At the centre, Henry Komakech stands next to his Opponent, Prof. Stella Neema, celebrating the successful defence of his doctoral thesis, alongside members of his examining team: External Examiner Dr. Stephen Langole, Internal Examiner Dr. Aloysius Ssennyonjo and Supervisors Prof. Christopher Garimoi Orach and Dr. Lynn M. Atuyambe, and Doctoral Committee member Dr. Juliet Kiguli. The defence meeting was chaired by Assoc. Prof. Christine Nalwadda, Head, Department of Community Health and Behavioural Sciences, on December 19, 2025.
On Friday, December 19, 2025, a doctoral defence at Makerere University School of Public Health (MakSPH) made visible how knowledge transcends across generations. Dr. Henry Komakech, who first trained at the School for his Master’s in Health Services Research (MHSR) between 2008 and 2010 and has served as a Research Associate in the Department of Community Health and Behavioural Sciences (CHBS) since 2014, defended his PhD titled Effects of the Repatriation of Refugees on the Health Services of the Host Populations in the West Nile Districts of Arua, Moyo, and Adjumani. The thesis examined what happens after refugees begin to return home and humanitarian partners withdraw, leaving district health systems to absorb the transition.
Just over two months later, on February 25, 2026, MakSPH took its place in the 76th Congregation of Makerere University at Freedom Square, presenting 231 graduands. The four-day ceremony, held from February 24 to 27, saw the University confer degrees and diplomas on 9,295 graduands across nine colleges and two schools, including 213 PhDs. Of the seven doctoral degrees presented by MakSPH, four came from the Department of Community Health and Behavioural Sciences, where Komakech’s work was supervised and examined. The defence in December had tested the scholarship; the congregation in February formally admitted it into the University’s record.
Henry Komakech is conferred upon the Doctor of Philosophy (Public Health) degree by Makerere University Chancellor Dr. Crispus Walter Kiyonga during the 76th Graduation Ceremony on February 25, 2026. His study examined how refugee repatriation reshapes health service delivery and system sustainability in host districts.
The scholarship itself engaged a structural public health question shaped by Uganda’s refugee experience. By mid-2025, the United Nations High Commissioner for Refugees (UNHCR) estimated that 117.3 million people were forcibly displaced worldwide due to conflict, persecution, or violence. Of these, 42.5 million were refugees, 67.8 million internally displaced persons, and 8.4 million asylum seekers, with 87 per cent of refugees hosted in low- and middle-income countries, including Uganda.
The country today remains one of the key actors responding to this humanitarian crisis, hosting close to two million refugees and asylum seekers and implementing one of the world’s most progressive refugee policies, which integrates displaced populations into national systems of service delivery under the Refugees Act of 2006 and the Refugees Regulations of 2010.
UN Secretary-General António Guterres greets refugee families during a visit to Imvepi Refugee Settlement in Arua District, northern Uganda, in June 2017. The visit drew global attention to Uganda’s open-door refugee policy and the significant social, economic, and health-system pressures borne by host communities and national services in responding to large-scale displacement. UN Photo/Mark Garten.
According to UNHCR, refugee repatriation is the return of refugees to their country of origin, ideally voluntarily, safely, and with dignity when conditions allow. It is one of the most preferred and recognised durable solutions to displacement, alongside local integration in the host country and resettlement to a third country, and is typically organised through tripartite agreements between the country of origin, the host country, and the UN refugee agency.
Yet when repatriation occurs, and sometimes this happens rapidly, numbers in host areas decline, affecting financing, staffing, drug supply, infrastructure, and district planning. In this case, repatriation, as Komakech investigates it, is therefore not simply demographic change due to sudden withdrawal but a health systems transition with governance and fiscal consequences.
Henry Komakech discusses health system transitions in refugee-hosting districts after repatriation during his doctoral defence on December 19, 2025.
“This work emerged from observations I made during earlier studies in Northern Uganda, a region that has hosted large refugee populations for many years,” Komakech observed.
He added, “I noticed that the presence of refugees had varied effects on health services, affecting both refugee and host communities. Yet despite this reality, there was limited research examining how health systems function during periods of transition, particularly as refugee populations move in and out of host districts. This raised an important question: Do districts and aid agencies design health services in ways that can accommodate both incoming and outgoing refugee populations, and what does this mean for service delivery for everyone involved? That question ultimately shaped my study.”
Komakech holds that repatriation matters in humanitarian action and public health emergencies because it offers closure for displaced populations while allowing host countries to reorganise health and social systems as displacement pressures change.
The question that shaped his doctoral research did not emerge in isolation, though. It developed within a field built over decades by Prof. Christopher Garimoi Orach, Professor of Community Health at Makerere University and Komakech’s principal supervisor, an author of more than 100 peer-reviewed publications in high-impact journals whose work has anchored refugee health and public health in complex emergencies within Uganda’s academic and policy landscape while also contributing to global scholarship in the field.
If Komakech examined what happens when humanitarian support withdraws, Orach’s earlier scholarship focused on how health systems respond when displacement arrives. The progression reflects an intellectual continuity grounded in history.
Prof. Garimoi Orach stands in jubilation with his doctoral supervisees, Henry Komakech (right) and Dr. David Lubogo (left), following the successful defence of Komakech’s PhD thesis at Makerere University on December 19, 2025. It reflects Orach’s decades of contribution to mentoring scholars and advancing refugee health and public health in complex emergencies.
“My work has enabled me to mentor many graduate students in disaster risk reduction and refugee health. About ten PhDs have completed under my supervision in this area,” Prof. Orach said, speaking with the benefit of hindsight after decades of academic mentorship and leadership at MakSPH. “Dr. Komakech’s work is extremely unique. His study examines how repatriation affects health systems in hosting districts, a question rarely studied at this depth, especially at PhD level.”
Uganda’s integrated refugee policy makes the study even more important. Unlike the parallel model, where refugee services operate separately from national systems, Uganda uses an integrated model where refugees and host populations share health services. Therefore, when refugees leave, the health system itself experiences a transition. His findings show the need for preparedness and sustainability planning, since humanitarian funding declines when refugee numbers decrease, Prof. Orach argued.
The field before the student
A South Sudanese refugee girl shields her face from the harsh sun while waiting for services at Maaji Health Center in Adjumani District, northern Uganda, on June 14, 2017. The scene reflects the heightened demand placed on frontline health facilities during refugee arrivals, when humanitarian support expands medicines, staffing and infrastructure, and the subsequent strain on host systems as services are absorbed following repatriation and partner withdrawal. This transition is examined in Komakech’s doctoral research. Photo: H. Athumani/VOA.
Orach’s entry into refugee health was not theoretical. After earning his Bachelor of Medicine and Bachelor of Surgery from Makerere University in 1988, he completed his internship at St. Francis Hospital, Nsambya, before being posted to West Nile as a Medical Officer at Maracha Hospital in Arua District in 1989. By 1990, he had become Medical Superintendent of the same hospital, serving in a region shaped by displacement from South Sudan and northern Uganda. Decades later, it would be the same West Nile districts where Komakech conducted his doctoral research.
In that environment, displacement was not a policy concept but a clinical reality. Hospital registers reflected migration patterns. Drug shortages, referral pressures, and fluctuating patient volumes were part of daily management. Refugee health was not yet an academic specialisation, Orach recalls. It was a lived service delivery, observed through overcrowded wards, strained supply chains, and district health systems adjusting in real time to population movements.
A woman and children return from collecting water in Bidi Bidi Refugee Settlement in northern Uganda on June 9, 2017. Large refugee influxes place immediate pressure on essential services such as water supply, sanitation and health care, expanding humanitarian support systems that host districts must later sustain as populations repatriate. Photo: Associated Press via VOA.
Those experiences gradually shifted his attention toward population health. Orach returned to Makerere University for postgraduate training in public health, completing the Diploma in Public Health in 1994, with the programme culminating in the Master of Medicine in Public Health in 1996. His master’s research examined maternal mortality in Gulu District using the Sisterhood methodology, a community-based study that earned him the Community Health Research Award from the World Health Organisation (WHO) Regional Office for Africa in 1997.
The recognition marked an early indication of the policy relevance of Prof. Garimoi Orach’s work. During this period, he also undertook specialised training in refugee studies at Oxford University in 1996 and later in large-scale emergency health response through the International Committee of the Red Cross (ICRC)–WHO Health Emergencies in Large Populations programme in 1997. The academic trajectory was beginning to align with what he had already encountered in practice in West Nile.
In 1999, after completing his master’s training, he intended to return to district service from where it all began. A senior academic intervened. “Professor Gilbert Bukenya asked me where I intended to work,” Orach recalls. “I told him I wanted to return to the district. He said, ‘Chris, you are not going anywhere. You will stay here at the university.’” That decision redirected his career toward academic public health. Between 1996 and 2002, he served as a Research Fellow at MakSPH, at the time called the Institute of Public Health (IPH), combining teaching, research, and field engagement.
Department of Community Health and Behavioural Sciences staff pose for a photo during a meeting at our training site in Kasangati in 2025. Prof. Christopher Garimoi Orach, second right, who led the Department from 2010 to 2019, stands alongside colleagues under the current leadership of Head of Department Assoc. Prof. Christine Nalwadda.
International collaboration soon expanded the scope of Orach’s work. Through a European Union–supported partnership linking Makerere University, Oxford University, the Institute of Tropical Medicine in Antwerp, and Moi University in Kenya, he deepened research into refugee welfare policy and emergency public health systems. The collaboration also opened further academic pathways. He pursued additional training at the Institute of Tropical Medicine in Antwerp, completing a second Master of Public Health in 2000, before later earning a PhD in Public Health from Vrije Universiteit Brussel in 2006.
His doctoral research examined reproductive health services for refugee and host populations in Uganda and the policy implications of integrating those services within national health systems. The work, published in The Lancet, which is one of the world’s oldest and most prestigious peer-reviewed general medical journals, informed policy reforms on refugee health at a time when Uganda was strengthening its legal and institutional framework for refugee protection, culminating in the Refugees Act of 2006 and the Refugees Regulations of 2010. Decades later, Komakech would revisit the same policy landscape from another angle, examining what happens to those integrated health systems when refugee populations begin to leave host districts, and humanitarian support recedes.
Orach’s academic career at Makerere subsequently progressed through successive ranks from being appointed Assistant Lecturer in 2003, Lecturer in 2006, Senior Lecturer in 2009, Associate Professor in 2012, and a full Professor of Public Health in 2015. Alongside teaching and research, he also served diligently as Head of the Department of Community Health and Behavioural Sciences from 2010 to 2019 and as Deputy Dean of the School of Public Health from 2012 to 2020. Over these years, he supervised postgraduate scholars and helped consolidate refugee health and public health in complex emergencies into an institutionalised field of teaching and research.
Prof. Garimoi Orach, Professor of Community Health and a leading scholar in public health in complex emergencies, gestures in celebration after successfully supervising three doctoral students, including Henry Komakech, to completion for Makerere University’s 2026 Graduation Ceremony.
Emergency response gradually became a curriculum. What began as field-informed training, including a short course in Public Health in Complex Emergencies (PHCE) that started in 1999, evolved into formal postgraduate programmes.
In 2014, the School established the Master of Public Health in Disaster Management, drawing on earlier emergency health initiatives and international collaborations. Refugee health systems, disaster preparedness, and post-disaster recovery had entered formal academic training within the institution. By the time Komakech embarked on his doctoral study three years later in 2017, the intellectual infrastructure for the questions he was asking had already been built, with the strong contribution to the field by front-runners like Orach. The scholar who would later examine the system at its point of transition had also grown within that very environment.
“Dr. Komakech’s journey mirrors mine. During my PhD, my supervisor’s illness delayed my completion. In his case, he suffered a severe road traffic accident that required multiple surgeries and interrupted his doctoral studies for several years,” Prof. Orach said, reflecting on the life-threatening accident that forced his student to withdraw from the programme before returning to defend his thesis in December 2025. “Despite this, he continued publishing and remained academically active. When he submitted his thesis draft, its quality surprised us greatly. His perseverance demonstrates true resilience, an essential quality in doctoral training.”
Prof. Garimoi Orach listens as Henry Komakech defends his doctoral thesis on refugee repatriation and health services in West Nile at Makerere University on December 19, 2025, reflecting scholarly continuity between field-building and new research on health system transitions during repatriation.
The student within the field
Komakech’s formation shows a long relationship with Makerere University and with the public health questions that would later shape his doctoral work. He first trained at Makerere’s Faculty of Social Sciences, earning a Bachelor of Arts in Social Sciences in 2005 before entering development and humanitarian work. Between 2006 and 2008, he worked with CARE International and the Charity for Peace Foundation, supporting communities affected by displacement and gender-based violence.
The work exposed him to the social and institutional pressures that accompany conflict and forced migration. Seeking stronger analytical tools to understand how health and social systems respond to those pressures, he later enrolled at Makerere University School of Public Health, completing a Master of Health Services Research in 2010.
Henry Komakech adjusts his doctoral bonnet after being conferred the Doctor of Philosophy (Public Health) degree during Makerere University’s 76th Graduation Ceremony at Freedom Square on February 25, 2026.
It was during this period that Komakech first met Prof. Garimoi Orach, beginning an academic relationship that would later shape his doctoral journey. Over more than a decade at the School now, he has served as a Research Associate, contributing to teaching, supervision, and the design and implementation of health systems research.
His work has spanned disaster resilience, refugee integration into national health systems, and the governance of health services in fragile settings, combining field research, project coordination, policy engagement, and academic publication. The doctoral study he defended in 2025 built directly on this sustained engagement with displacement, humanitarian response, and the capacity of public systems to adapt to changing pressures.
Dr. Henry Komakech (centre) stands with fellow MakSPH PhD graduands at Makerere Universitys 76th Graduation Ceremony (L–R): Dr. Olivia Nakisita, Dr. Aber Harriet Odonga, Dr. David Lubogo, Dr. Samalie Namukose, Dr. Moses Ntaro and Dr. Jimmy Osuret. February 25, 2026, Freedom Square, Makerere University.
The question that emerges when people leave
Komakech’s doctoral study examined the large-scale repatriation of South Sudanese refugees between 2006 and 2009 in the West Nile districts of Arua, Moyo, and Adjumani. Conducted between 2017 and 2019, the research used a mixed-methods design to analyse how district health systems adjust when refugee populations begin to decline.
The study investigated three related questions of how the repatriation process unfolded in the districts, how health services were reorganised once refugees left, and whether those services remained sustainable after humanitarian actors scaled down operations. Evidence was drawn from policy and programme documents alongside 81 key informant interviews with government officials, district health managers, humanitarian agencies, and community stakeholders.
A young South Sudanese refugee carries a foam mattress toward a communal reception tent at Imvepi Reception Centre in northern Uganda on June 9, 2017, as newly arrived families undergo registration and settlement. Refugee influxes trigger rapid expansion of humanitarian support for shelter and essential services; as repatriation later occurs and partners withdraw, host systems often absorb these responsibilities with limited resources. Photo: Associated Press via VOA.
The results from the study confirm that the repatriation process itself within the areas was highly structured and collaborative. In this process, national and district governments worked with UN agencies, humanitarian organisations, and refugee communities to organise voluntary return. Information campaigns, confidence-building visits to areas of origin, health screening, and reintegration support helped prepare refugees for departure and reduce uncertainty about conditions back home. Through this coordinated system, nearly 95,000 South Sudanese refugees were repatriated from settlements across the West Nile districts between 2005 and 2009.
The departure of refugees, however, was found to reshape local health systems within host communities. Dr. Komakech’s thesis reports that during periods of influx, humanitarian agencies expanded district capacity by providing essential medicines, health workers, infrastructure, and logistical support. Once repatriation began and aid organisations withdrew, district health teams assumed responsibility for facilities and services previously supported by humanitarian partners.
Although Uganda’s integrated refugee policy enables these services to be absorbed into the national health system, the study reports, districts often face persistent shortages of medicines, personnel, and operational funding. Many facilities established for emergency response were found to remain in place but lacked sustainable financing for routine service delivery.
Displaced families walk toward registration and settlement areas on arrival at Imvepi Refugee Settlement in northern Uganda. Komakech’s research highlights how health systems must adapt to support both refugees and host communities during arrival, settlement, and eventual repatriation, emphasising planning for continuity of care and sustainable services. Photo: Kieran Doherty / Oxfam.
In earnest, the study characterises repatriation as a health systems shock, affecting governance, financing, and service sustainability. Its author cogently states that humanitarian resources tend to decline rapidly when refugee numbers fall, while government allocations adjust more slowly through national budget cycles. Consequently, he notes, district health systems in the areas inherit expanded responsibilities without equivalent continuity of resources;
“Districts do not experience relief when NGOs leave,” Komakech explained. “They transition from supported service delivery to unfunded responsibility.” The research also reveals variation across districts. In Arua, earlier integration of partner-supported services into district structures helped cushion the transition, suggesting that governance choices and early planning indeed influence how systems absorb the shift from humanitarian response to routine service delivery.
The evidence in his study points to the need to treat repatriation as a planned health systems transition rather than a simple population movement. Dr. Komakech, in his recommendations, calls for humanitarian agencies to align exit strategies with district health planning, urges the government to integrate refugee-supported services into national systems early, and highlights the need for sustained investment by both government and development partners to ensure that district health services remain functional as humanitarian support declines.
For his mentor and principal supervisor, Prof. Orach, the study confirms Komakech’s growing authority in the field, following his graduation with a PhD in Public Health from Makerere University on February 25, 2026.
“I now consider Dr. Komakech a health systems expert in refugee health. Having worked in this field for nearly a decade now, he is well-positioned to advance research on health systems in emergency settings. His work demonstrates how governments, NGOs, and communities can collaborate to sustain healthcare during repatriation. He is an important asset to the university and will likely be sought after by humanitarian organisations. I hope he remains in academia to continue advancing this developing field.”
Mentorship and the reproduction of scholarship
MakSPH faculty join the School’s seven newly graduated PhD scholars, including Dr. Henry Komakech (third right), for a group photograph during Makerere University’s 76th Graduation Ceremony at the Freedom Square on February 25, 2026.
Mentorship was at the heart of the bond between Prof. Orach and Dr. Komakech, built on trust, mutual respect, and a shared commitment to advancing public health scholarship and research at Makerere University School of Public Health. For Orach, supervising a PhD was never only about research guidance; it meant nurturing a scholar, shaping independent thinking, and opening paths for leadership in the field.
“My mentorship philosophy is simple,” Orach explained. “I see students as future scholars who should surpass me. I guide them toward unexplored areas where they can lead. Knowledge must be shared openly, and students should always have direct access to their mentors. Silence concerns me. Active engagement is essential.”
The philosophy prioritises intellectual independence. Rather than directing students toward his own research agenda, Prof. Orach encourages them to pursue critical questions that expand the boundaries of public health scholarship. Dr. Henry Komakech’s own doctoral work exemplified this approach. “Prof. Orach played a critical role throughout my PhD journey, offering guidance beyond academics, shaping study design, methodological rigour, theoretical grounding, and policy relevance. His mentorship helped me navigate difficult phases of fieldwork, analysis, and writing while encouraging independence and critical thinking,” Komakech reflected.
MakSPH Dean Prof. Rhoda Wanyenze, flanked by Head of Department of CHBS Assoc. Prof. Christine Nalwadda, present MakSPH graduands during Makerere University’s 76th Graduation Ceremony on February 25, 2026, reflecting the School’s growing contribution to public health workforce development, including training for humanitarian and complex emergency settings.
Mentorship remains a cornerstone of MakSPH’s scholarly culture, reflected in the Department of Community Health and Behavioural Sciences, chaired by Assoc. Prof. Christine Nalwadda, since March 2020 Dr. Nalwadda praised Komakech’s contribution to advancing the School’s mission, noting: “As a School, we are proud of the work of our scholars and the impact it has on the University and the communities we serve. Dr. Komakech’s research addresses a matter of national and regional importance. Uganda hosts nearly two million refugees, the largest refugee population in Africa, and understanding how health systems adjust when populations move is critical. His work provides vital evidence to guide planning and ensure health services remain responsive during these transitions.”
She said her department now has 12 faculty members, 11 holding doctoral degrees, with the remaining colleague progressing through their doctoral training. This concentration of expertise reflects a culture where mentorship and scholarly development are central. Within this environment, the mentor-student relationship between Orach and Komakech represents more than individual achievement. Orach’s scholarship established refugee health and public health in complex emergencies as an institutionalised area of study at the School, and Komakech’s research extends this trajectory, examining how health systems endure once humanitarian intensity declines.
Looking ahead, Dr. Henry Komakech wants to consolidate this emerging field, mentor younger scholars, and ensure research evidence informs policy and practice for refugee and displaced populations. For Prof. Christopher Garimoi Orach, this progression represents the deeper purpose of doctoral training. “Public health must lead in fragile and humanitarian settings,” he asserts. “We must train highly skilled professionals like Komakech in disaster and humanitarian response who can operate within strong governance and funding structures. My greatest satisfaction is producing more PhDs equipped to lead in these contexts. I am confident our efforts are bearing fruit, though much work remains.”
Assoc. Prof. Christine Nalwadda, Head of the Department of Community Health and Behavioural Sciences, congratulates Dr. Henry Komakech following his conferment of the Doctor of Philosophy in Public Health degree of Makerere University on February 25, 2026.
In many low- and middle-income countries, mortality data remains a critical gap in public health planning, often leaving a significant portion of the population “invisible” in official records. In Uganda, where national death registration completeness has historically hovered around a mere 20%, Makerere University Centre for Health and Population Research (MUCHAP) is leading a transformative initiative. By leveraging the infrastructure of the Health and Demographic Surveillance System (HDSS), MUCHAP has demonstrated how academic research frameworks can be integrated into national systems to strengthen Civil Registration and Vital Statistics (CRVS).
A Bridge between research and governance
The core of this success lies in the collaboration between Makerere University’s infrastructure and government agencies, specifically the National Identification and Registration Authority (NIRA). This partnership, supported by the Uganda National Public Health Institute (UNPHI) and international partners like the Bloomberg Philanthropies Data for Health Initiative at the CDC Foundation, aimed at aligning local death recording practices with the legal requirements of the Registration of Persons Act (ROPA) 2015.
By utilizing the existing MUCHAP Iganga Mayuge HDSS platform, which has monitored births and deaths in the Iganga and Mayuge districts since 2005, the project demonstrated the use of a decentralized notification process. This model utilises Village Health Teams (VHTs) who already serve as HDSS scouts and part of the Ministry of Health systems as official death notifiers. These VHTs assist households in completing official NIRA notification forms at the household/community level, which are then verified by local leaders and submitted to District Registration Offices.
Impact: From 20% to over 70% completeness
The results of this collaboration have been profound. In the pilot sub counties in the districts of Iganga and Mayuge, death registration completeness reached 73–79%, a dramatic improvement over the prevailing national estimates. During the study period, 2,992 deaths were officially registered within the national CRVS system.
Key drivers of this success included:
Reduced barriers: Decentralization brought the registration process closer to home, with an average travel distance of only 4–5 km for notification, compared to the significant distances previously required to reach district offices.
Cost savings: Families reported that the community-based process eliminated unofficial fees and high transportation costs, facilitating essential cultural and legal tasks like property inheritance and appointing heirs.
Advanced surveillance: The project proved that local health personnel could successfully conduct verbal autopsies (VA) in non-HDSS settings, providing critical data on causes of death that were previously unavailable for home-based deaths.
Sustainability and future potential
The MUCHAP-IMHDSS model is designed for long-term sustainability and national scalability. By embedding these tasks within the routine activities of VHTs and local leaders, the process becomes streamlined and cost-effective over time. The project also highlights that community sensitization is vital to maintaining trust and ensuring high participation rates, particularly in rural areas.
Looking forward, this initiative serves as a scalable blueprint for the rest of Uganda and other low-resource settings. Future engagements are expected to focus on:
National scale-up: Applying the lessons learned from Iganga and Mayuge to the entire country to close the mortality surveillance data gap.
Integration with health systems: Linking the CRVS data with broader health information systems to enhance pandemic preparedness and routine public health actions.
Regional leadership: Aligning with the Africa CDC’s initiative to strengthen mortality surveillance across the continent, positioning Uganda’s university-led model as a regional gold standard.
The HDSS-CRVS integration Project Leader Dr. Dan Kajungu who is the Executive Director of MUCHAP emphasised that “through this work, Makerere University has again proved that academic infrastructure is not just for research, but a vital engine for building resilient national governance and health systems”. This work was disseminated at the 2026 CRVS Research Forum in Bangkok, Thailand and can be accessed at https://shorturl.at/8JLTd
Dan Kajungu Msc PhD is the Executive Director MUCHAP
World Malaria Day 2026: Makerere scientists have found the countdown clock for when Ugandan children will die from malaria: The question is whether anyone is listening
On a day when the world declares it can and must end malaria, new research from Eastern Uganda shows climate change is working against us and that the evidence to fight back exists right here at home
Special Feature | World Malaria Day, 25 April 2026
By Health and Science Correspondent
Today, 25 April 2026, Uganda joins the rest of the world in marking World Malaria Day under the global theme: “Driven to End Malaria: Now We Can. Now We Must.” It is a rallying cry rooted in genuine optimism. Since 2000, 2.3 billion malaria cases and 14 million deaths have been averted globally. Forty-seven countries have been certified malaria-free, and between 2000 and 2024, the number of malaria-endemic countries fell sharply from 108 to 80.
Uganda is not one of those success stories, not yet. Malaria is endemic in 96% of Uganda, accounting for 29.1% of outpatient visits and 39.5% of hospital admissions, with over 17,556 estimated malaria deaths annually, the highest burden falling on children under five years of age. And on this World Malaria Day, a new alarm has been sounded from the heart of one of Uganda’s most malaria-burdened communities, not by foreign researchers, not by a distant global health organisation, but by scientists at Makerere University, drawing on two decades of data they have collected in the villages of Iganga and Mayuge in Eastern Uganda.
Their message is urgent: climate change is silently and measurably worsening Uganda’s malaria crisis. But this is the equally important half of the story. They have now identified the precise conditions under which children die, and exactly how long in advance those deaths can be predicted. Uganda has, for the first time, a scientifically validated early warning system for climate-driven malaria mortality. Whether the country chooses to use it is now a question of political will, not scientific capacity.
The study and the platform that made it possible
Published in BMC Public Health in August 2025, the study — “Climate-driven malaria mortality among children in malaria-endemic areas of Uganda” — was led by Dan Kajungu of Makerere University‘s Centre for Health and Population Research (MUCHAP). It analysed 14 years of weekly malaria death data from January 2008 to December 2022 matched against climate variables, using a sophisticated time-series statistical approach called the Distributed Lag Non-linear Model.
The data came from the Iganga Mayuge Health and Demographic Surveillance Site (IMHDSS), the population research platform that Makerere University has operated continuously since 2005. The IMHDSS population cohort collects data from 65 villages located within an area of 155 square kilometres, monitoring a population of close to 100,000 people. The site has 23 health facilities, including two general hospitals, and a bimodal tropical climate with rainfall seasons from March to May and September to November.
What makes the IMHDSS extraordinary and what made this study possible is its method of capturing deaths. Rather than relying on hospital registers that miss the majority of rural deaths, malaria deaths were identified using verbal autopsies and the InterVA algorithm, a probabilistic tool that uses verbal autopsy questionnaires and Bayesian statistical techniques to estimate the probabilities of various causes of death based on signs and symptoms reported by bereaved families. Three different WHO verbal autopsy tools are used, tailored for neonates, children, and adults respectively.
In other words, when a child dies in a village in Iganga, the IMHDSS knows about it. It interviews the family. It determines why the child died. And it has been doing this, without interruption, for twenty years. The result is a dataset that is both scientifically rare and profoundly Ugandan, generated here, about us, by our own researchers.
A total of 858 malaria-related deaths were recorded in the Iganga-Mayuge districts between 2008 and 2022. Of these, 53% were among males and 47% females. The vast majority, about 73% occurred among children under five years of age, while the fewest deaths occurred among those aged 15 to 49 years. Males exhibited higher mortality proportions across all age groups, except among the elderly.
Eight hundred and fifty-eight deaths. Each one a child or adult with a name, a family, a community. Each one counted.
The finding that changes everything: Uganda now has a malaria early warning system
The scientific heart of this study, the finding that every health planner, every district malaria coordinator, and every Minister of Health in Uganda should understand is this: the researchers have identified the exact temperature and rainfall thresholds at which malaria deaths among children rise, and how many weeks in advance those deaths can be predicted.
The study found an increased mortality risk across all ages at a lag of 11 to 12 weeks following exposure to rainfall above 646 mm. Higher risks of malaria mortality were also observed at a lag of 5 to 11 weeks when temperatures ranged between 25.2°C and 29.9°C. Critically, the relative risk of malaria mortality in children under five years and children aged between 5 and 14 years was more sensitive to temperature than to rainfall.
Read that again, slowly. When temperatures in Eastern Uganda climb into the range of 25.2°C to 29.9°C, children begin dying of malaria five to eleven weeks later. When extreme rainfall events exceed 646 mm, deaths rise eleven to twelve weeks after that exposure. Uganda’s meteorological service measures temperature and rainfall continuously. Uganda’s health system manages malaria interventions. These two systems have never been formally connected, but the science to connect them now exists.
This is what a malaria early warning system looks like. Not a foreign technology imported at great expense. Not a satellite system requiring international expertise to interpret. A Ugandan scientific finding, produced from Ugandan data, that tells Ugandan health authorities: when you see these weather conditions, stock your health centres, distribute your bed nets, deploy your community health workers, and prepare, because the deaths are coming in six to twelve weeks if you do not act.
On this World Malaria Day, when the global community declares that ending malaria is now possible, Uganda has precisely this tool in its hands. The only question is whether it will use it.
Climate change is not a future threat, it is already killing children
The global theme for World Malaria Day 2026 carries urgency partly because climate change, conflict, and humanitarian crises continue to drive malaria resurgence and disrupt essential services. The Makerere study puts specific, local flesh on that global warning.
Malaria is climate-sensitive, changes in temperature, rainfall patterns, and relative humidity affect the dynamics and intensity of malaria transmission by influencing the habitats of mosquitoes and parasites and their biological growth cycle. Climate remains an indirect cause of malaria mortality by affecting parasite development during periods of high rainfall and temperatures, leading to increased transmission, morbidity, and severe malaria outcomes.
The malaria parasite Plasmodium falciparum, the species responsible for almost all malaria deaths in Uganda requires specific temperature ranges to complete its development inside the Anopheles mosquito. Too cold, and development slows or stops. Too hot, and it also stops. But within the range that Eastern Uganda increasingly inhabits, and will inhabit more frequently as global temperatures rise, the parasite thrives, multiplies, and kills.
The World Malaria Report 2025 warns that drug resistance is now confirmed in four African countries including Uganda, where artemisinin partial resistance has been detected. Insecticide resistance to pyrethroids – the main chemical on bed nets is now confirmed in 48 out of 53 reporting countries. As the tools Uganda currently relies on including bed nets, indoor spraying, artemisinin-based drugs face mounting biological resistance, the importance of climate-informed prevention strategies grows exponentially. Deploying interventions at exactly the right time, guided by weather data, becomes not just efficient but essential.
The children most at risk: a finding that demands a policy response
Among the study’s most striking findings is the specific vulnerability of school-age boys. A group almost entirely absent from Uganda’s current malaria prevention architecture.
Male children aged between 5 and 14 years were found to be more vulnerable to temperature-related malaria mortality compared to females in that age group and compared to children under five years. Rainfall did not have a significant association with malaria mortality in children.
Uganda’s National Malaria Control Programme, like most in sub-Saharan Africa, has historically concentrated resources on two priority groups: children under five and pregnant women. These groups are undeniably vulnerable and deserve protection. But this study shows that school-age boys are dying from temperature-driven malaria at rates that demand their inclusion in prevention strategies.
School-aged children between 5 and 14 years have higher malaria prevalence, with 70% carrying the malaria parasite asymptomatically in high transmission settings. They carry the parasite silently, sustaining transmission in their communities, and they die when temperatures rise, particularly the boys, who in rural Uganda spend more time outdoors, sleep less consistently under nets, and receive less parental health supervision than their sisters as they grow older.
The study’s area is itself among the most heavily burdened in Uganda. The Iganga-Mayuge area has a malaria prevalence rate of 39.4% in children under five years old, making it one of the areas in Uganda most severely impacted by malaria, and the disease is the leading cause of mortality in children there. In such a high-transmission setting, the combination of asymptomatic carriage, temperature-driven transmission spikes, and inadequate prevention coverage for school-age children is a formula for preventable death.
On World Malaria Day 2026, as Uganda declares its commitment to ending malaria, the national malaria strategy must be updated to reflect this evidence. School-based distribution of insecticide-treated nets, school health programmes that include malaria education and early symptom recognition, and targeted community outreach for families with boys aged 5 to 14 are not optional additions, they are evidence-based necessities.
The platform: Makerere‘s IMHDSS as a national asset for malaria elimination
None of the findings in this study would have been possible without the IMHDSS and on World Malaria Day, it is worth being explicit about what that platform represents for Uganda’s future.
The IMHDSS platform has measured various indicators about coverage and uptake of national interventions including the coverage and utilisation of immunisation and vaccines, mosquito nets for malaria vector control, household income improvement, and family planning, and other behaviour change interventions at community level, strengthening the evaluation of burden of disease at the subnational level.
For malaria specifically, the IMHDSS has now produced the most granular mortality data in Uganda’s history capturing not just how many children die, but exactly which weather conditions preceded those deaths, which sex and age group is most vulnerable, and what the biological and epidemiological mechanisms are that connect climate to the grave. This is the kind of intelligence that a National Malaria Control Programme needs to move from reactive crisis management to proactive, evidence-driven prevention.
Scarcity of quality data remains a key development bottleneck in low and middle-income countries, and the Iganga-Mayuge HDSS represents a Makerere University platform for research and research training with a population-based cohort that longitudinally generates data for evidence-based decisions and policy.
Uganda’s malaria elimination goal, to bring mortality to zero will not be achieved by effort and goodwill alone. It requires data. It requires the kind of longitudinal, community-level, cause-of-death data that only a platform like the IMHDSS can generate. And it requires the institutional will to connect that data to the decisions that determine whether children live or die.
What must happen now
The global call on World Malaria Day 2026 is clear: “Now We Can. Now We Must.” For Uganda, the Makerere climate-malaria study translates that call into three specific and achievable actions.
First, the Ministry of Health and Uganda National Meteorological Authority must establish a formal, operational malaria early warning system. One that uses real-time weather monitoring to trigger predetermined health system responses when temperature and rainfall thresholds identified by this research are breached. The science is ready. The infrastructure for meteorological monitoring exists. What is needed is the institutional bridge between them.
Second, Uganda’s National Malaria Control Programme must extend its prevention focus to include school-age children, particularly boys aged 5 to 14, in all high-transmission areas. Bed net campaigns must reach schools, not just health centres and antenatal clinics. Community health workers must be equipped to identify and treat malaria in this age group as a priority.
Third, and most fundamentally, the Government of Uganda must formally recognise and domestically resource the IMHDSS as national public health infrastructure. The 2024 global malaria funding of US$3.9 billion was less than half of the US$9.3 billion target, leaving a projected shortfall of US$5.4 billion that leaves the response dangerously under-resourced. In a world where international health financing is under historic pressure, Uganda cannot afford to have its most powerful evidence-generation platform dependent entirely on foreign philanthropy. The IMHDSS is a Ugandan asset. It must be funded as one.
Today, children in Iganga and Mayuge are alive who might not be, because the research generated by the IMHDSS informed the malaria interventions that reached their communities. Today, Makerere scientists have given Uganda a tool, a climate-based early warning system for malaria deaths that no other country in East Africa currently possesses.
Now we can. Now we must.
The evidence is there. The science is done. The only thing Uganda needs now is the will to act on it.
“Climate-driven malaria mortality among children in malaria-endemic areas of Uganda” is published open-access in BMC Public Health, Volume 25, Article 2825, August 2025. Full text available at: https://link.springer.com/article/10.1186/s12889-025-23678-0
The Iganga Mayuge Health and Demographic Surveillance Site (IMHDSS) is operated by MUCHAP, Makerere University. Contact: info@muchap.mak.ac.ug or dkajungu@muchap.mak.ac.ug| Tel: +256 772 207127 (Dr. Dan Kajungu)
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.
General2 weeks ago
General6 days ago
Agriculture & Environment3 days ago
General2 weeks ago
General1 week ago