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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