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.
A joint study between Makerere University School of Public Health (MakSPH) and The Open University, UK, is investigating a possible link between maize cultivation and malaria risk in Uganda, as evidence increasingly points to livelihoods and everyday economic activities as key drivers of transmission of the disease.
The research initiative was advanced during a stakeholders’ workshop held on April 15, 2026, at MakSPH’s Resilient Africa Network in Kololo, where a team led by Assoc. Prof. David Musoke of Makerere University and Dr. Kevin Deane of The Open University presented ongoing and previous findings on the social determinants of malaria. The meeting brought together academics, policymakers, and practitioners to examine how agricultural practices, particularly maize farming, may be shaping malaria patterns in both rural and urban settings in Uganda.
The work builds on a growing body of research linking malaria to economic activity. One such study, led by the two researchers and published in Global Public Health in December 2025, found that livelihood activities such as farming, livestock keeping, and night-time work significantly influence malaria exposure. The study identified agriculture, especially maize cultivation near homes, as a key factor associated with increased mosquito density and heightened infection risk.
Assoc. Prof. David Musoke presents research findings on how livelihoods, including maize cultivation near homes, may influence malaria exposure during a stakeholder workshop at the Resilient Africa Network, Kololo, on April 15, 2026.
At the workshop, Dr. Musoke said the new inquiry reflects a broader shift in how malaria is understood, outlining how livelihoods, particularly agriculture, shape exposure through multiple pathways, from crop production and water use to the timing of daily activities that coincide with peak mosquito biting hours. These patterns, he argued, extend risk beyond what conventional interventions, such as insecticide-treated nets and indoor spraying, are designed to address.
Uganda remains one of the countries most affected by malaria, with the disease accounting for a significant share of outpatient visits, hospital admissions, and deaths. It is consistently ranked among the leading causes of illness and mortality, particularly among children under five and pregnant women. Despite sustained investment in prevention and treatment, including widespread distribution of insecticide-treated nets and indoor residual spraying, transmission remains high in many parts of the country. This persistence has increasingly drawn attention to factors beyond conventional interventions, including the role of livelihoods, environment, and everyday exposure to mosquitoes.
Maize grown close to homes, with damp ground conditions, may increase exposure to malaria in rural communities.
“As researchers, our role is to generate evidence, and that evidence should inform decision-making,” Dr. Musoke said. “We do not work in isolation. What we hear from stakeholders matters. We are bringing together different sectors, disciplines, and institutions because this work is still in progress, and we intend to build it collaboratively. Increasingly, research requires not just academics, but policymakers, implementers, and communities to be part of the process.”
The collaboration with The Open University has been central. Dr. Deane said the idea of examining the relationship between maize and malaria emerged from several years of joint research on social determinants with MakSPH. He pointed to a gap in malaria research, which has largely focused on biomedical and indoor interventions, while overlooking the role of livelihoods and outdoor exposure.
Assoc. Prof. David Musoke (left), Dr. Paul Mulumba (centre), a Health Inspector in Wakiso District, and Dr. Kevin Deane (right) share insights during the workshop at the Resilient Africa Network, Kololo, on April 15, 2026.
“We cannot continue relying solely on bed nets, spraying, and treatment,” Dr. Deane said. “These remain essential, but they are not sufficient for elimination. There is significant outdoor malaria transmission, particularly among adults, and that is linked to how people live and work.”
He added that maize presents a complex case. As one of Uganda’s most widely grown staple crops, it is central to both food security and household income, making it impractical to separate farming from living spaces. This, he said, underscores the need to better understand the relationship and develop responses grounded in evidence and local realities.
Evidence presented during the workshop drew on both community experiences and existing scientific literature. Prior qualitative research by the team found that mosquito populations increase during maize growing seasons, particularly in the evenings. Scientific studies also show that maize pollen can enhance mosquito survival and longevity, potentially increasing their capacity to transmit malaria.
Dr. Kevin Deane of The Open University emphasised the need to move beyond conventional malaria interventions to better understand how livelihoods and everyday activities shape exposure during the stakeholder workshop in Kololo, Kampala, on April 15, 2026.
Previous work in Wakiso district further situates maize within a wider set of risk factors. Findings show that agriculture, including crop production and animal husbandry, can create conditions that support mosquito breeding through stagnant water, water storage practices, and environmental changes. These risks are compounded by outdoor activities in the early morning and evening, when exposure is highest. The research also points to the growing role of urban agriculture, which is bringing crop cultivation and potential mosquito habitats closer to residential spaces, altering traditional patterns of transmission.
Ms. Doreen Nabwire Wamboka, in-charge at Namayumba Epicentre Health Centre III in Wakiso District, said the discussions challenged long-held assumptions that malaria is a “well-understood” condition.
“I used to think malaria had been fully researched, that we already knew what we needed to know,” she noted. “I now see that what has been studied is the conventional side of it. There are emerging factors we have not paid attention to. This work is opening up new ways of thinking, even about things we take for granted, like the crops we grow around our homes. We treat malaria as ordinary, yet it is still one of the most common conditions. Understanding these connections could change how we approach the disease.”
Ms. Doreen Nabwire Wamboka, In-charge at Namayumba Epicentre Health Centre III in Wakiso District, engages in a co-creation session as a fellow participant looks on during the stakeholder workshop in Kololo on April 15, 2026, underscoring the need for collaborative approaches to design interventions to tackle malaria.
The initiative will now combine spatial analysis, entomological studies, and community-based research to better understand how maize cultivation influences malaria risk. It will also involve farmers and other stakeholders in shaping potential interventions, reflecting a broader shift toward co-produced solutions.
The workshop, funded by The Open University, marked an important step in refining this research agenda. As the work progresses, its findings could inform policy and practice not only in Uganda, but also in other malaria-endemic countries where maize is widely cultivated. For now, the research signals a shift from isolated interventions to a more integrated understanding of how livelihoods and environments drive malaria transmission.
Update: Application deadline extended to 30th April 2026
Makerere University School of Public Health (MakSPH) is pleased to announce the Certificate Course in Water, Sanitation and Hygiene (CWASH) – 2026.
This intensive and practical short course is designed to strengthen the knowledge, skills, and attitudes of professionals involved in the planning, implementation, and management of Water, Sanitation and Hygiene (WASH) services. The programme responds to the growing demand for competent WASH practitioners in local government, non-governmental organisations, and the private sector.
Course Highlights
Duration: 8 weeks (01 June – 24 July 2026)
Mode: Day programme (classroom-based learning and field attachment)
Fees:
UGX 900,000 (Ugandans / East African Community)
USD 500 (International participants)
Application deadline:Thursday, 30 April 2026
Who Should Apply?
Practising officers in the WASH sector
Environmental Health workers seeking Continuous Professional Development (CPD)
Applicants with at least UACE (or equivalent) and one year of WASH-related work experience
Attached to this announcement, interested persons will find:
The course flier, providing comprehensive programme details, and
The application form, which should be completed and returned to MakSPH together with the required supporting documents.
For full course details, application procedures, and contact information, please carefully review the attached documents. Eligible and interested applicants are strongly encouraged to apply before the deadline and take advantage of this opportunity to build practical competence in WASH service delivery.
Makerere’s School of Public Health (MakSPH) is expanding faster than it can house itself. It now hosts more than 1,000 students, runs programmes across multiple countries, and anchors a large share of the University’s research output. Yet parts of its operation still spill into rented space, costing over $113,000 a year, because the infrastructure has not kept pace with its growth.
That constraint sits uneasily with the School’s economic weight. Health research accounts for more than half of Makerere University’s academic output, making it one of the University’s most productive engines. As Vice Chancellor Barnabas Nawangwe put it, “An educated population is a healthy population, and an educated and healthy population is a prosperous population.”
Beyond the university, health is not just a social outcome but a driver of economic performance. Healthier populations are more productive, more resilient, and less costly to sustain. Investments in public health, whether in prevention, systems, or infrastructure, raise an economy’s productive capacity, not just improve outcomes.
A construction worker undertakes metal fabrication works at the Makerere University School of Public Health (MakSPH) building site.
Institutions that generate public health knowledge and train professionals are not peripheral to growth; they are part of its foundation.
It is this logic that is shaping how Makerere’s School of Public Health is positioning itself. At its centre is a new, unfinished complex on the University’s main campus, intended to anchor the School’s next phase as a regional hub for research, training, and policy support. But like much of the system it supports, it is being built gradually, in a “build-as-you-go” approach constrained as much by funding realities as by design.
Construction of Phase II of the MakSPH complex is now at an advanced stage, with progress recorded across all sections of the site. As of March 2026, Phase 2B is nearing completion at 98%, while Phase 2A stands at 89%, and Phase 2C at 69%, each tracking close to or slightly ahead of planned targets. Current works are concentrated on interior finishes—including tiling, terrazzo installation, and external rendering—as well as preparations for lift installation, signaling a transition from structural works to final detailing. The project team is working toward a practical completion date of August 31, 2026, with timelines calibrated to align with broader resource flows and implementation considerations.
Six years ago, in February 2020, construction began on what will be the new home of the School of Public Health. The building, a permanent, purpose-built public health facility on Makerere’s main campus, will accommodate a growing student body, provide space for doctoral and postdoctoral fellows, and strengthen the University’s ability to respond to Africa’s most pressing public health challenges.
Professor David Serwadda, Professor Emeritus at Makerere University and Chair of the MakSPH Infrastructure Fundraising Committee, said the construction journey reflects the School’s “ambition, intent, and courage”—a bold step despite limited resources. He was speaking at a public lecture on health financing held at Makerere University on April 9, 2026.
But the ambition behind the project is not modest. “We are not building for today—we are building for the future,” said Professor David Serwadda, reflecting on a decision that shaped the entire construction effort. “We need to build for the next 100 years.”
Professor David Serwadda, Professor Emeritus at Makerere University and Chair of the MakSPH Infrastructure Fundraising Committee, speaks at a public lecture on health financing for Uganda’s future, held on April 9, 2026.
That long view helps explain both the scale of the project and the risks taken to start it. When construction began, the School did not have the full funding. “We started with about a third of the required budget,” Serwadda said.
The approach was not without setbacks. A major grant from USAID, worth over a million dollars, was later withdrawn, midway through the construction, due to the closure of USAID. “We received what is called a ‘Dear John letter,’” he recalled. “At that moment, we felt the situation was a major blow, almost terminal for the project.”
But the project did not stop. It adjusted. “We said, let us continue, piecemeal,’” he said. “Finish the auditorium first, use it, and keep building the rest.”
“We have come a long way as the School of Public Health,” said Professor Rhoda Wanyenze, the Dean. “We are proud of that history, but we also recognize that it comes with responsibility.”
Professor Rhoda Wanyenze, Dean of the Makerere University School of Public Health, speaks at a public lecture on health financing for Uganda’s future, held on April 9, 2026.
She argued that responsibility is no longer confined to Uganda. With ongoing collaborative work in more than 25 African countries currently, the Dean says this is “a responsibility to provide leadership in public health not only in Uganda but across the continent.”
The scale of that growth has been visible from what was once a small training unit in the Faculty of Medicine in the 1950s, which has expanded into 12 academic programmes and more than 1,000 students.
“When I came back for my public health training, we were about 40 students,” she said. “Now, we have more than 1,000.” “Public health is growing and evolving,” Wanyenze said. “And we are doing our best to develop the skills needed for this changing landscape.”
That includes new areas such as health informatics and data science, driven by the digitisation of health systems and the growing role of data in decision-making and AI. The School is already coordinating regional platforms on digital health, linking multiple countries in shared learning and practice.
But this growth has outpaced the physical systems needed to sustain it. For the University leadership, the implications extend beyond infrastructure.
“One of the most effective ways to invest in health in Uganda is to invest properly in Makerere University,” said Vice Chancellor Barnabas Nawangwe. “We must recognize Makerere as a research-led university with a special national role—not fund it like any other institution or department. Makerere is one of the government’s greatest assets. Invest in her, and the returns will exceed expectations.”
Professor Nawangwe hailed Dr. Ramathan Ggoobi, the Permanent Secretary to the Treasury, who delivered a keynote on investing in health for Uganda’s future in view of Vision 2040. “I wish to thank Dr. Ramathan Ggoobi and his team for their personal intervention in allocating resources in next year’s budget to complete the new School of Public Health building. That support is deeply appreciated,” he said.
Vice Chancellor Professor Barnabas Nawangwe speaks at a public lecture on health financing for Uganda’s future on April 9, 2026.
Uganda’s progress in health outcomes is evident, but uneven. Life expectancy has risen significantly from about 50 years in 2000 to roughly 68.8 years in 2024, according to the Permanent Secretary to the Treasury, Ramathan Ggoobi. Yet the gains sit alongside persistent financial strain on households. About 4% of Ugandans still spend more than a quarter of their consumption on healthcare, pushing many into poverty as a result of illness.
For Ggoobi, this points to a structural gap that recurrent government spending alone cannot close. “We must mobilise long-term domestic capital without adding fiscal risk,” he argued, pointing to the need for more sustainable financing mechanisms. Central to this is the gradual design and rollout of a national health insurance scheme. Evidence from countries such as Rwanda, Kenya, and Ghana suggests that well-structured contributory models can expand coverage while reducing catastrophic out-of-pocket spending.
“My Ministry and the School of Public Health must be partners. … Evidence framed in fiscal terms drives policy,” said Ggoobi, stressing the need for locally grounded solutions. “What works in Ghana might not work here. We need a model that fits Uganda.”
Uganda’s current macroeconomic conditions, relatively low inflation, currency stability, and expanding private credit may provide a window to move in that direction.
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