Health
Research Links Social Support to Improved Contraceptive Decision-Making for Women
Researchers at Makerere University School of Public Health (MakSPH) are urging the Ugandan government to boost healthcare funding to enhance reproductive health services. Dr. Dinah Amongin, an obstetrics and gynecology expert at MakSPH, has expressed concern about the lack of access to family planning methods, which forces women to use less preferred options due to unavailability.
Dr. Amongin notes that within just six months to a year of using contraception, some women encountered issues and switched methods. This highlights the need for the Ministry of Health to improve the availability of various contraceptive options. A rights-based approach to contraception ensures that women have access to a range of methods, preventing situations where desired options are unavailable at health facilities.
“Stockouts are a significant issue, and this extends to parliamentary discussions on health sector budgets. As we focus on human capital development and improving maternal and newborn health outcomes, we must consider crucial components like preventing unwanted pregnancies through family planning. The budget allocation for the health sector directly impacts this issue. When women cannot access their preferred contraceptive methods due to stockouts, it reflects a failure in our legislative and budgeting processes. This situation forces women to switch to fewer desirable methods, which is not acceptable,” says Dr. Amongin.
Adding that; “These are things we need to continue discussing as a country but we must invest into family planning. We can talk about human capital development but until we step up and actually support women to prevent unwanted pregnancies, support them in their decisions of whether she wants to use a method for contraception or not. That is her choice. We must make sure access to the methods of her choice is actually addressed.”
Dr. Amongin’s comments follow a recent study on the I-CAN/Nsobola/An atwero social support intervention, piloted in Mayuge and Oyam districts in 2023. The study highlights that social support significantly improves women’s ability to make informed contraceptive choices, potentially leading to better reproductive health outcomes.
Part of the Innovations for Choice and Autonomy (ICAN) project, the study shows that self-injection with DMPA-SC (Sayana Press) could increase contraceptive use, especially among women with limited access to healthcare. Despite the rollout of this method in 2017, its use remains low in Uganda. Sayana Press as popularly known is a subcutaneous depot medroxyprogesterone acetate (DMPA-SC). It is a hormonal birth control shot, administered under the skin and is an all-in-one contraceptive that puts women in charge of their reproductive health.
Social support boosts self-efficacy, enhances privacy, and reduces access barriers, making self-management easier. Family planning helps manage the number and timing of children, lowering maternal and infant mortality rates and reducing complications from pregnancy. Conversely, unmet contraceptive needs can lead to unintended pregnancies and their associated risks.
In Uganda, 52% of pregnancies are unwanted or mistimed, with over 43% due to unmet family planning needs. The country’s youthful population complicates the issue, with 50% under 17 years old, at least according to the recent National Population Census. Notably, 10% of girls, one in every 10 girls you encounter, has already had sex before she turns 15 years, and 20% of boys, two in 10 boys have engaged in sexual intercourse by the same age.
Methods of contraception include oral contraceptive pills, implants, injectables, patches, vaginal rings, intra uterine devices, condoms, male and female sterilization, lactational amenorrhea methods, withdrawal and fertility awareness-based methods.
Global statistics show that 77.5% of women aged 15–49 had their family planning needs met with modern methods in 2022, up from 67% in 1990. In sub-Saharan Africa, the proportion of women who have their need for family planning satisfied with modern methods (SDG indicator 3.7.1) continues to be among the lowest in the world at 56 per cent. Nevertheless, it also increased faster than in any other region of the world, having more than doubled since 1990, when this proportion was only 24 per cent.
Among 1.9 billion women of reproductive age (15-49 years), an estimated 874 million women use a modern contraceptive method and 92 million, a traditional contraceptive method. The number of modern contraceptive users has nearly doubled worldwide since 1990 (from 467 million). Yet, there are still 164 million women who want to delay or avoid pregnancy and are not using any contraceptive method, and thus are considered to have an unmet need for family planning.
Slow progress is due to factors like limited method choices, restricted access, fear of side effects, cultural opposition, and gender-based barriers.
Between 2015 and 2019, there were 121 million unintended pregnancies annually worldwide – 48 per cent of all pregnancies. Despite decreases in the rate of unintended pregnancy in all regions over the past three decades, nearly one in 10 women in sub-Saharan Africa, Western Asia and Northern Africa, and Oceania (excluding Australia and New Zealand) continue to experience an unintended pregnancy every year
In Uganda, where healthcare services are stretched thin and women juggle numerous responsibilities, accessing contraceptives can be challenging.
Dr. Amongin emphasizes that self-injection methods like DMPA-SC, also known as Sayana Press could ease the burden on women facing long queues and logistical challenges at health facilities. “This method allows for discretion and reduces the need for frequent visits, which is crucial for women with busy lives,” she says.
Researchers argue that the health sector’s budget should include substantial funding for family planning. The high cost of inaction is evident: neglecting family planning leads to unplanned pregnancies, which ultimately burdens families and the nation. Addressing this issue early in the life cycle is crucial to prevent these long-term consequences.
“This is the gist of the matter behind all our research, that a woman’s preference needs to be respected. The health facilities must stock commodities so that when a woman is in need, she actually gets it,” noted Dr. Amongin.
Dr. Peter Waiswa, an Associate Professor at MakSPH, stresses the importance of informed choice in family planning. ICAN studies across Kenya, Malawi, Nigeria, and Uganda show that self-injection benefits all women, including young adolescents. “Supporting young people to make informed choices helps prevent unintended pregnancies,” says Prof. Waiswa.
“We spent four years trying to understand which women benefit from injecting themselves. And we found that all women benefit from it, including younger children. Because younger children in Uganda, whether we hide our heads in the sand or not, especially those 12 years and above are having sex and some of them using contraceptives,” Professor Waiswa says.
What is factually true is that by age 18, 60% of Ugandans have reported having sexual intercourse. Despite the benefits, dropout rates from family planning methods remain high due to side effects and lack of support. Dr. Waiswa also, a Public Health specialist, critique and dreamer for better health systems for mothers, newborns and children in Africa calls for better education and support to address these issues.
“As a way of being supported in a safe space whereby people are not asking questions, they are not fearing parents, they are not fearing other people, then they can use the methods. What we did in Mayuge and Oyam, we trained women who are users of family planning. To identify people who need to use family planning but are not currently using and then they go and see whether they can use or not. And we found that when people are supported, those groups which are currently not being reached can be reached by family planning,” argues Prof. Waiswa.
A 2021 study found that contraceptive discontinuation significantly impacts the effectiveness of family planning services, leading to higher fertility rates, unwanted pregnancies, and induced abortions.
Analysis of data from PMA 2020 show that 6.8% of women discontinued contraceptive use, with discontinuation linked to factors such as age, marital status, method type, and health concerns. The study suggests prioritizing interventions to encourage contraceptive use among young people and promoting partner involvement and awareness, as many contraceptive methods are not discreet.
Prof. Waiswa is concerned of the high dropout rate from family planning methods, where many women discontinue use due to side effects, a need for better education and support.
“We need to see how to educate women so that they are informed when they are choosing a method to use. They need to have enough information because when they discontinue, the method can be ineffective, can cause side effects, but also these methods are expensive, so they waste money. There are a lot of those who change to other methods. We are learning a lot on the use of family planning why we still have a large unmet need,” says Prof. Waiswa.
Ms. Roseline Achola, Technical Specialist for Sexual and Reproductive Health and Self-Care at the Ministry of Health, hailed the MakSPH study on self-injection contraception. She noted that the findings will help her enhance support for self-care initiatives. However, she expressed that only 29% of women willing to self-inject as indicated in the study is still low, highlighting a need to address barriers to increase acceptance as well as managing sexually active adolecents. “We must discuss how to handle minors seeking contraception to prevent unintended pregnancies,” she says.
On Friday August 23, 2024, the Daily Monitor reported, an increase in young girls adopting family planning to combat teenage pregnancies and school dropouts. Quoting data from the Uganda Health Information System, statistics show that between March 2023 and March 2024, 2,476 girls under 15 had their first antenatal care visit, and 1,755 gave birth. The highest number of pregnancies among this age group was in Oyam district.
In this period, Lango subregion saw 52 pregnancies among this age group, with Oyam district recording the highest at 10 cases. The 2021 UNFPA fact sheet indicates that Busoga region, particularly Kamuli and Mayuge districts, has the highest rates of teenage pregnancies, with 6,535 and 6,205 cases respectively.
“As the country, it’s clear that adolescents are limited to access to contraception because of so many reasons. For us as a Ministry, any woman between the age of 15 to 49 is a woman of reproductive age and that tells you that she is capable of getting pregnant and when such a girl of probably 15 years goes to a facility to seek for contraception, it rings a message that actually she is sexually active. So how do we handle her? So that is a matter of discussion for the country.
It is a matter that the nation needs to decide on, because we all know the girls are getting pregnant, the girls want to use contraception, but they have no access because of the fact that they are children,” wondered Achola.
Unintended pregnancies and Uganda’s abortion paradox
Abortion in Uganda, is largely illegal except in specific circumstances. It contributes to maternal death due to unsafe practices. Between 2010 and 2014, WHO reported that 30.6million abortions conducted were safe and 25.1million were unsafe. 97% of these occurred in developing countries. In East Africa, the total number of abortions per year according to the Lancet are around 2.65million.
The Ministry of Health’s HMIS data show a rise in abortion cases, with 96,620 reported between July 2020 and June 2021in both government and private health facilities.
Another recent study on the quality of post-abortion care by MakSPH researchers Assoc. Prof. Lynn Atuyambe, Dr. Justine Bukenya, Dr. Arthur Bagonza and Mr. Sam Etajak highlights the need for accurate post-abortion care data to improve healthcare planning and policymaking.
Dr. Arthur Bagonza, a Public Health Consultant and Research fellow with specialization in health systems at MakSPH and one of the uality of post-abortion care has called for accurate abortion data to improve healthcare planning and policymaking. He notes that health workers often avoid documenting abortion data due to legal fears and calls for reforms to restrictive laws to ensure accurate reporting without legal repercussions.
“All assessed health facilities reviewed in our study achieved a 100% timeliness rate for report submissions. However, significant disparities were observed in data accuracy between different levels of health facilities, with lower-level facilities (HC IIs and HC IIIs) showing higher rates of data discrepancies,” says Dr. Bagonza.
According to Dr. Amongin, the high incidence of early sexual activity among Uganda’s youth is a pressing public health issue.
“We know as a country many women continue to die following unsafe abortions; abortions for pregnancies that they did not want. And these abortions are highest among adolescents and also other women categories.
We would want to ensure that we actually enhance access to contraceptives, but making it easier for them to have it and putting the power in the hands of a woman to as much extent as we can. So that a woman can practice what we call self-care, but of course she also will need the support of the healthcare system. But we want this power in women’s hands because of all the challenges that the women actually can encounter in accessing these methods,” she said.
On her part, Achola insists that abortion should not be a last resort for women and urges them to abstain or use protective means in order to avoid unwanted pregnancies. She notes that as long as abortion remains illegal in Uganda, many health workers will avoid addressing it, leading people to unsafe alternatives.
“I can’t be happy because abortion means we have failed to give people a method of their choice to prevent that pregnancy. Or the people are not able to access contraception to prevent unintended pregnancies. Abortion is not the last resort, it’s not a solution because it has its own complications as well,” says Achola.
Despite this, Achola, notes most of the women who walk in health facilities with post-abortion complications must be attended to. “Whereas we don’t encourage people to do abortions, as Ministry of Health we are mandated to handle all complications for anyone who walks in our facilities because our priority is to save life. We want to urge women to avoid certain things. Why should you wait for unintended pregnancy to occur and then abort?”
Dr. Charles Olaro, a Senior Consultant Surgeon and the Director Health services – Curative in the Ministry of Health highlights the financial burden on individuals seeking health services and suggests exploring private sector opportunities and community-based approaches to improve access. “We need to balance values and rights while addressing access barriers,” he notes.
According to Dr. Olaro, the autonomy and agency of women in sexual and reproductive health, particularly in African cultures remain a challenge where social norms may require women to defer decisions to their partners.
He notes that there is a high burden of abortion and self-harm, with a significant portion of maternal mortality attributed to sepsis, which is often a result of unsafe abortions in Uganda.
“We still need evidence to ensure that access barriers are addressed. And this is a question I keep on asking Makerere University, yes, we have a young population but how are these people accessing contraceptives. Other issue we have to deal with is complex. I know we have to do a balance between values and rights, but we will be able to look at that when they gain the success to do it.”
Dr. Olaro points out that individuals often face a financial burden in health services, spending more on prescriptions than on the medications themselves. He suggests exploring private sector opportunities and a community-based approach to improve access to healthcare.
NB: The PMA surveys are spearheaded by Associate Professor Fredrick Makumbi and Dr. Simon Kibira of MakSPH, with support from the Uganda Bureau of Statistics and the Ministry of Health. The initiative also receives funding from the Bill & Melinda Gates Foundation, The Children’s Investment Fund Foundation (CIFF), and is supported by the Bill & Melinda Gates Institute for Population and Reproductive Health at Johns Hopkins University and Jhpiego.
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
-
General2 weeks agoRe-advert: Admission to Undergraduate Programmes 2025/2026
-
General1 week agoRe-Advert for Applications for Diploma and Certificate Training
-
General5 days agoMakerere University Fees Waiver for 40 First Year Female Students 2025/2026
-
General2 weeks agoPress Statement on Ranking
-
Health1 week agoCall for Applications: Responsible Conduct of Research (RCR) Training Course