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The African Critical Illness Outcomes Study (ACIOS): a point prevalence study of critical illness in 22 nations in Africa

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The African Critical Illness Outcome Study (ACIOS) is the largest study to date on critical illness in Africa, highlighting a significant burden of life-threatening conditions in hospitals across the continent. The study aimed to assess the prevalence, management, and outcomes of critically ill patients while identifying gaps in essential emergency and critical care (EECC).

Associate Professor Arthur Kwizera (College of Health Sciences, Makerere University) was a Co-Investigator and National Lead for Uganda in partnership with researchers from Europe and Africa.

A Research publication detailing the study was published in the Lancet and can be downloaded here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02846-0/fulltext

Key Findings

  • High Prevalence of Critical Illness: One in eight hospital inpatients (12.5%) in Africa are critically ill.
  • High Mortality Rate: Critically ill patients face a 21% seven-day mortality rate, significantly higher than the 2.7% mortality for non-critically ill patients.
  • Limited Access to Intensive Care: Nearly 70% of critically ill patients receive care in general hospital wards rather than intensive care units (ICUs) or high-dependency units.
  • Insufficient Emergency Care: Over 56% of critically ill patients do not receive essential emergency and critical care (EECC), including oxygen therapy, intravenous fluids, and airway management.

Significance
The study provides first-of-its-kind epidemiological data on critical illness across multiple African countries. The findings highlight severe gaps in emergency care infrastructure and resources, emphasizing the need for investment in low-cost, lifesaving interventions to reduce mortality. Addressing these gaps through EECC can save many lives without requiring high-cost ICU infrastructure.

Study Methodology
ACIOS was a multi-country prospective study, involving 20,000 patients from 180 hospitals in 22 African countries. Investigators assessed all adult inpatients (≥18 years) across different hospitals, identifying those with severely deranged vital signs. Patients were then followed up over seven days to determine their health outcomes. Additionally, the study collected hospital resource availability data to assess the readiness of facilities to provide critical care.

Funding and Collaboration
The study was funded by the National Institute for Health and Care Research (NIHR) Global Health Group in Perioperative and Critical Care (NIHR133850) with Professors Rupert Pearse and Bruce Biccard as PIs, and conducted in partnership with Makerere University (Uganda) led by Associate Professor Arthur Kwizera (as Co-PI and national lead), Busitema University (Uganda) led by Dr Adam Hewitt Smith, University of Cape Town (South Africa) led by Bruce Biccard, Muhimbili University of Health and Allied Sciences (Tanzania) Led by Dr Tim Baker, Queen Mary University of London (UK), the African Perioperative Research Group, and the EECC Network.

Policy Implications
The findings call for urgent action by health policymakers and hospital administrators to:

  • Strengthen emergency and critical care services in general hospital wards.
  • Improve the availability of essential life-saving interventions such as oxygen therapy and IV fluids.
  • Train healthcare workers in essential emergency and critical care (EECC) protocols to enhance patient outcomes.

Relevance to Uganda
Uganda, like many African countries, faces a severe shortage of ICU beds and critical care services. The study underscores the urgent need for investment in critical care infrastructure and workforce training to improve survival rates among critically ill patients.

Conclusion
The ACIOS study is a wake-up call for Africa’s healthcare systems, urging greater focus on low-cost, high-impact interventions that can significantly reduce mortality among critically ill patients. By prioritizing essential emergency and critical care, health systems can improve survival rates without requiring large investments in ICU infrastructure.

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Mak Staff Receive Prestigious International “Future of the Field” Recognition in Global Research Administration Class of 2026.

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Mr. Mordecai Tayebwa (L) and Ms. Bonny Tusiime(R)

Makerere University proudly celebrates the recognition of Mr. Mordecai Tayebwa, Senior Grants Manager, Makerere University Lung Institute and Ms. Bonny Tusiime, Grants and Contracts Officer, Makerere University College of Health of Sciences (MakCHS) as recipients of the prestigious Future of the Field Award of Society of Research Administrators International (SRAI), an international recognition that Honors emerging leaders making outstanding contributions to the advancement of research administration. This year’s ‘Future of the Field’ honorees were formally recognized at SRAI’s Annual Meeting held in Honolulu, Hawaii, USA in October, 2026.

The Future of the Field Award recognizes professionals who demonstrate exceptional leadership, innovation, and commitment to strengthening research management and administration. The award celebrates individuals whose work is shaping the future of the profession by improving research support systems, fostering collaboration, and advancing excellence in research administration.

At Makerere University, Mr. Tayebwa and Ms. Tusiime have played key roles in strengthening grants and contracts management, supporting researchers throughout the grant lifecycle, promoting compliance with sponsor requirements, and contributing to the development of sustainable research management systems. Their efforts have enhanced institutional capacity to attract, manage, and administer competitive research funding while ensuring accountability and excellence. Commenting on the recognition, the award recipients expressed their gratitude for the opportunity to contribute to the growth of research administration. “This recognition reflects not only our individual efforts but also the collaborative environment at  MakCHS and Makerere University. It inspires us to continue strengthening research administration and supporting researchers in generating impactful scientific discoveries that improve lives.” They said.

The achievement highlights the growing international recognition of research administration professionals in Africa and underscores Makerere University and MakCHS’s  general commitment to building strong research support systems that enable world-class research. This also reflects the institution’s investment in professional development and its dedication to advancing research excellence through effective grants management.

Commenting on the award, Dara C. Little, President, (SRAI) said “In a field as dynamic and rapidly evolving as research administration, the need for visionary,adaptable leaders have never been greater,” . “SRAI’s Future of the Field recipients represent the next generation of changemakers – those who will not only navigate complexity but shape the future of our profession. To embrace change, is to lead your innovation, resilience, and leadership are exactly what this moment demands. Rise to the opportunity and you will do great things!”

Makerere University congratulates Mr. Mordecai Tayebwa and Ms. Bonny Tusiime on this significant achievement and wishes them continued success as they contribute to shaping the future of research administration both regionally and globally

Zaam Ssali
Zaam Ssali

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Mayuge Study Finds NCD Risks Emerging in Adolescence, and Shows Early Action Can Help

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Prof. David Guwatudde, Principal Investigator (centre), and Dr. Justine Bukenya with researchers and stakeholders at the ARISE-NUTRINT dissemination meeting in Iganga, 1 October 2026.

Prof. David Guwatudde, Principal Investigator (centre), and Dr. Justine Bukenya with researchers and stakeholders at the ARISE-NUTRINT dissemination meeting in Iganga, 1 October 2026.

Adolescence is a consequential period for health, when diets, behaviours and other risks can form and persist into adulthood. In Mayuge District, new evidence from Makerere University School of Public Health is showing how some of these early vulnerabilities could contribute to the later risk of non-communicable diseases (NCDs), and what can change when interventions begin early.

The evidence comes from the ARISE-NUTRINT project, a three-year EU-funded study led by Prof. David Guwatudde and Dr. Justine Bukenya. The project examines health and behavioural risks among adolescents and young adults, with a particular focus on nutrition-related NCD risks, and tests interventions designed to improve nutrition fluency and diet quality.

The work comes against a substantial NCD burden in a country where 73.2% of the population is below 30. WHO estimates that NCDs accounted for 42.2% of deaths in Uganda in 2023, while the country’s latest national NCD risk-factor survey found significant risk factors persisting in the population, with little overall change from the previous survey in 2014. Together, the evidence strengthens the case for prevention much earlier in life.

“There is strong evidence from literature demonstrating that most behavioral NCD risk factors, including nutrition-related, are established during childhood, persisting into adulthood. This may lead to development of actual NCDs if such risks are not reversed early,” Prof. Guwatudde said.

The study, he explained, linked assessment of young people’s health risks with developing responses suited to their circumstances. Since enrolling 1,206 participants aged 10–24 in Mayuge District in March 2024, the team has conducted three annual rounds of data collection, with young people and local stakeholders also helping evaluate interventions to reduce the risks identified.

Prof. David Guwatudde (right) addresses stakeholders alongside the ARISE-NUTRINT study team in Iganga on 1 October 2026.

A problem that starts early

The findings, shared with community and district stakeholders in Iganga on October 1, 2026, show that some vulnerabilities were already evident at baseline. Nearly one in three participants had anaemia, 49% had low nutrition literacy, while about one in ten reported symptoms of anxiety and a similar proportion reported depressive symptoms.

Anaemia, a condition in which the blood does not have enough healthy red blood cells or haemoglobin to carry adequate oxygen around the body, was highest among the youngest participants. Overall, 375, or 31%, had anaemia, rising to 35.7 per cent among 10–14-year-olds, compared with 18.9% among those aged 15–19 and 10.6 per cent among young adults aged 20–24.

Nutrition presented another challenge. At baseline, 49% of participants had low nutrition literacy and 13% had poor overall diet quality. Low nutrition literacy was associated with more than four times the odds of poor diet quality.

Gaps also emerged in sexual and reproductive health knowledge and behaviour. About 14 per cent of participants did not know that HIV cannot be transmitted by sharing food with a person living with HIV, 10% believed a condom could be used more than once, and 13 per cent did not know pregnancy could occur during first sexual intercourse. Among 168 participants who reported having had sex, more than half reported using no method to prevent pregnancy during their first or most recent sexual intercourse.

Mental health findings added another dimension. Anxiety symptoms were reported by 10 per cent of participants, depressive symptoms by 9.5% and loneliness by 6.3 per cent. Among 534 participants aged 13–24 assessed for suicidal ideation, 1.9% reported suicidal thoughts.

Together, the baseline findings show that vulnerabilities extended beyond any single health issue. For nutrition, the study went further to examine what shaped everyday food choices and whether those influences could be changed.

Nutrition literacy goes beyond knowing which foods are healthy. It includes understanding nutrition information and applying it to everyday choices. The study found those choices were also shaped by parents, peers, food vendors, culture, prices, seasons, and what was available locally. Improving diets, therefore, required reaching beyond individual knowledge to the households and communities where food choices are made.

What early action changed

The baseline evidence informed the Adolescent Nutrition Fluency Intervention. Working with adolescents and young adults, caregivers, Community Health Workers (CHWs), district teams and other stakeholders, the project adapted nutrition messages to local foods, language and household realities. Ten trained CHWs delivered nine monthly household sessions covering balanced diets, physical activity, vitamins and minerals, meal planning and anaemia prevention.

The household approach reached young people in and out of school. The nutrition literacy, diet-quality and intervention analyses form part of the PhD research of Mr. Thomas Buyinza, supported through ARISE-NUTRINT. At endline, participants who received the sessions recorded higher nutrition literacy and overall diet-quality scores.

“The improvement in nutrition literacy and diet quality suggests that practical education, grounded in local foods and household realities, can support healthier choices among adolescents and young adults. In addition, involving parents and caregivers is important because they influence what families buy, prepare, and eat,” Dr. Bukenya said.

She stressed that nutrition education needed to be complemented by better access to affordable, nutritious foods. Dr. Bukenya also called for continued follow-up, including the use of nutrition and dietary data from DHIS2, to assess whether improvements were maintained and guide district planning.

Dr. Justine Bukenya emphasises family involvement in nutrition education and access to affordable, nutritious foods during the ARISE-NUTRINT dissemination meeting in Iganga on 1 October 2026.
Dr. Justine Bukenya emphasises family involvement in nutrition education and access to affordable, nutritious foods during the ARISE-NUTRINT dissemination meeting in Iganga on 1 October 2026.

Changes in other outcomes were mixed. Participants reporting no physical activity fell from 22.6% to 7.4%, while those active on four to seven days a week increased from 46% to 54.8%. But activity duration did not improve: those reporting more than 60 minutes a day declined from 28.2% to 21.1%. Underweight fell modestly from 6.2% to 5%, while overweight and obesity did not change significantly.

Anaemia recorded the largest change, falling from 31.1% before the intervention to 9.9% afterwards. During the intervention period, participants received weekly iron and folic acid supplementation and deworming alongside nutrition education on iron-rich foods, dietary diversity and practices that improve iron absorption.

Illustration of the ARISE-NUTRINT household approach: ten trained community health workers delivered nine monthly nutrition education sessions to adolescents and young adults, involving parents and caregivers. AI-generated illustration.
Illustration of the ARISE-NUTRINT household approach: ten trained community health workers delivered nine monthly nutrition education sessions to adolescents and young adults, involving parents and caregivers. AI-generated illustration.

Mayuge District’s Assistant District Health Officer, Ms. Elizabeth Kawaala, said the findings reflected problems recognised locally and highlighted the need for a response involving families and other stakeholders.

“There is a serious challenge that needs to be tackled with many stakeholders, with parents at the centre because these are children. We also learnt that many parents, I think, lack the skills to communicate with their adolescents,” she said.

Mayuge District’s Assistant District Health Officer, Ms. Elizabeth Kawaala, speaks during the dissemination of ARISE-NUTRINT study findings in Iganga on 1 October 2026.
Mayuge District’s Assistant District Health Officer, Ms. Elizabeth Kawaala, speaks during the dissemination of ARISE-NUTRINT study findings in Iganga on 1 October 2026.

She said the findings had been shared with colleagues and described integrating health education and sensitisation into services. She also called for departments to use the evidence when planning activities in their workplans.

Beyond Mayuge

Seen alongside Uganda’s 2023 STEPS survey, the Mayuge findings add an earlier-life dimension to the national evidence. Makerere University School of Public Health contributed to both studies, with Prof. Guwatudde contributing to the national STEPS survey and now leading ARISE-NUTRINT. While STEPS found significant NCD risk factors persisting among adults, ARISE-NUTRINT shows that some behaviours and vulnerabilities relevant to later NCD risk are already evident during adolescence and young adulthood. The Mayuge research goes further by testing what can change when interventions begin during this period.

The findings leave Mayuge with more than a measure of the problem. They show where vulnerabilities are emerging, what changed when interventions were introduced and where challenges remain. For ARISE-NUTRINT, the evidence now turns attention to which approaches can be sustained and how lessons from Mayuge can inform efforts to support healthier transitions from adolescence into adulthood.

John Okeya

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PhD Fellowship Opportunity: NETOMA Study

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Dr. Henry Komakech (centre) stands with fellow MakSPH PhD graduands at Makerere University’s 76th Graduation Ceremony (L–R): Dr. Olivia Nakisita, Dr. Aber Harriet Odonga, Dr. David Lubogo, Dr. Samalie Namukose, Dr. Moses Ntaro and Dr. Jimmy Osuret. February 25, 2026, Freedom Square, Makerere University. Makerere University School of Public Health Communications Office, Graduation Profiles Series, 76th Graduation Ceremony, Dr. Henry Komakech, “Effects of the Repatriation of Refugees on the Health Services of the Host Populations in the West Nile Districts of Arua, Moyo, and Adjumani,” Kampala Uganda, East Africa.

Makerere University School of Public Health invites applications for a PhD fellowship under the Wellcome Trust-supported NETOMA study, which examines the coexistence of health worker shortages and unemployment among qualified health professionals in Africa.

The successful candidate will undertake doctoral research involving ethnographic fieldwork and qualitative analysis of health workers’ professional identities, employment experiences and livelihoods. Applicants should hold a Master’s degree in Anthropology, Sociology, Development Studies, Political Economy or a closely related discipline, with training in qualitative research methods.

Application deadline: 21 October 2026

Full details and application instructions: https://sph.mak.ac.ug/careers/?view_job=21462

Mak Editor

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