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The Road from Climate Promises to Care in Uganda

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This week, world leaders, negotiators and researchers are gathered in Antalya, Türkiye, for COP31, the United Nations climate conference, seeking to turn years of climate commitments into action countries can finance and implement. Among them is Dr. John Bosco Isunju, a climate and health researcher at Makerere University School of Public Health, named among TIME’s 100 most influential climate leaders in 2024.

Dr. Isunju led the School’s technical support to the Ministry of Health for Uganda’s 2023 Climate Change Health Vulnerability and Adaptation Assessment (VAA) and the subsequent development of the Health National Adaptation Plan (H-NAP) 2025–2030. The assessment covered 716 health facilities across 43 districts, documenting vulnerabilities that helped shape the country’s priorities for protecting healthcare from climate hazards.

Flood damage at Kilembe Mines Hospital in Kasese District. Damaged wards can disrupt treatment and limit access to care. Photo: H-NAP Team. Makerere University School of Public Health, Kampala, Uganda, East Africa joins world leaders, negotiators and researchers are gathered in Antalya, Türkiye, for COP31, the United Nations climate conference, discusses School’s technical support to the Ministry of Health for Uganda’s 2023 Climate Change Health Vulnerability and Adaptation Assessment (VAA) and the subsequent development of the Health National Adaptation Plan (H-NAP) 2025–2030.
Flood damage at Kilembe Mines Hospital in Kasese District. Damaged wards can disrupt treatment and limit access to care. Photo: H-NAP Team.

That experience speaks directly to the task before the 9–20 November summit. With “Dynamic and Resilient Health Systems” among the COP31 Presidency’s Action Agenda priorities, the conference is seeking practical solutions and financing to keep services functioning through climate shocks. Adaptation, the practical changes needed to cope with a changing climate, must ultimately reach the facilities where people seek care.

Protecting facilities from floods and drought also safeguards the public investment behind them, giving Uganda’s adaptation effort an economic significance alongside its importance to patients. In a 27 October 2026 statement ahead of COP31, UN Climate Change Executive Secretary Simon Stiell placed climate action within that wider calculation of public benefit.

“More governments are taking climate action right across their economies, to bank the vast benefits of clean energy and climate resilience,” he said. “Almost every major economy, and many medium-sized and smaller economies, now see climate action as a central driver of economic growth, jobs, and affordable and secure energy.”

UN climate chief Simon Stiell delivers opening remarks at COP31 in Antalya, Türkiye. Photo: UN Climate Change/Kiara Worth. Makerere University School of Public Health, Kampala, Uganda, East Africa joins world leaders, negotiators and researchers are gathered in Antalya, Türkiye, for COP31, the United Nations climate conference, discusses School’s technical support to the Ministry of Health for Uganda’s 2023 Climate Change Health Vulnerability and Adaptation Assessment (VAA) and the subsequent development of the Health National Adaptation Plan (H-NAP) 2025–2030.
UN climate chief Simon Stiell delivers opening remarks at COP31 in Antalya, Türkiye. Photo: UN Climate Change/Kiara Worth.

On 21 October, nearly three weeks before the Antalya talks, the H-NAP was before Ugandan parliamentarians in Kampala. Convened by the Ministry of Health and Parliamentary Forum on Climate Change Uganda, with support from Regenerate Africa and the Clinton Health Access Initiative, the engagement examined the plan and Parliament’s role in securing funding, scrutinising implementation and ensuring accountability.

Presenting the VAA, Dr. Isunju explained that the team examined the hazards facing each area, the extent of exposure and the weaknesses that made services vulnerable. They also considered the communities the facilities served. A flood could turn an already difficult journey to treatment into one that patients and staff could no longer make, as seen in many parts of Uganda, including Kasese.

“Either health workers will not work, or communities will not be able to access care, or outreaches will not be possible because roads are cut off,” he told legislators.

MPs at the orientation on implementing Uganda’s Health National Adaptation Plan, led by Makerere University School of Public Health, the Ministry of Health and partners in Kampala, 21 October 2026. Makerere University School of Public Health, Kampala, Uganda, East Africa joins world leaders, negotiators and researchers are gathered in Antalya, Türkiye, for COP31, the United Nations climate conference, discusses School’s technical support to the Ministry of Health for Uganda’s 2023 Climate Change Health Vulnerability and Adaptation Assessment (VAA) and the subsequent development of the Health National Adaptation Plan (H-NAP) 2025–2030.
MPs at the orientation on implementing Uganda’s Health National Adaptation Plan, led by Makerere University School of Public Health, the Ministry of Health and partners in Kampala, 21 October 2026.

Uganda’s H-NAP grew out of commitments made at COP26 in Glasgow in 2021 to assess health vulnerabilities and develop an adaptation response. The Ministry of Health commissioned the School to undertake the VAA in 2023, with Rockefeller Foundation funding supporting both the assessment and the plan’s development. Developed through stakeholder consultation, with WHO technical support and contributions from other partners, the plan was launched on 22 August 2024.

What the assessment found

The VAA found that drought and floods were disrupting the conditions needed to deliver care. Nearly half of the assessed facilities reported drought exposure, while about two in five reported floods. Among the 284 facilities reporting flood exposure, 141 (about half) said health professionals had been unable to arrive at or leave their workplaces, and 198 (about seven in ten) reported shortages of safe water. Because districts were selected for their history of hazards, these findings describe the assessed facilities and cannot be treated as national estimates.

Findings from Uganda’s 2023 health vulnerability assessment helped shape its Health National Adaptation Plan 2025–2030. Makerere University School of Public Health, Kampala, Uganda, East Africa joins world leaders, negotiators and researchers are gathered in Antalya, Türkiye, for COP31, the United Nations climate conference, discusses School’s technical support to the Ministry of Health for Uganda’s 2023 Climate Change Health Vulnerability and Adaptation Assessment (VAA) and the subsequent development of the Health National Adaptation Plan (H-NAP) 2025–2030.
Findings from Uganda’s 2023 health vulnerability assessment helped shape its Health National Adaptation Plan 2025–2030.

The H-NAP responds across ten components of the health system, including leadership, workforce training, risk monitoring and sustainable financing. Its proposed actions include revising infrastructure standards and using weather and disease information to warn of health risks earlier. Protecting care requires investment in buildings alongside the people and systems that make them function.

“A significant proportion of healthcare facilities lack water management and safety plans to address contamination risks,” the H-NAP states. “They lack water safety plans and contingency plans for monitoring and reducing contaminants as well as on-site water purification equipment.” Such gaps can leave facilities unable to maintain hygiene, clean equipment and provide treatment safely when water supplies fail or become contaminated.

The H-NAP already includes a budget, giving implementation a basis for resource mobilisation. The UN climate secretariat’s 2026 report on national adaptation plans across sectors identifies the difficulty of turning priorities into fundable projects. It recommends costing specific interventions and securing delivery partners, steps that can help advance Uganda’s health adaptation priorities.

At household level, climate pressures on livelihoods can leave families less able to get care or keep children in school, as community consultations showed.

“Their problems are interconnected. If climate, for example, affects their livelihoods, it directly impacts their health, because that means when they fall sick they can’t get care, and they can’t take their children to school, so things are all interconnected,” Dr. Isunju said.

Dr. John Bosco Isunju briefs MPs on climate risks to Uganda’s health services in Kampala, 21 October 2026. Makerere University School of Public Health, Kampala, Uganda, East Africa joins world leaders, negotiators and researchers are gathered in Antalya, Türkiye, for COP31, the United Nations climate conference, discusses School’s technical support to the Ministry of Health for Uganda’s 2023 Climate Change Health Vulnerability and Adaptation Assessment (VAA) and the subsequent development of the Health National Adaptation Plan (H-NAP) 2025–2030.
Dr. John Bosco Isunju briefs MPs on climate risks to Uganda’s health services in Kampala, 21 October 2026.

The Ministry’s Focal Point for Climate Change and Health, Dr. Didacus Namanya, told MPs that resilience, the ability to withstand disruption and keep providing care, must inform how services are built and managed.

“So, our vision in the H-NAP is to have a responsive, adaptive, and resilient health system. Adaptive, we are talking about adaptation. These impacts will not stop; they will continue coming, but we must develop our adaptive capacity. The way we build our health facilities, the way we tackle the disease burden, we must be highly adaptive,” he said.

Dr. Namanya called for district-specific assessments, noting the different conditions in Nakasongola and Bududa, and described an ongoing review of infrastructure design standards. Dr. Isunju reported that guidelines for coordinating climate and health action across institutions were undergoing approval.

A partnership announced in October 2025 by the Rockefeller Foundation and the International Development Research Centre is helping the School and the Clinton Health Access Initiative, working with the Ministry of Health, build an investment case for H-NAP implementation. A separate Ministry of Health and Global Green Growth Institute initiative, begun in June 2026, is advancing climate-resilient water, sanitation and hygiene standards, investment plans for health facilities and the government’s capacity to deliver improvements.

Rt. Hon. Lukia Isanga Nakadama signs a display copy of Uganda’s Health National Adaptation Plan at its launch in Kampala, 22 August 2024. Makerere University School of Public Health, Kampala, Uganda, East Africa joins world leaders, negotiators and researchers are gathered in Antalya, Türkiye, for COP31, the United Nations climate conference, discusses School’s technical support to the Ministry of Health for Uganda’s 2023 Climate Change Health Vulnerability and Adaptation Assessment (VAA) and the subsequent development of the Health National Adaptation Plan (H-NAP) 2025–2030.
Rt. Hon. Lukia Isanga Nakadama signs a display copy of Uganda’s Health National Adaptation Plan at its launch in Kampala, 22 August 2024.

Questions for Antalya

Legislators sought evidence of what implementation had delivered. Terego East MP Hon. Wilfred Babanga Erima asked how much of the plan had been implemented, how many facilities had been audited and refitted for climate resilience, and how funding was divided between domestic and donor sources. Hon. Shafiga Wanyenya, Vice Chairperson of Parliament’s Committee on Climate Change, proposed joint follow-up with the health committee and regular progress reviews.

“Our role is to ask the difficult questions and also identify implementation gaps, to advocate for the vulnerable communities and ensure that the national commitments translate into tangible improvements in the lives of our people,” Hon. Wanyenya said.

Hon. Shafiga Wanyenya, Vice Chairperson of Parliament’s Climate Change Committee, calls for oversight of Uganda’s health adaptation plan in Kampala, 21 October 2026. Makerere University School of Public Health, Kampala, Uganda, East Africa joins world leaders, negotiators and researchers are gathered in Antalya, Türkiye, for COP31, the United Nations climate conference, discusses School’s technical support to the Ministry of Health for Uganda’s 2023 Climate Change Health Vulnerability and Adaptation Assessment (VAA) and the subsequent development of the Health National Adaptation Plan (H-NAP) 2025–2030.
Hon. Shafiga Wanyenya, Vice Chairperson of Parliament’s Climate Change Committee, calls for oversight of Uganda’s health adaptation plan in Kampala, 21 October 2026.

Those questions belong in Antalya too. The Yearbook of Global Climate Action 2026 identifies gaps in global data for assessing whether health systems are becoming more resilient, underlining the importance of tracking what adaptation efforts deliver for health.

The COP31 health programme links implementation of the Belém Health Action Plan with a financing framework intended to help turn health priorities into investable projects. Launched on 9 November, the Antalya Initiative for Health Resilience provides a platform for countries to share practical experience. The COP28 adaptation framework sets targets for climate-resilient health services by 2030 and progressively beyond, alongside national adaptation planning by 2030 and multi-hazard early-warning systems by 2027.

The H-NAP gives Uganda a practical agenda for that next stage. It calls for climate and health priorities to enter government budgets and for proposals capable of attracting finance. It also identifies academic partnerships as a route to research and capacity-building funds. Annual reviews would then assess progress and guide subsequent work.

As negotiations continue in Antalya, the next test is whether decisions there, and action at home, help keep care available, on the road to a health facility, and at the water point on which safe treatment depends.

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John Okeya

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Makerere University’s Prof. Peter Waiswa Appointed to WHO Technical Working Group on Essential Child Health Services

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Prof. Peter Waiswa (C) with participants at the World Health Regional Summit on 29 April 2026 in Nairobi Kenya. Photo: MNCH. Makerere University Center of Excellence for Maternal, Newborn and Child Health (MNCH), based at the Makerere University School of Public Health in Kampala Uganda

Makerere University’s Professor Peter Waiswa has been appointed to the World Health Organization (WHO) Technical Working Group of Experts tasked with developing the Essential Child Health Services (ECHS) framework.

The appointment, communicated in an official letter dated October 21, 2026, and signed by Dr. Pascale Allotey, Director of WHO’s Department of Sexual, Reproductive, Maternal, Child, Adolescent and Ageing Health, runs until December 31, 2027.

The technical working group will support WHO in defining a core package of essential health services for newborns, older children and adolescents, alongside practical approaches for delivering these services effectively and equitably to improve their health and well-being.

As a member of the working group, Prof. Waiswa will contribute scientific and technical expertise to the development of the framework. His responsibilities will include participating in technical consultations, reviewing draft documents, providing written feedback and contributing to consensus-building on key technical issues.

The group is expected to hold approximately five online meetings between November 2026 and mid-2027. Members will serve in their individual capacities as independent experts rather than as representatives of their respective governments or institutions.

The appointment builds on Prof. Waiswa’s longstanding service and contributions to WHO. He previously served for seven years on WHO’s Strategic and Technical Advisory Group of Experts (STAGE) on Maternal, Newborn, Child and Adolescent Health and Nutrition, with his tenure concluding in June 2026.

Congratulations Prof. Peter Waiswa.

Mak Editor

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Mak Staff Receive Prestigious International “Future of the Field” Recognition in Global Research Administration Class of 2026.

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Mr. Mordecai Tayebwa (L) and Ms. Bonny Tusiime(R)

Makerere University proudly celebrates the recognition of Mr. Mordecai Tayebwa, Senior Grants Manager, Makerere University Lung Institute and Ms. Bonny Tusiime, Grants and Contracts Officer, Makerere University College of Health of Sciences (MakCHS) as recipients of the prestigious Future of the Field Award of Society of Research Administrators International (SRAI), an international recognition that Honors emerging leaders making outstanding contributions to the advancement of research administration. This year’s ‘Future of the Field’ honorees were formally recognized at SRAI’s Annual Meeting held in Honolulu, Hawaii, USA in October, 2026.

The Future of the Field Award recognizes professionals who demonstrate exceptional leadership, innovation, and commitment to strengthening research management and administration. The award celebrates individuals whose work is shaping the future of the profession by improving research support systems, fostering collaboration, and advancing excellence in research administration.

At Makerere University, Mr. Tayebwa and Ms. Tusiime have played key roles in strengthening grants and contracts management, supporting researchers throughout the grant lifecycle, promoting compliance with sponsor requirements, and contributing to the development of sustainable research management systems. Their efforts have enhanced institutional capacity to attract, manage, and administer competitive research funding while ensuring accountability and excellence. Commenting on the recognition, the award recipients expressed their gratitude for the opportunity to contribute to the growth of research administration. “This recognition reflects not only our individual efforts but also the collaborative environment at  MakCHS and Makerere University. It inspires us to continue strengthening research administration and supporting researchers in generating impactful scientific discoveries that improve lives.” They said.

The achievement highlights the growing international recognition of research administration professionals in Africa and underscores Makerere University and MakCHS’s  general commitment to building strong research support systems that enable world-class research. This also reflects the institution’s investment in professional development and its dedication to advancing research excellence through effective grants management.

Commenting on the award, Dara C. Little, President, (SRAI) said “In a field as dynamic and rapidly evolving as research administration, the need for visionary,adaptable leaders have never been greater,” . “SRAI’s Future of the Field recipients represent the next generation of changemakers – those who will not only navigate complexity but shape the future of our profession. To embrace change, is to lead your innovation, resilience, and leadership are exactly what this moment demands. Rise to the opportunity and you will do great things!”

Makerere University congratulates Mr. Mordecai Tayebwa and Ms. Bonny Tusiime on this significant achievement and wishes them continued success as they contribute to shaping the future of research administration both regionally and globally

Zaam Ssali
Zaam Ssali

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Mayuge Study Finds NCD Risks Emerging in Adolescence, and Shows Early Action Can Help

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Prof. David Guwatudde, Principal Investigator (centre), and Dr. Justine Bukenya with researchers and stakeholders at the ARISE-NUTRINT dissemination meeting in Iganga, 1 October 2026.

Prof. David Guwatudde, Principal Investigator (centre), and Dr. Justine Bukenya with researchers and stakeholders at the ARISE-NUTRINT dissemination meeting in Iganga, 1 October 2026.

Adolescence is a consequential period for health, when diets, behaviours and other risks can form and persist into adulthood. In Mayuge District, new evidence from Makerere University School of Public Health is showing how some of these early vulnerabilities could contribute to the later risk of non-communicable diseases (NCDs), and what can change when interventions begin early.

The evidence comes from the ARISE-NUTRINT project, a three-year EU-funded study led by Prof. David Guwatudde and Dr. Justine Bukenya. The project examines health and behavioural risks among adolescents and young adults, with a particular focus on nutrition-related NCD risks, and tests interventions designed to improve nutrition fluency and diet quality.

The work comes against a substantial NCD burden in a country where 73.2% of the population is below 30. WHO estimates that NCDs accounted for 42.2% of deaths in Uganda in 2023, while the country’s latest national NCD risk-factor survey found significant risk factors persisting in the population, with little overall change from the previous survey in 2014. Together, the evidence strengthens the case for prevention much earlier in life.

“There is strong evidence from literature demonstrating that most behavioral NCD risk factors, including nutrition-related, are established during childhood, persisting into adulthood. This may lead to development of actual NCDs if such risks are not reversed early,” Prof. Guwatudde said.

The study, he explained, linked assessment of young people’s health risks with developing responses suited to their circumstances. Since enrolling 1,206 participants aged 10–24 in Mayuge District in March 2024, the team has conducted three annual rounds of data collection, with young people and local stakeholders also helping evaluate interventions to reduce the risks identified.

Prof. David Guwatudde (right) addresses stakeholders alongside the ARISE-NUTRINT study team in Iganga on 1 October 2026.

A problem that starts early

The findings, shared with community and district stakeholders in Iganga on October 1, 2026, show that some vulnerabilities were already evident at baseline. Nearly one in three participants had anaemia, 49% had low nutrition literacy, while about one in ten reported symptoms of anxiety and a similar proportion reported depressive symptoms.

Anaemia, a condition in which the blood does not have enough healthy red blood cells or haemoglobin to carry adequate oxygen around the body, was highest among the youngest participants. Overall, 375, or 31%, had anaemia, rising to 35.7 per cent among 10–14-year-olds, compared with 18.9% among those aged 15–19 and 10.6 per cent among young adults aged 20–24.

Nutrition presented another challenge. At baseline, 49% of participants had low nutrition literacy and 13% had poor overall diet quality. Low nutrition literacy was associated with more than four times the odds of poor diet quality.

Gaps also emerged in sexual and reproductive health knowledge and behaviour. About 14 per cent of participants did not know that HIV cannot be transmitted by sharing food with a person living with HIV, 10% believed a condom could be used more than once, and 13 per cent did not know pregnancy could occur during first sexual intercourse. Among 168 participants who reported having had sex, more than half reported using no method to prevent pregnancy during their first or most recent sexual intercourse.

Mental health findings added another dimension. Anxiety symptoms were reported by 10 per cent of participants, depressive symptoms by 9.5% and loneliness by 6.3 per cent. Among 534 participants aged 13–24 assessed for suicidal ideation, 1.9% reported suicidal thoughts.

Together, the baseline findings show that vulnerabilities extended beyond any single health issue. For nutrition, the study went further to examine what shaped everyday food choices and whether those influences could be changed.

Nutrition literacy goes beyond knowing which foods are healthy. It includes understanding nutrition information and applying it to everyday choices. The study found those choices were also shaped by parents, peers, food vendors, culture, prices, seasons, and what was available locally. Improving diets, therefore, required reaching beyond individual knowledge to the households and communities where food choices are made.

What early action changed

The baseline evidence informed the Adolescent Nutrition Fluency Intervention. Working with adolescents and young adults, caregivers, Community Health Workers (CHWs), district teams and other stakeholders, the project adapted nutrition messages to local foods, language and household realities. Ten trained CHWs delivered nine monthly household sessions covering balanced diets, physical activity, vitamins and minerals, meal planning and anaemia prevention.

The household approach reached young people in and out of school. The nutrition literacy, diet-quality and intervention analyses form part of the PhD research of Mr. Thomas Buyinza, supported through ARISE-NUTRINT. At endline, participants who received the sessions recorded higher nutrition literacy and overall diet-quality scores.

“The improvement in nutrition literacy and diet quality suggests that practical education, grounded in local foods and household realities, can support healthier choices among adolescents and young adults. In addition, involving parents and caregivers is important because they influence what families buy, prepare, and eat,” Dr. Bukenya said.

She stressed that nutrition education needed to be complemented by better access to affordable, nutritious foods. Dr. Bukenya also called for continued follow-up, including the use of nutrition and dietary data from DHIS2, to assess whether improvements were maintained and guide district planning.

Dr. Justine Bukenya emphasises family involvement in nutrition education and access to affordable, nutritious foods during the ARISE-NUTRINT dissemination meeting in Iganga on 1 October 2026.
Dr. Justine Bukenya emphasises family involvement in nutrition education and access to affordable, nutritious foods during the ARISE-NUTRINT dissemination meeting in Iganga on 1 October 2026.

Changes in other outcomes were mixed. Participants reporting no physical activity fell from 22.6% to 7.4%, while those active on four to seven days a week increased from 46% to 54.8%. But activity duration did not improve: those reporting more than 60 minutes a day declined from 28.2% to 21.1%. Underweight fell modestly from 6.2% to 5%, while overweight and obesity did not change significantly.

Anaemia recorded the largest change, falling from 31.1% before the intervention to 9.9% afterwards. During the intervention period, participants received weekly iron and folic acid supplementation and deworming alongside nutrition education on iron-rich foods, dietary diversity and practices that improve iron absorption.

Illustration of the ARISE-NUTRINT household approach: ten trained community health workers delivered nine monthly nutrition education sessions to adolescents and young adults, involving parents and caregivers. AI-generated illustration.
Illustration of the ARISE-NUTRINT household approach: ten trained community health workers delivered nine monthly nutrition education sessions to adolescents and young adults, involving parents and caregivers. AI-generated illustration.

Mayuge District’s Assistant District Health Officer, Ms. Elizabeth Kawaala, said the findings reflected problems recognised locally and highlighted the need for a response involving families and other stakeholders.

“There is a serious challenge that needs to be tackled with many stakeholders, with parents at the centre because these are children. We also learnt that many parents, I think, lack the skills to communicate with their adolescents,” she said.

Mayuge District’s Assistant District Health Officer, Ms. Elizabeth Kawaala, speaks during the dissemination of ARISE-NUTRINT study findings in Iganga on 1 October 2026.
Mayuge District’s Assistant District Health Officer, Ms. Elizabeth Kawaala, speaks during the dissemination of ARISE-NUTRINT study findings in Iganga on 1 October 2026.

She said the findings had been shared with colleagues and described integrating health education and sensitisation into services. She also called for departments to use the evidence when planning activities in their workplans.

Beyond Mayuge

Seen alongside Uganda’s 2023 STEPS survey, the Mayuge findings add an earlier-life dimension to the national evidence. Makerere University School of Public Health contributed to both studies, with Prof. Guwatudde contributing to the national STEPS survey and now leading ARISE-NUTRINT. While STEPS found significant NCD risk factors persisting among adults, ARISE-NUTRINT shows that some behaviours and vulnerabilities relevant to later NCD risk are already evident during adolescence and young adulthood. The Mayuge research goes further by testing what can change when interventions begin during this period.

The findings leave Mayuge with more than a measure of the problem. They show where vulnerabilities are emerging, what changed when interventions were introduced and where challenges remain. For ARISE-NUTRINT, the evidence now turns attention to which approaches can be sustained and how lessons from Mayuge can inform efforts to support healthier transitions from adolescence into adulthood.

John Okeya

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