The ward is never quiet during labour. Even at night, there are cries, some sharp with pain, others muted by exhaustion. Monitors beep. Midwives move quickly between beds. In the moments just before birth, everything narrows to breath, pressure, and time.

It was in places like this, years ago, that Phillip Wanduru first learned how fragile that moment can be.

Working as a clinical nurse at Nakaseke Hospital in central Uganda, he watched babies who should have survived struggle for breath. Some were born still. Others cried briefly, then went silent. Many were not premature or unusually small; they were full-term babies whose lives unraveled during labour.

“What troubled me most,” Wanduru recalls, “was that these were complications we have known how to manage for more than a hundred years, prolonged labour, obstructed labour, and hypertension. And yet babies were still dying or surviving with brain injuries.”

Those early encounters never left him. They became the questions that followed him into public health, into research, and eventually into a doctoral thesis that would confront one of Uganda’s most persistent and preventable tragedies.

A Public Defense, Years in the Making

On Friday, June 13, 2025, Wanduru stood before colleagues, mentors, and examiners in a hybrid doctoral defense held at the David Widerström Building in Solna, Sweden, and online from Kampala. The room was formal, but the subject matter was anything but abstract.

His PhD thesis, “Intrapartum-Related Adverse Perinatal Outcomes: Burden, Consequences, and Models of Care from Studies in Eastern Uganda,” was the culmination of years spent listening to mothers, following newborns long after delivery, and documenting what happens when birth goes wrong.

He completed the PhD through a collaborative programme between Makerere University and Karolinska Institutet, under the supervision of Prof. Claudia Hanson, Assoc. Prof. Peter Waiswa, Assoc. Prof. Helle Mölsted Alvesson, and Assoc. Prof. Angelina Kakooza-Mwesige, a team that bridged global expertise and local reality. His doctoral training unfolded as the two institutions marked 25 years of collaboration, a partnership that has shaped generations of public health researchers and strengthened research capacity across Uganda and beyond.

By the time he defended, the findings were already unsettlingly clear.

One in Ten Births

In hospitals in Eastern Uganda, Wanduru’s research found that more than one in ten babies experiences an intrapartum-related adverse outcome. This medical term refers to babies who are born still, die shortly after birth, or survive with brain injury caused by oxygen deprivation during labour.

Among those outcomes, stillbirths accounted for four in ten cases. Five in ten babies survived with brain injury.

“These are not rare events,” Wanduru explains. “They are happening every day, often in facilities where care should be available.”

But survival was only part of the story.

Following infants diagnosed with intrapartum-related neonatal encephalopathy for a year, his research revealed that about seven in ten babies with severe brain injury died before their first birthday. Among survivors, many faced lifelong challenges, difficulty walking, talking, and learning.

“What happens in labour,” he says, “does not end in the delivery room. It follows families for years.”

He describes the findings of his PhD research as appalling, evidence of an urgent failure in how labour and delivery are managed, and a call for immediate action to prevent avoidable complications. “Babies with severe brain injuries,” he notes, “faced the greatest odds. Even when they survived birth, nearly seven in ten died before their first birthday. Of those who lived beyond infancy, about half were left with long-term challenges, including difficulties with walking, talking, or learning.”

Mothers at the Centre—Yet Often Invisible

Wanduru’s work did not stop at numbers. Through in-depth interviews with mothers and health workers, he uncovered a quieter truth that parents, especially mothers, were desperate to help their babies survive, but often felt unsupported themselves.

Mothers followed instructions closely. They learned to feed fragile babies, keep them warm, and monitor breathing. They complied with every rule, driven by fear and hope in equal measure.

“The survival of the baby became the only focus,” Wanduru says. “But the mothers were exhausted, emotionally drained, and often ignored once the baby became the patient.”

Even as mothers remained central to care, their own physical and mental well-being received little attention. For the poorest families, the burden was heavier still: long hospital stays, transport costs, and uncertainty about the future.

These insights shaped one of the thesis’s most powerful conclusions: saving newborn lives requires caring for families, not just treating conditions.

Why Care Fails—Even When Knowledge Exists

One of the most uncomfortable findings in Wanduru’s research was that emergency referrals and caesarean sections did not consistently reduce the risk of brain injury, except in cases of prolonged or obstructed labour.

The problem, he found, was not the intervention, but the delay.

In many facilities, hours passed between identifying a complication and acting on it. Ambulances were unavailable. Referral systems were weak. Operating theatres lacked supplies or staff.

“These are not failures of science,” Wanduru says. “They are failures of systems.”

His work reinforces a sobering reality for policymakers that most intrapartum-related deaths and disabilities are preventable, but only if care is timely, coordinated, and adequately resourced.

From Bedside to Systems Thinking

Wanduru’s path into public health began at the bedside. After earning a Bachelor of Science in Nursing from Mbarara University of Science and Technology in 2011, he trained as a clinician, caring for patients during some of their most vulnerable moments. He later completed a Master of Public Health at Makerere University in 2015, a transition that gradually widened his focus from individual patients to the health systems responsible for their care.

His work gradually drew him deeper into the systems shaping maternal and newborn care. As a field coordinator for the MANeSCALE project, he worked within public and private not-for-profit hospitals, helping to improve clinical outcomes for mothers and babies. Under the Preterm Birth Initiative, he served as an analyst, contributing to efforts to reduce preterm births and improve survival among vulnerable infants through quality-improvement and discovery research across Uganda, Kenya, and Rwanda.

In the Busoga region, he coordinated prospective preterm birth phenotyping, following mothers and babies over time to better understand the causes and consequences of early birth. Since 2016, this work has been anchored at Makerere University School of Public Health, where he serves as a Research Associate in the Department of Health Policy, Planning, and Management.

Across these roles, he found himself returning to the same question: why babies continue to die during a moment medicine has long learned to handle.

Models of Care That Could Change Outcomes

Wanduru’s thesis does more than document failure; it points toward solutions.

He highlights family-centred care models, including Kangaroo Mother Care, which keep babies and parents together and improve recovery, bonding, and brain development. He emphasizes early detection of labour complications, functional referral systems, and rapid access to emergency obstetric care.

“These are not new ideas,” he says. “The challenge is doing them consistently.”

He also calls for recognizing stillbirths, not as inevitable losses, but as preventable events deserving data, policy attention, and bereavement support.

“Stillbirths are often invisible,” he notes. “But they matter to mothers, to families, and to the health system.”

Research That Changes Practice

For Wanduru, the most meaningful part of the PhD journey is that the evidence is already being used. Findings from his work have informed hospital practices, advocacy reports, and quality-improvement discussions.

“Yes, the PhD was demanding,” he admits. “But knowing that the work is already contributing to change makes it worthwhile.”

His mentors see him as part of a broader lineage, researchers committed not only to generating evidence but to ensuring it improves care.

With a PhD in his bag, Wanduru sees his work as a continuation rather than a conclusion.

“The fight to make birth safe for every mother and baby continues,” he says. “I want to contribute to improving care and to building the capacity of others to do the same.”

That means mentoring young researchers, strengthening hospital systems, and keeping the focus on families whose lives are shaped in the delivery room.

Dr. Wanduru joins fellows in the MakSPH PhD forum who concluded their doctoral journeys in 2025, and his work speaks for babies who never cried, for mothers who waited too long for help, and for health workers doing their best within strained systems. It insists that birth, while always risky, does not have to be deadly.

— Makerere University School of Public Health Communications Office, Graduation Profiles Series, 76^th Graduation Ceremony

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_{By Joseph Odoi}

In the remote villages of Eastern and Northern Uganda, a small medical device is doing far more than preventing unintended pregnancies, it appears to be quietly shifting the balance of power in women’s lives.

A new study titled “Is choosing self-injectable contraception associated with enhanced contraceptive agency? Findings from a 12-month cohort study in Uganda” has revealed that self-injection gives women more than just a health service, it can boost their confidence, control, and agency over their reproductive health.

The research was conducted by Makerere University namely; Professor Peter Waiswa, Catherine Birabwa, Ronald Wasswa, Dinah Amongin and Sharon Alum in collaboration with colleagues from the University of California, San Francisco

Why this Study matters for Uganda

For decades, family planning in Uganda has followed a provider-client model. Women travel long distances to clinics, wait in queues, and rely on health workers to administer contraception. This system creates barriers transport costs, clinic stock-outs, long waiting times, and limited privacy.

Self-injectable contraception, known as DMPA-SC, disrupts this model by shifting care from the clinic to the individual woman.

DMPA-SC is a discreet, easy-to-use injectable that women can administer themselves after receiving basic training and counselling.

What the Data Tells Us

To see if self-care technology actually shifts the needle on women’s power, researchers tracked 1,828 women across Eastern (Iganga and Mayuge Districts) and Northern Uganda (Kole, Lira, and Oyam Districts) for a full year. They compared women who chose to self-inject their birth control (216 women) against a control group, most of whom chose methods requiring dependency on clinics (1,612 women).   

The Six-Month “Agency Spike”

The study used a Contraceptive Agency scale (scored from 0 to 3) to measure a woman’s internal confidence and her ability to act on her health choices.

The Self-Injectors

For the Self Injectors, their agency scores rose significantly, from 2.65 to 2.74 by the six-month mark.

The Clinic-Dependent Group

Scores for the group using mostly provider-led methods (like clinic shots or implants) remained nearly flat, moving from 2.61 to only 2.63.

Within just six months, women who took control of their own injections noted that they felt a measurable boost in their Consciousness of reproductive Rights (0.08 points) since they transitioned from being passive recipients of care to active decision-makers.

Using the Agency in Contraceptive Decisions Scale (scored 0–3), the study found a clear empowerment advantage for women who chose self-injection.

The findings come at a time when Uganda has reaffirmed its commitments under FP2030, aiming to expand access to voluntary, rights-based family planning. The study also aligns with the National Family Planning Costed Implementation Plan, which prioritises method choice, equity, and continuation, as well as national gender and youth empowerment strategies.

Can Uganda Sustain and Scale DMPA-SC?

Self-injectable contraception does not require continuous high-cost investment. Training and rollout costs are largely one-time, and the main recurring expense is the contraceptive commodity itself. Compared with the cumulative costs of repeated clinic visits for both the health system and women self-injection is more cost-effective over time.

Advancing primary health care with DMPA-SC

Beyond cost savings, self-injection eases pressure on health facilities and allows health workers to focus on more complex care. It also extends health services into communities, supporting continuity of care in areas where facilities are few and far between. In this way, family planning is no longer confined to the clinic.

While donor support has helped introduce the method, it can be sustained locally without relying on external funding. “With predictable national financing and reliable commodity supply chains, DMPA-SC can reach more women and be fully integrated into Uganda’s health system, strengthening both access and community-level service delivery’’ according to the researchers.

Implications for Policy and Practice

As Uganda continues to reform its primary health care system, the findings add evidence to ongoing discussions about how family planning services are delivered, financed, and prioritised.

The research also positions self-injectable contraception not as a temporary innovation, but as a scalable method with the potential to be embedded within national systems provided that commodity availability and financing are safeguarded.

To ensure these gains are lasting, researchers recommend moving beyond the technology and addressing the structural and social barriers that can limit women’s agency.

Key recommendations from the researchers include the following

1. Reliable Supply Chains

Empowerment collapses when products are unavailable. DMPA-SC must be consistently stocked at the community level.

2. Creating a Supportive Social Environment

Privacy concerns, stigma, and partner resistance must be tackled through community engagement and sensitisation.

3. Prioritizing Informed Choice

Self-injection should be offered as a top-tier option in every facility, framed as a fundamental right to autonomy rather than just a medical convenience.

4. Integrated Counseling

Providers must be trained to support women not only in the “how to inject” but also in navigating the social challenges of self-care.

On the next step, the researchers call for a clear integration of DMPA-SC into national health financing, protection of family planning commodity budgets, and deliberate scaling of self-injectable contraception within Primary Health Care reforms. These actions will ensure sustainability, reliable access, and greater control for women over their reproductive choices according to the researchers.

Read the full study here: https://www.contraceptionjournal.org/article/S0010-7824(26)00003-X/fulltext

On a weekday morning in Kampala, the city snarls without any signs of awakening. Cars grind bumper to bumper along crumbling asphalt, their horns locked in a long, impatient argument. Rusting taxis and private vehicles shudder under the rising sun. Boda bodas slice through impossibly narrow gaps, mount pavements, edge past crossings, and assert dominance wherever there is room to move. The road belongs to whoever is bold enough to seize it.

And on the margins of this contest, there are children.

At 6 a.m., long before office doors open, primary school pupils begin their walk. Backpacks bounce against narrow shoulders as they navigate broken sidewalks and dusty road edges. When they reach a main road, their rhythm changes. Some stop and scan, small hands grip the straps. Others hesitate, then dart, misjudging speed, trusting that a driver will slow down.

But traffic rarely slows.

In Kampala, pedestrians do not command the road; they negotiate with it. Every crossing is a calculation. Every pause carries risk. Children learn early that movement requires courage. They watch for gaps, read the body language of drivers, and step forward in faith.

It is in that fragile second, between hesitation and impact, that the question begins to form.

For Jimmy Osuret, this is not an abstract problem of urban mobility but a daily reality, etched into memory long before it became research.

In 1996, as a Primary Four pupil at Shimoni Demonstration School, then located along the busy Nile Avenue corridor in Uganda’s capital, Kampala, he watched a classmate attempt to cross the road on an ordinary school day. A truck did not slow down. The child did not make it to the other side.

“It stayed with me,” Osuret recalls. “At the time, I didn’t have the language for it. But that moment shaped how I came to understand injuries—not as accidents, but as something patterned, preventable, and deeply unfair.”

Nearly three decades later, the school has moved, and the road has changed, but Kampala’s traffic has only grown more unforgiving. Children still gather at pavements across the city, backpacks bouncing, eyes fixed on gaps in traffic that may or may not come. And Osuret would return to these streets, not as a schoolboy navigating danger, but as a public health scientist determined to change what danger looks like for Uganda’s children.

From Personal Loss to Public Health Purpose

Osuret’s journey into injury research unfolded through lived experience, service, and grief, each layer sharpening his understanding of why pedestrian safety matters.

After completing his Bachelor’s degree in Environmental Health at Makerere University, he volunteered with the Uganda Red Cross Society in Bushenyi District between 2009 and 2011. There, he was exposed to emergency response, first aid, and trauma care. Road crashes were no longer statistics but bleeding bodies, panicked families, and systems struggling to respond in time.

“That experience changed how I saw injuries,” he reflects. “They weren’t isolated events. They were predictable outcomes of unsafe systems.”

His MSc in Public Health at Oxford Brookes University deepened that lens. Focusing his dissertation on alcohol-related road traffic injuries, Osuret built strong skills in epidemiology and behavioural research, tools he would later bring back home.

But it was personal loss that cemented his resolve. A cousin was killed in a hit-and-run crash. Another reminder that vulnerability on Uganda’s roads often carries the highest cost.

Together, these experiences shaped the research question that would define his PhD: Why are Kampala’s roads so unsafe for children, and what actually works to protect them?

Kampala’s Roads, Through a Child’s Eyes

Every day, millions of Ugandans walk to school, to work, to markets, to taxi stages. At some point in the day, everyone becomes a pedestrian. For children, walking is not a choice; it is the only option. Yet Kampala’s roads tell children they do not belong.

Rapid urbanisation and motorisation have transformed the city, but road design continues to privilege vehicles over people. Sidewalks are missing or obstructed. Safe crossings are rare. Speed control is weak. Children are forced to negotiate fast-moving traffic despite their limited ability to judge speed and distance.

Osuret’s research confirms what many parents already fear. Pedestrians account for more than a third of road casualties in Uganda, with children bearing a disproportionate share of that burden. Unsafe crossing behaviours, running, failing to stop at the pavement, and weaving between vehicles are not acts of carelessness. They are survival strategies in hostile environments.

“Children are expected to behave safely in systems that are fundamentally unsafe,” he explains. “That is not reasonable, and it is not ethical.”

Watching the Road Tell Its Story

Rather than relying on self-reports or simulations, Osuret turned to the road itself. Using discreetly mounted video cameras at school crossings across Kampala, his team observed thousands of real interactions between children, vehicles, and the built environment. The footage captured moments of hesitation, confusion, urgency, and occasionally, near misses that left the researchers gasping for air.

His findings were sobering. One in five children failed to wait at the pavement. More than a quarter crossed outside marked crosswalks. Many ran. Some crossed between vehicles, often when drivers failed to yield.

“These behaviours are not random,” Osuret notes. “They respond directly to what drivers do and what the road allows.”

Crucially, the data revealed something else: where trained school traffic wardens were present, children behaved differently, and drivers did too.

The Power of a Raised Hand

Osuret’s PhD went beyond observation. It tested a solution.

In a cluster-randomized trial across 34 public primary schools, his team introduced a school traffic warden behavioural promotion programme, a low-cost intervention placing trained adult wardens at school crossings during peak hours. The wardens wore reflective gear, used stop paddles, made eye contact with drivers, and guided children through safe crossing routines: stop, look, wait, walk.

Strikingly, drivers were more than seven times more likely to yield to child pedestrians where a traffic warden was present. Children were 70% more likely to cross safely, stopping at the pavement, walking instead of running, and avoiding dangerous gaps between vehicles.

“What surprised me most,” Osuret recalls, “was how quickly children adapted. When the system supported them, safer behaviour became the norm.”

The intervention faced some resistance. Some drivers ignored wardens. Others were openly hostile. These moments revealed a deeper truth that behaviour change cannot rely on goodwill alone. It requires enforcement, legitimacy, and policy backing.

Behaviour Is Not the Problem—Systems Are

A central insight of Osuret’s work is that road safety debates often focus on the wrong actor.

“Children are told to be careful,” he says. “But children are not the ones designing roads, setting speed limits, or enforcing laws.”

His research shows that driver behaviour, especially yielding and speed, has a direct protective effect on children. Higher driver-yielding rates are consistently associated with fewer pedestrian collisions. Behaviour change among drivers is therefore not optional but foundational.

This perspective aligns with the Safe Systems Approach, which recognises human error as inevitable and places responsibility on systems to prevent fatal outcomes. In Kampala, where infrastructure and enforcement gaps are stark, behavioural interventions like traffic wardens offer an immediate, scalable bridge, especially in school zones.

Scholarship Grounded in Community

Osuret’s academic home at Makerere University School of Public Health shaped how his research evolved. Mentorship from senior injury researchers at Makerere University grounded his work in rigorous methods and local relevance.

“I worked closely with Dr. Olive Kobusingye at the Trauma, Injury, and Disability Unit and became involved in research on pedestrian road safety through international collaborations. Makerere taught me to ask questions that matter here,” he says. “Not just what is publishable, but what is usable.”

That grounding helped him navigate the most challenging phase of his PhD, especially balancing full-time academic work, research, and personal responsibilities. Like many African scholars, he conducted much of his doctoral research while teaching, mentoring, and engaging communities.

“It made me deeply aware of the structural barriers young researchers face,” he reflects. “And it strengthened my commitment to mentorship.”

From Evidence to Action

On January 10, 2025, Osuret publicly defended his PhD in a hybrid session at the Makerere University School of Public Health Auditorium. The defense was both a scholarly milestone and a personal reckoning, a moment when decades of memory, loss, and inquiry converged.

But for Osuret, the PhD was never an endpoint.

Today, he serves on the National Road Safety Committee, contributing evidence to Uganda’s National Road Safety Action Plan. He mentors students, collaborates with policymakers, and continues to argue, persistently, that injuries deserve the same public health urgency as infectious diseases.

“The gap is not knowledge,” he says. “We know what works. The gap is translating evidence into action.”

If policymakers took just one lesson from his research, “design roads around children, not vehicles,” he says. Osuret believes that speed management, safe crossings, and visible enforcement around schools are essential obligations, not luxuries.

Walking Toward Safer Futures

As the country prepares for the 76th Makerere University Graduation Ceremony this February 2026, where Osuret and 184 others will receive their PhDs, we are reminded of what scholarship can do when it remains rooted in lived reality.

Every day, children still gather on the road pavements outside schools like Shimoni. Traffic still hums, and risk has not disappeared. But in some places, a raised hand, a reflective vest, and a trained presence have shifted the balance, if only slightly, toward safety.

When asked what responsibility he now carries, Osuret does not hesitate.

“To ensure that evidence informs decisions,” he says. “Because at some point in the day, we are all pedestrians. And no one should have to gamble with their life just to cross the road.”

—A publication of the Makerere University School of Public Health Communications Office, Graduation Profiles Series, 76th Graduation Ceremony

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