In Uganda, children arrive at health facilities every day with fever, cough, injuries or routine illnesses. What health workers rarely recognise is that some of these children are already living with alcohol or other substance use disorders, conditions that complicate diagnosis, delay treatment, and quietly undermine children’s health, development, and long-term wellbeing.
This hidden reality was uncovered by Dr. Harriet Aber Odonga during her doctoral research at Makerere University School of Public Health (MakSPH). Her PhD study, titled “Substance Use among Children in Mbale, Uganda: Health System Landscape and Support Structures,” examined how Uganda’s health system detects and responds to substance use among children aged six to 17 years.
The findings revealed a problem far more widespread than many health workers and caregivers assumed. Nearly one in four children attending health facilities showed signs of alcohol or other substance use problems, with alcohol the most common substance. In the study, a child was classified as having a “probable” substance use disorder when responses to a standard screening questionnaire indicated harmful or dependent patterns of use requiring further clinical assessment.
Harriet Aber Odonga defending her PhD at MakSPH in October 2025. Her study found that nearly one in four children attending health facilities in Mbale showed signs of alcohol or other substance use problems, many of which go undetected within routine care.
The discovery adds urgency to an already serious public health challenge. Globally, alcohol and other substance use is responsible for one in five deaths and contributes to more than 200 disease and injury conditions, according to WHO. Across Africa, alcohol alone accounts for 6.4 per cent of all deaths and 4.7 per cent of disability-adjusted life years. In Uganda, alcohol use disorder affects roughly 7.1 per cent of the population and contributes to about 7% of all deaths, while research among young people shows that alcohol exposure often begins early in life.
Despite these risks, most policy and research attention has historically focused on adults and older adolescents. Much less is known about children who begin experimenting with alcohol and other substances earlier in their childhood, a gap Aber set out to examine by studying how Uganda’s health system identifies and responds to substance use among children.
An AI-generated image shows a health worker examining a young child at a clinic, reflecting the kind of routine care settings where Dr Harriet Aber’s research found that many children with substance use challenges often go undetected.
A research question begins
Aber’s interest in the subject began unexpectedly. “I remember seeing a notice calling for PhD students to research child alcohol use,” Dr. Aber recounted. “The phrase struck me immediately. I could not believe that children were drinking alcohol. That moment sparked my curiosity, so I began reviewing the literature on the subject in Uganda. During that search, I came across a study documenting alcohol use among children as young as five years old. That finding was deeply unsettling and raised many questions for me.”
With a longstanding interest in child health, Aber saw the research as an opportunity to investigate a problem that had received little systematic attention. What began as disbelief developed into a doctoral investigation examining how Uganda’s health system identifies and responds to substance use among children. She began her doctoral studies in 2021 at MakSPH under the supervision of Dr. Juliet N. Babirye, Prof. Fred Nuwaha, and Prof. Ingunn Marie S. Engebretsen from the University of Bergen, Norway. She defended her thesis on October 25, 2025, before graduating during Makerere University’s 76th graduation ceremony on February 25, 2026.
Harriet Aber (centre) celebrates with her internal examiner, Dr Justine Bukenya; supervisors Dr Juliet N. Babirye, Prof. Fred Nuwaha, and Prof. Ingunn Marie S. Engebretsen; Chair of the defence, Prof. David Guwatudde; and mentor, Prof. Christopher Garimoi Orach, following her successful PhD defence on October 29, 2025, at MakSPH.
Investigating the health system response
Aber’s study examined four key questions. It measured how common substance use disorders are among children visiting health facilities. It assessed whether health facilities are equipped to screen and manage these cases. It evaluated whether screening tools are acceptable to children, caregivers, and health workers. It also examined how families seek help when children begin using substances.
To answer these questions, the research used a mixed-methods design combining quantitative surveys and qualitative interviews. Aber collected data from 834 children attending health facilities in Mbale District, assessed 54 health facilities in the district to determine their readiness to screen and manage substance use disorders, and interviewed health workers, caregivers, and children to understand experiences of care and barriers to seeking help. Additional surveys involving 602 children and 355 caregivers examined help-seeking patterns and support structures.
Quantitative data were analysed to estimate prevalence and identify associated risk factors, while qualitative interviews provided insight into how families, communities and health workers respond when children begin using substances.
What the research found
A patient walks into the Masaba Wing outpatient clinics at Mbale Regional Referral Hospital, one of the key study sites for Dr. Harriet Aber’s research on substance use among children in Mbale, Uganda. Photo: Mbale Regional Referral Hospital.
Data collected between 2023 and 2024 across health facilities in Mbale District in Eastern Uganda showed that substance use among children was far more common than many health workers and caregivers assumed. Alcohol use disorder emerged as the most prevalent form of substance use disorder among children in the study. The analysis also showed that children were significantly more likely to use substances if they were exposed to peer or sibling use, lived in lower-income households, or experienced strained relationships with caregivers.
The research also revealed major health system gaps. Only 19 of the 54 health facilities assessed, representing 35 per cent, met the minimum readiness criteria required to screen, diagnose or manage substance use disorders. Many facilities lacked trained staff, standardised screening guidelines, and clear referral pathways for specialised care.
Aber explained that substance use often goes undetected because it is rarely the primary reason children visit health facilities. “Substance use is hidden,” she asserted, reflecting on evidence from her doctoral study. “While health workers are treating other illnesses, some children coming to these facilities are already struggling with alcohol or other substances.”
She added that early substance use can have lasting consequences for children’s development. “Risk was higher among children exposed to peer or sibling substance use, lower household income, lower caregiver education, and strained child-caregiver relationships. The public should be concerned because early substance use affects brain development, mental health, education completion, and long-term well-being.”
Families often navigate the problem alone
Illustrative AI image: Alcohol displayed in a typical community setting. Aber’s study in Mbale highlights how early exposure within everyday environments can shape children’s risk of substance use.
Her research also examined how families and communities respond when children begin using substances. She found formal help-seeking to be rare. Many caregivers relied on informal networks, including relatives, teachers, religious leaders, and local authorities. Health services were seldom the first point of support.
Meanwhile, punitive responses such as discipline or punishment were sometimes used by caregivers attempting to stop the behaviour of substance use among children, but these responses rarely addressed the broader social and family pressures influencing the vice.
CRAFFT screening tool used to assess substance use risk among children and adolescents. Courtesy photo.
One encouraging finding emerged from her study’s assessment of early detection tools. Aber evaluated the use of the CRAFFT screening tool, a short set of structured questions used by health workers to identify whether a child may be using alcohol or other substances. Children, caregivers, and health workers generally found the questions from the tool easy to understand and acceptable to use. In the study, over 85 per cent of children reported the questions were easy to answer, and nearly nine in ten caregivers were comfortable with the screening process.
These findings, however, suggest that routine early detection could be integrated into primary healthcare within the communities. “If policymakers were to act on one finding from my research, I would prioritise integrating routine, age-appropriate substance use screening into primary healthcare,” Aber argued. “With proper training and referral systems, health workers can identify early risk and support children before the problem escalates.”
Training across nutrition, public health and health systems
Aber’s approach to the problem reflects a research journey shaped by training across multiple areas of child and public health. She first studied Food Science and Technology at Kyambogo University, graduating in 2011, before specialising in Nutrition during her Master of Public Health at Makerere University, graduating in 2015, before embarking on her doctoral training in Public Health at the School, completing in 2025 to graduate at Makerere University 76th Congregation.
Dr. Harriet Aber moments after being conferred a PhD in Public Health by Chancellor Dr. Crispus Walter Kiyonga during Makerere University’s 76th Graduation Ceremony on February 25, 2026.
Before beginning her PhD, she worked on nutrition research and later coordinated studies examining climate risks, anticipatory humanitarian action and community health systems. This background shaped how she approached substance use among children, not as an isolated behavioural problem but as an issue influenced by broader health and social conditions.
“I do not see child substance use as a problem with a single cause,” she noted. “It is influenced by biological, psychological, social, and system-level factors. My nutrition training helped me appreciate how substance use intersects with broader child health concerns such as mental health, family stress, and even food insecurity.” These pressures are visible in her research site in Mbale, where environmental shocks, economic hardship, and family instability persistently shape daily life. Recurrent landslides and livelihood disruptions place strain on households, and adolescents facing stress or instability may turn to substances as a coping mechanism, she holds.
From evidence to solutions
Completing her PhD has now shifted Aber’s perspective from documenting problems to identifying solutions for social impact. “Completing my PhD shifted my perspective from simply generating evidence to actively providing solutions,” she observed. “Child health challenges such as substance use, nutrition, and climate-related risks are interconnected. As a researcher, I have become more systems-focused, and as an advocate, I feel a stronger responsibility to ensure evidence informs policies that improve children’s wellbeing.”
Dr. Harriet Aber (centre) poses with family members during Makerere University’s 76th Graduation Ceremony on February 25, 2026.
For Aber, that responsibility extends to the families whose experiences informed the research. Parents, teachers, and health workers often notice behavioural changes first, even when they feel unprepared to respond. Listening without judgment, recognising warning signs, and linking children to appropriate support can make a significant difference, she noted, especially in a context where formal services remain limited.
Her research ultimately sends a clear message for Uganda’s health system. Children affected by substance use are already present in communities and health facilities. Detecting the problem earlier, strengthening screening systems, and equipping frontline health workers with appropriate tools could significantly improve outcomes for vulnerable children.
Behind the research journey stood a wide network of support, including MakSPH supervisors and doctoral committee, the TREAT consortium, the MakSPH PhD forum, the Health Development Centre secretariat, study participants, research assistants, family and friends, and funding support from the Government of Uganda through the Makerere University Research and Innovations Fund (MAKRIF) and the Norwegian Research Council, all of whom she remains grateful.
Aber’s research ultimately points to a critical gap in Uganda’s health system. Children affected by substance use are already present but remain largely invisible. Without routine screening, trained health workers, and clear referral systems, opportunities for early intervention are often missed. Addressing this gap, as indicated by her study, goes beyond clinical care. It requires strengthening how the health system recognises and responds to emerging risks that affect children’s long-term health and development.
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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