Kampala wakes early, but for some girls, the day begins already heavy. In Uganda, nearly three-quarters of the population is under 30, growing up happens fast, and often without protection. One in four Ugandan girls aged 15–19 has already begun childbearing, giving Uganda the highest teenage pregnancy rate in East Africa.
Layered onto this is displacement. The country hosts about 1.7 million refugees, many living in cities like Kampala, where survival depends on navigating systems not designed with them in mind. Also, nationally, 1.4 million people live with HIV, and 70 per cent of new infections among young people occur in adolescent girls, a reminder that vulnerability is rarely singular. When COVID-19 shut the country down, the consequences were immediate, with pregnancies among girls aged 15–19 rising by 25.5 per cent, while pregnancies among girls aged 10–14 surged by 366 per cent.
The numbers tell a story of youth, risk, and quiet urgency. But they do not tell it all. For years, Olivia Nakisita, a public health researcher,has followed how adolescent girls, many of them refugees, navigate pregnancy in Kampala: how far they must travel for care, how early they arrive or delay, and how often services that exist fail to meet them where they are. Her work lives at the uneasy intersection of policy and lived reality, where access does not always translate into care.
February 25th 2026, is the day that her work on whether urban health systems are truly ready for the youngest mothers they now serve will bring her to Freedom Square at Makerere University, where she will graduate with a PhD in Public Health.
Olivia Nakisita defending her doctoral thesis on December 16, 2025. Photo by John Okeya
Her doctoral journey, focused on maternal health services for adolescent refugees in urban Uganda, has unfolded at the intersection of scholarship, community service, and the daily realities of young girls navigating pregnancy far from home.
The Work That Came Before the Question
Long before she began writing a PhD proposal, Olivia Nakisita was already immersed in adolescent health. As a Research Associate in the Department of Community Health and Behavioral Sciences at Makerere University’s School of Public Health, she taught graduate and undergraduate students, supervised Master’s research, and worked closely with communities. Beyond the university, she led New Life Adolescent and Youth Organization (NAYO), a women-led organisation she founded in 2021 to strengthen access to sexual and reproductive health and rights (SRHR) information and services for adolescents and young people.
It was through this community work that a troubling pattern began to surface.
“During our community service,” she explains, “we noted increasing teenage pregnancies, and we also noted challenges with access to maternal health services by teenage pregnant girls.”
Community engagement with young mothers at the NAYO Offices, Kiwenda, Busukuma Division, Nansana Municipality, Wakiso District (2022).
Among those girls were adolescents living as urban refugees in Kampala, young, displaced, often poor, and navigating pregnancy in a city not designed with them in mind.
For Nakisita, the concern deepened through her academic training in Public Health Disaster Management, one such programme that prepares multidisciplinary professionals with the technical expertise and leadership competencies required to plan for, mitigate, respond to, and recover from complex disasters through a public health lens. This programme sharpened Nakisita’s interest in how displaced populations survive within complex urban systems. Uganda’s integrated health model, where refugees and host communities are expected to use the same facilities, appears equitable on paper. In practice, it can be unforgiving.
“I got interested in understanding how these refugees who get pregnant manage to navigate the complexities of integration in host societies like Kampala,” she says. “This was driven by the desire to address their needs and to inform and evaluate existing refugee health policies.”
Olivia Nakisita during a data collection training session at the African Humanitarian Agency (AHA) offices in Kabuusu, a suburb of Kampala in Rubaga Division.
That desire became the foundation of her PhD.
Asking Hard Questions in a Crowded City
Her doctoral research, “Maternal Health Services for Adolescent Refugees in Urban Settings in Uganda: Access, Utilisation, and Health Facility Readiness,” was conducted in Kampala between November 2023 and August 2024. It combined quantitative surveys with qualitative interviews, engaging 637 adolescent refugees aged 10–19 years, alongside health workers and facility assessments.
Her findings showed high perceived access to maternal health services. Clinics existed. Services were available. Yet utilisation, particularly of antenatal care (ANC), lagged. “About three-quarters of the girls attended at least one antenatal visit,” she explains, “but only about four in ten attended in the first trimester.”
And that gap matters. Public health research shows that early and regular antenatal care allows health workers to detect high-risk pregnancies, initiate supplements such as iron and folic acid, monitor fetal development, and provide psychosocial support. Without it, risks compound silently.
By contrast, her study found that facility-based deliveries were remarkably high, with nearly all adolescent refugees (98.3%) giving birth in health facilities, suggesting that the system was reachable, but uneven.
Dr. Nakisita during a School outreach initiative, distributing free NAYO reusable pads to learners at Kiwenda New Primary School, Busukuma Division, Nansana Municipality, Wakiso District.
Where the System Falls Short
Her research went beyond utilisation to examine whether health facilities were actually ready to serve adolescent refugees.
Findings show that lower-level health centres in Kampala were moderately prepared to offer adolescent-friendly maternal health services. Some staff were trained. Some spaces existed. Despite this, critical gaps remained. For instance, facilities lacked essential equipment and supplies. Non-provider staff were often untrained. Separate, private spaces for adolescents were limited. Language barriers complicated care. Overcrowding strained already stretched health workers.
In her qualitative interviews, health workers expressed empathy and willingness to help. Many relied on peer educators and community health workers to reach adolescent refugees. But good intentions were not enough.
“They recommended training of healthcare workers, translators for refugees, and improvement in the availability of essential drugs, supplies, and equipment,” Nakisita notes.
She notes that readiness is not just about infrastructure but about the people, preparation, and priorities.
Research with an Emotional Cost
For Nakisita, working with adolescent refugees required care, not only methodologically, but emotionally.
Finding participants in Kampala was itself a challenge. Unlike settlement settings, urban refugees are dispersed, often invisible. Ethical considerations were constant. Adolescents who had given birth were legally considered emancipated minors, but their vulnerability remained.
Though the thesis focused on systems rather than personal narratives, Nakisita’s earlier work with adolescents informed every decision she made. It shaped how she framed questions, interpreted data, and weighed policy implications. This was not detached research, but careful, deliberate, and grounded.
The Scholar Formed by Continuity
Nakisita’s PhD sits atop more than 18 years of experience in training, research, and community service. She is an alumna of Makerere College School (UCE), 1996 and Greenhill Academy Secondary School (UACE), 1998, a long journey through Uganda’s education system before her Diploma in Project Planning and Management at Makerere University completed in early 2000s.
She would later return eight years later to Makerere University for her Bachelor’s degree in Social Sciences and a Master’s in Public Health Disaster Management, and now a PhD in Public Health.
Her academic rigor is reflected in extensive training across SRHR, impact evaluation, research methods, ethics, disaster resilience, and humanitarian health. She has presented at regional and international conferences and published in peer-reviewed journals on adolescent health, refugee maternal care, gender-based violence, and health systems readiness.
As a PhD student, she supervised three Master’s students to completion, with another currently progressing, quietly extending her influence through mentorship.
Dr. Nakisita with family shortly after her PhD Defense.Dr. Nakisita joined by supervisors, examiners and family in a ceremonial cake cutting. L-R: Prof. Christopher Orach, Dr. Christine Nalwadda, Dr. Juliet Kiguli, Olivia Nakisita, Dr. Sabrina Kitaka and Associate Prof. Lynn Atuyambe.Dr. Olivia Nakisita during the PhD Defense.
When Evidence Demands Action
If policymakers were to act on one lesson from her research, Nakisita says; “Emphasis should be given to maternal health services for adolescents.” “They are high-risk mothers,” she adds.
Her findings call for targeted community-based interventions, outreaches, home visits, and financial support for adolescents who cannot afford prescribed drugs, delivery requirements, or critical tests like ultrasound scans.
They also call for health systems to move beyond one-size-fits-all models, recognising that age, displacement, and poverty intersect to shape how care is accessed and experienced.
Now that her PhD is complete, Nakisita plans to translate research into action. Several papers from her study have already been published. A policy brief is planned to influence decision-making in urban and humanitarian health settings.
When asked what she would say directly to adolescent refugee girls navigating pregnancy in unfamiliar cities, her response is simple and direct.
“If it happens,” she says, “as soon as you find out, go to the nearest health facility and seek care. Always return for the visits as asked by the health worker. Ensure that you deliver in a health facility with a skilled health worker.”
Dr. Christine K. Nalwadda, Senior Lecturer and Chair of the Department of Community Health and Behavioural Sciences (CHBS), congratulates her student as the Department prepares to present four PhDs at Makerere University’s 76th Graduation Ceremony.
Arrival, Without Illusion
When Dr. Olivia Nakisita steps onto the graduation stage at Freedom Square, applause will follow. But the true significance of that moment lies in health facilities still struggling to adapt; in adolescent refugees whose pregnancies unfold quietly in rented rooms and crowded neighborhoods; in policies waiting to be sharpened by evidence.
Her scholarship does not promise quick fixes but offers clarity.
Among the PhDs conferred at Makerere University’s 76th graduation, her work reminds us that some research does not begin in libraries and does not end with theses. It lives on in the slow, necessary work of making health systems see those they have long overlooked.
— Makerere University School of Public Health Communications Office,Graduation Profiles Series, 76th Graduation Ceremony
The Makerere University School of Public Health 2025 Annual Report documents a defining year in the School’s institutional journey. Effective January 2025, MakSPH attained stand-alone status within Makerere University, recognising seven decades of growth in public health training, research, policy engagement and community service. The transition gives the School greater focus and institutional agility to respond to Uganda’s and Africa’s evolving health priorities.
During the 2024/2025 academic year, MakSPH had more than 1,000 students across 12 degree programmes and different years of study. It presented 269 graduands at Makerere University’s 75th Graduation Ceremony, more than 80 per cent at graduate level, while 12 doctoral candidates successfully defended their studies. Training remained closely connected to practice through eight district field-training sites and student participation in outbreak response, disease surveillance and community-based public health action.
The School produced more than 350 peer-reviewed publications. Its evidence informed national and global action across HIV, tuberculosis, maternal and newborn health, antimicrobial resistance, health systems, climate change, urban health, injuries and noncommunicable diseases. MakSPH’s contribution to the PURPOSE 1 trial supported evidence showing more than 99 per cent protection from twice-yearly injectable lenacapavir, while locally led programmes expanded HIV screening, prevention and referral services for underserved populations.
This work was sustained through partnerships with government, communities, funders, universities and implementation agencies. MakSPH’s research and training network extended across more than 35 African countries, while longstanding collaborations were renewed and new institutional relationships established. Strong research governance, unqualified audits and positive due-diligence assessments continued to reinforce partner confidence in the School’s ability to manage complex national and multi-country programmes with accountability.
Construction of the new MakSPH building on Makerere University Main Campus advanced during 2025, with completion targeted for 2026. Designed as a modern public health hub, the facility will expand teaching and specialised laboratory space, strengthen digital learning and research, and provide improved environments for students, faculty, innovation and collaboration.
These achievements reflect the shared contribution of faculty, staff, students and partners. Guided by its 2025–2030 Strategic Plan, MakSPH remains committed to training public health leaders, generating evidence that informs policy and practice, strengthening health systems and improving health in Uganda, across Africa and beyond.
The post holder will be required to provide nursing care to patients attending IDC, provide health education and advise to patients and their family members, provide translation whenever necessary, guide in clinical practice and duties of other nurses. Participate in clinical research studies.
Key Responsibilities
Provides nursing care to patients attending the IDC
To provide clinical care including triaging, clinical assessment of patients of patient’s problems, investigations to HIV/AIDS patients attending IDI-supported health facilities in line with standard treatment guidelines.
Assist in management of very sick patients brought in Urgent care with knowledge, skills and Support appropriate referral of complex patients’ through liaison with immediate team members, senior clinicians and other specialized facilities.
Lead education and facility sensitization efforts to continuously build knowledge among clients and the attendants at Urgent care and the general clinic.
Participate in identification, implementation and documentation of continuous quality improvement activities along client care and treatment.
Assists medical doctors in carrying out clinical procedures.
Provides translation services to visiting medical doctors as required
Ensures patient flow in the clinic ( IDC)
Performs quality assurance and quality control (QA/AC) to ensure completeness of source documents.
Participates in giving Medicines when required.
Checks medical supply stock and ensures procedure charts are fully equipped
Guides the clinical practice and duties of other nursing staff
Participates as a full member of the IDC health care team
Attends clinic staff meetings on a daily basis as available
Participate whenever requested to do so in clinic research studies.
Participate in compilation and submission of accurate activity reports according to the set guidelines.
This job description is not exhaustive and the post holder will need to be flexible and to undertake such other duties as may become necessary with the development of the Infectious Diseases Institute.
Academic Qualifications
Diploma or Bachelors Degree in Nursing
Full and active registration with the Uganda Nurses and Midwives council (Valid general practice license).
Person Specification
Completion of Nurses Training in a recognized educational institution with Diploma/ Bachelors
Minimum of 3 years work experience in a clinical setting
Full and active registration with the Uganda Nurses and Midwives council (Valid general practice license).
Self- motivated and capable of meeting deadlines.
Excellent communication skills.
Good interpersonal skills and able to interact productively with other team members.
More details
Job Code: NPCT001 No of Positions: 1 Station: IDI-Mulago Classification: Full-time Duration: 1 Months Reports to: NURSE TEAM LEAD Posted Date: 2026-07-06 09:06:27.000 Closing Date: 2026-07-19 17:00:00.000
Across Kampala, families use saucepans, cooking pots, frying pans, kettles, and pressure cookers every day. Makerere University School of Public Health is now investigating whether some of these items may expose households to lead, a toxic heavy metal that can enter food during cooking if contaminated materials are used to make them.
The year-long study, titled “Assessment of Lead Contamination in Domestic Cookware, Supply Chains, and Exposure Pathways in Informal Settlements of Kampala,” was launched on 11 June 2026 at MakSPH’s ResilientAfrica Network (RAN) in Kololo. Supported through the Lead Exposure Elimination Project (LEEP), with funding from Bloomberg Philanthropies, and led by Mr. Douglas Bulafu, Mr. Tom Okade, and Dr. Rawlance Ndejjo, the study will assess total and leachable lead levels in commonly used cookware, map how the products are sourced, distributed, and sold, and identify feasible interventions to reduce household exposure to lead.
Ms. Prossy Nabaggala, Senior Standards Officer at the Uganda National Bureau of Standards, pictured centre, consults with study co-investigators Mr. Tom Okade and Mr. Douglas Bulafu during the launch of MakSPH’s study on possible lead exposure from domestic cookware in Kampala.
Today, lead remains a major and preventable public health concern globally. WHO reports that no level of exposure is known to be without harmful effects and estimates that lead exposure contributes to more than 3.5 million deaths worldwide, mainly through cardiovascular effects. Children and women of child-bearing age are said to be especially vulnerable, with exposure linked to impaired brain development, reduced learning ability, harm to unborn children, high blood pressure, cardiovascular disease and kidney damage.
In Uganda, lead exposure concerns also extend to household products and informal markets. Aluminium pots and saucepans, particularly low-cost locally fabricated items, may be made from recycled scrap metal. If contaminated materials are used, lead may leach into food during cooking or other food-contact use, creating a possible route of exposure in homes.
During the launch, Assoc. Prof. David Musoke, Head of MakSPH’s Department of Disease Control and Environmental Health, underscored the importance of involving stakeholders throughout the research process. He said engaging stakeholders from the generation of research ideas to implementation and dissemination helps ensure findings do not remain within the University but are translated into evidence that can inform policy, practice, and community action.
“We engage with stakeholders throughout the research process, from developing ideas and designing projects to implementation and dissemination,” Dr. Musoke noted. “I am pleased that this workshop brings together policymakers, the Ministry of Health, non-governmental organisations, Kampala Capital City Authority, academia, staff and students. This helps ensure that research findings do not remain at the University but are beneficial to our stakeholders.”
Assoc. Prof. David Musoke delivers remarks during the study launch, emphasising sustained stakeholder engagement to ensure research findings inform policy, practice and community action.
He observed that the study was timely, as it addresses an important yet under-examined public health concern, arguing that while lead exposure from paint, pipes and drinking water has received considerable attention, exposure through cookware remains less understood despite its widespread use in many households. He added that the new research builds on MakSPH’s broader work in disease control and environmental health and will generate critical evidence to inform action on lead exposure risks in Uganda. Dr. Musoke also commended the study team for initiating this work.
Previously, MakSPH researchers Mr. Abdullah Ali Halage, Mr. Tom Okade, Dr. James Muleme and Dr. Juliet Kiguli, together with Mr. Ahmada Zziwa and Mr. Robert Mugabi, assessed knowledge, perceptions and practices related to heavy metal contamination and health risks among residents living near Kiteezi in Kampala, Katikolo in Mukono and Nkumba in Entebbe. The study, done in 2024, reached 505 residents and captured community and frontline perspectives from people living and working around the dumpsites. It showed how daily contact with dumpsite environments may expose communities to toxic heavy metals such as lead, arsenic, cadmium, and mercury through soil, water, air, food crops, animal products and waste-handling practices.
Evidence from the study, funded by the Government of Uganda through the Makerere University Research and Innovation Fund (MakRIF) and disseminated on 26 June 2025, showed that heavy metal exposure risks around the three municipal dumpsites within the Kampala Metropolitan Area were shaped by both environmental conditions and community behaviour.
Dr. Sabrina Kitaka, Member of the MakRIF Grant Management Committee, pictured centre, with research team members including Mr. Abdullah Ali Halage, Mr. Tom Okade and Dr. Juliet Kiguli, following the dissemination of findings on heavy metal exposure risks around Kampala Metropolitan dumpsites on 26 June 2025.
Although residents lived near dumpsites where waste can release heavy metals into soil, water and food chains, 76.4 per cent could not define heavy metals, and only 45.9 per cent had adequate knowledge of contamination and related health risks. Gaps extended to daily exposure pathways, with 38.4 per cent unaware that vegetables grown near dumpsites may contain high heavy metal levels and 39.8 per cent unaware that milk or meat from animals grazed near dumpsites may also be contaminated. More than half viewed dumpsite soils as fertile, 50.7 per cent considered such milk safe, and 51.3 per cent believed dumpsite waste could be used as manure.
The study recommended stronger risk communication, environmental monitoring, safer land-use enforcement and community education. The work on lead in domestic cookware now extends this focus from dumpsite-related heavy metal exposure to a possible household pathway. Mr. Douglas Bulafu, an early-career researcher and Principal Investigator of the study, said the team will examine whether commonly used cooking pots, saucepans and related utensils contribute to exposure, and generate evidence to guide safer cookware use, standards and market oversight.
“Lead contamination has been documented from sources such as paint, fuel and air pollution, but less attention has been given to cookware as a potential pathway of exposure. That is the gap this study seeks to address,” Mr. Bulafu said. “We focused on Kampala because it has many informal settlements, small-scale cookware workshops and a large consumer market where low-cost cookware is widely produced, sold and used. When people buy these products, they often do not know where they were made, what materials were used, or whether they contain lead. The supply chains are also poorly understood, meaning households could be exposed without knowing.”
Mr. Douglas Bulafu, Principal Investigator, speaks during the launch of the MakSPH study on possible lead exposure from domestic cookware in Kampala, highlighting the need for evidence to guide safer cookware use, standards and market oversight.
The study will use a cross-sectional, mixed-methods design to connect laboratory evidence with supply-chain realities in Kampala’s informal settlements. The team will purchase about 100 cookware samples from open-air markets, roadside vendors, retail shops and supermarkets in Kisenyi, Katanga, Bwaise, Namuwongo, Banda and Kasubi, test them for total and leachable lead, and conduct about 30 key informant interviews across the supply chain to understand how cookware is sourced, produced, distributed and used.
Findings will be validated with stakeholders and used to identify feasible interventions, including stronger regulation and enforcement, raw-material control, better manufacturing practices, market surveillance and consumer awareness. The evidence is expected to support standards development, product testing, policy uptake, safer manufacturing practices and public guidance on cookware choices, helping reduce household exposure to lead and associated health risks.
Speaking on behalf of the Ministry of Health, Dr. Didacus Namanya, a health geographer and environmental health expert, welcomed the study, saying scientific evidence on lead exposure is critical because public health decisions can have lasting consequences for life and wellbeing.
Dr. Namanya implored the research team to ensure the evidence from the study informs decisions beyond academia, shaping policy, strengthening public health practice and guiding practical measures to reduce lead exposure in communities. He emphasised that research should not remain in the “ivory tower” but reach decision-makers and the public, so that evidence from the study translates into policy, practice and stronger protection for communities.
Dr. Didacus Namanya, speaking on behalf of the Ministry of Health, delivers remarks during the study launch on 11 June 2026, urging the research team to ensure evidence on lead exposure informs policy, practice and practical community protection measures.
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