleges and Halls of Residence, the Mak RTI Project Coordinator Dr. Hassan Mulema emphasized that the App is very secure and as such, users should not be worried about any information leakages. The medical team at Makerere University Hospital will continue to uphold matters of privacy, confidentiality and the ethical standards that govern the medical profession when using the Mak RTI App to provide services to students, staff and the general public.

The Mak Students’ Guild who attended the launch appreciated the University Hospital for coming up with the Mak RTI App, which is bringing the health services closer to the people. The student leaders pledged to popularize the Mak RTI App to the University community.

The launch of the Mak RTI App that was witnessed by medical practitioners, the Ministry of Health, Mak Student Leaders, Public Relations Office, DICTS, Journalists and staff from Makerere University Hospital was moderated by Ms Ritah Namisango assisted by Dr. David Mukasa.

Important notes: The Mak RTI App is a one-stop center for reproductive tract infection and other health services available at Makerere University hospital. The app enables users easily talk to medical officers for any services they may be in need of. The app is currently available for android users and can be downloaded on the Google Play Store using this link: https://play.google.com/store/apps/details?id=com.makererehospital.rti