Makerere University School of Public Health (MakSPH) is running its sixth intake for the Water, Sanitation and Hygiene (WASH) short course. This intake commenced on May 27th, 2019 at the School’s premises in Mulago. This year’s intake has individuals from Uganda, Tanzania, Sudan, and Somalia.

Some of the participants in the WASH short course 2019 at the launch of the sixth intake. Participants this year came from as far as Tanzania, Sudan and Somalia.


At the opening ceremony of the course, the Course Co-Coordinator, Mr. Rawlance Ndejjo, said the course targets individuals who lack qualifications in WASH yet have an interest in the sector. These include
academic staff, graduate students, policy makers and practitioners without a background in WASH who would wish to broaden their knowledge and skills as a form of continuous professional development. "We realized so many people don't have expertise, grounding and qualification to make them efficient in their work,” said Mr. Ndejjo. The course is designed to equip trainees with the knowledge and skills necessary to gather, analyse and disseminate the knowledge needed to conceptualize and implement health policies and programmes related to WASH. Indeed, the main aim of this course is to promote WASH programmes in terms of disease prevention and control, management and administration of WASH services in communities. The course also encourages the development of a pool of practitioners with knowledge and competencies in different areas relevant to WASH.

Dr. David Musoke, the Course Coordinator explained that the course will run for eight weeks with three weeks of full time class studies, four weeks of short field projects, and a final week of presentations, writing project reports, an examination, and graduation.

Dr. David Musoke, one of the Course Coordinators speaking at the launch. He explained what the 8 weeks of the course duration will cover.

Representing the Dean of MakSPH and Chair Department of Disease Control and Environmental Health at the event, Dr.  Richard Mugambe said water and sanitation are critical for health if we are to achieve the Sustainable Development Goals (SDGs). Citing a UN report, Dr Mugambe noted that 2.4 billion people lack access to basic sanitation and safe drinking water. He explained that the responsibility of getting Africa to catch up with its more developed counterparts, lies with different organisations and partners enabling access to water and basic sanitation.Dr. Mugambe also thanked Dr. Musoke and the team for the noble job they have done under WASH course over the years. He further urged the trainees to inform other people about the course. 

 


Brenda Wagaba one of the Course Coordinators speaking at the launch.


This intake will run from 27th May, 2019 up to 19th July, 2019. Upon completion, graduands from the short course will be awarded certificates in WASH. 
MakSPH has been offering this unique certificate course in WASH for the last five years and so far 101 students have successfully graduated from it.  

 



On Friday 7th June 2019, Makerere University School of Public Health (MakSPH) in partnership with Nsamizi Training Institute for Social Development (NTISD) organised a Stakeholders Meeting to address the legal gaps and inconsistencies in relation to the age of consent for marriage. The meeting had Members of Parliament, Civil Society, policy makers, and Academicians who also held discussions around forging a way forward and finding common ground around this subject.

Representatives from different sectors at the Stakeholders meeting that convened to call for the amendment of the customary law.

Speaking at the Hilton Garden Inn Hotel in Kampala, Ms Sherina Tibenkana a consultant of SET-SRHR (Strengthening Education and Training Capacity in Sexual and Reproductive Health and Rights in Uganda) Project, asked the policy makers to amend the current law on customary marriages. According to the Registration Act of 1973 Section 11a, the Customary Law indicates that females are considered ready for marriage at 16 years while for males, it is 18 years. Tibenkana noted that this law is gender-insensitive and discriminatory against females according to the Constitution of Uganda. In addition, she also pointed out that the customary law forces the girl-child to get married at the consent of their parents or guardians. Citing a case in Mayuge district where 8 and 7 year-olds got married in the presence of their families, she noted that children’s rights were violated according to the Children's Act yet no action was taken.

Left is Charles Otim, the Project Manager of Nsamizi Training Institute of Social Development, the organisers of this meeting. Right is Sherina Tibenkana, a consultant.

                                                                                                                                             

"Most marriages are initiated by parents who see it as a source of security and dowry. This is because the law doesn't criminalise child marriage. We therefore need to come up with clear provisions to tackle these issues,” Tibenkana urged.

In context to the region, Tibenkana called upon Ugandan policymakers to emulate other East African Countries like Kenya and Burundi who have amended their laws to stop early child marriage. Tibenkana also beseeched participants to remain committed in the fight against early child marriage since Uganda is a signatory of various human rights conventions.

 

Sherina Tibenkana, a consultant on child marriages speaking at the meeting. She noted that the Customary Law Act gives 16 years as the age of consent, an article that contradicts the constitution which puts this age at 18 years.

 

Speaking about the effects of early child marriage, Tibenkana noted that it is a violation of their human rights besides being the driver of high maternal mortality rate. “Early marriages also expose vulnerable underaged victims to sexually transmitted diseases" she added. In this regard, she stressed the need for creating awareness about the dangers of early marriage since most people simply view it as an interference with their culture.

Way Forward-Tackling Early Marriage

As part of tackling early marriage, Dr. Elizabeth Nabiwemba from Makerere University School of Public Health and Director of SRHR highlighted that a lot of research and implementation is being done to inform policy and practice. Some of this research is already ongoing with their programmes already running in Kawempe Town council and Iganga District. In addition, she also noted that the project has a continuous curriculum development that has trained over 200 people to impact institutions with standard Sexual Reproductive Health Services.

Dr. Elizabeth Nabiwemba, the SET-SRHR Project Director-Uganda speaking.

Also at the meeting was Mr John Paul Edoku, a Senior State Attorney in the Ministry of Justice and Constitutional Affairs said he would be surprised if the Customary Law is not taken for Legal Interpretation. "The provisions are redundant, null and void, we need reforms since 16 years as the age for marriage consent contradicts the Constitution of Uganda " Mr Edoku said

In her presentation, Kumi Woman Member of Parliament Hon Amoding Monica said the Marriage Bill of 2009 is yet to be tabled again and it also consolidates amending the customary Marriage Act.

Right, Hon. Monica Amoding, the Kumi Woman MP, giving her submission at the meeting. Left is Jova Kamateeka, the Woman MP of Mitooma district.

In his submission, the Executive Director of Reproductive Health Uganda, Jackson Chekweko said despite the fact that a lot of work has been done by various organisations, over 50% of all girls get married before 18 years and this calls for more action.

"We are aware of the consequences of early marriage, therefore, the issue of child marriage should be handled in a multi-dimensional perspective. We need to look at the social dimension, we can't only look at the legal means, we also need Ministry of Health, politicians, religious leaders and Ministry of Justice and Constitutional Affairs among others Chekweko said

The Executive Director of Reproductive Health Uganda calling for a multi-dimensional approach to handling the issue of child marriages.

In her closing remarks, Hon Jovia Kamateeka, the Woman MP of Mitooma district said although the constitution is in place, there are other causes of early marriage that must be addressed.

"Why are most children getting married early? We have to be sensitive towards communities while supporting positive cultural norms and doing away with the negative ones like marrying off minors" Kamateeka said.

She also thanked MakSPH, Nsamizi Training Institute of Social Development and Reproductive Health Uganda for coming together to forge a way forward on age of consent of marriage in Uganda.

This meeting was attended by officials from the Ministry of Justice, Ministry of Gender, Labour and Social Development, Ministry of Health, Parliamentarians, JLOS and Uganda Police among others.

A member from the Uganda Police gives her contribution on how the organisation is fighting early marriages.


FACTS ON CHILD MARRIAGES ACCORDING TO SET-SRHR

Over 15% of women aged 20-49 who have ever been married entered this institution by the age of 15. 49% were married by the age of 18.

17% of mothers aged 15 face maternal mortality.

Uganda has the 16th highest prevalence rate of child marriages in the world.


Prof. Nazarius Tumwesigye of Makerere University School of Public Health (MakSPH) has urged policy makers to pass new laws that will address the rising levels of alcohol abuse in Uganda.

Speaking at the Alcohol and Harm Symposium Seminar held at MakSPH on 24th May 2019, Prof Tumwesigye said Ugandan laws are old and inefficient to curb alcohol abuse.

"The laws are very weak and archaic,” he noted, explaining that when you are caught selling alcohol illegally, you pay a paltry 3000 shillings which is a mockery. Because the penalty is laughable, alcohol is consumed with reckless abandon. He welcomed government's recent move to ban alcohol sold in sachets, as timely.

Participants at the symposium listening attentively to the presentations. Participants included students from Makerere University School of Public Health, Georgia State University in the US, Ministry of Health and academicians.

In his presentation, the passionate professor made shocking revelations about the rising number of people brought to health facilities with alcohol-related illness in the Country. The finding were from a preliminary report for a study done in northern Uganda which showed that northern Uganda has the highest increase in the number of people with alcohol-related illnesses. East and Central Uganda reported the lowest cases. The report also highlighted Western Uganda as having a spike in alcohol-related illnesses since 2016. Equally shocking were WHO records which show that 90% of alcohol consumed in Uganda is produced informally, with waragi (alcohol in sachets) being the most common, the presentation read.

Prof. Tumwesigye added that researchers are still trying to figure out why the numbers of alcohol-related illnesses are rising. Some of the probable reasons could be the rising levels of income and the numerous offers of alcohol given during the election period.

Speaking in terms of seasonal patterns that were recorded during the study, Prof. Tumwesigye noted that a spike in alcohol morbidity was observed towards the end of the year. “This is because, during the festive seasons, many people gather and celebrate using beer,” he explained

Health Risks
On gender patterns, the report revealed that women are more affected because of their genetic make-up. Prof. Mbona explained that for the same amount of alcohol, women become more intoxicated than men which directly affects their physical and mental ability.

Also at the seminar, Mr. Toko Santiago of Palliative Care Uganda noted that Uganda's capital alcohol consumption stands at 9.8 hence the need to push for new policies that can reduce that level of consumption. Capital Alcohol Consumption of a country refers to… Mr. Santiago was making a presentation on the culture of alcohol in Uganda.Mr. Toko added that waragi causes lower levels of productivity and liver cancer and is thus a serious matter that should be handled accordingly.

In his presentation, Dr Godfrey Bbosa from the Department of Pharmacology and Therapeutics, College of Health Sciences at Makerere University, noted that alcohol consumption becomes complicated when addiction kicks in. He explained that taking huge quantities of alcohol can lead to the suppression of body organs. Dr. Bbosa was presenting a paper titled, “Tools for Screening Alcoholic Beverages Abuse among Exposed Individuals.” Citing a UN report, Dr Bbosa, noted that at least 85 per cent of the alcohol consumed in Uganda is unregulated, home brewed and illegally sold. He therefore stressed the need for sensitization in schools and communities to curb its consumption.



In her presentation, Prof. Monica Swan of Georgia State University, also wondered why marketing agencies in Uganda employ youth and offer them alcohol as part of brand promotion. In Uganda, it has been noted that beer companies employ children younger than 18 in their promotions for example to dance on trucks that advertise their products in preparation for an event. “This is unthinkable in the US,” she remarked. The professor said the development of new policy should be extradited to cut down on the high level of alcohol consumption. She also called upon health stakeholders like doctors and the general public to reveal factual information to researchers as part of tackling the alcohol syndrome. Prof. Swahn made a presentation on
Alcohol Use & High Risk Behavior among Youth in Kampala.”

Students from Georgia State University in the US who attended the Alcohol and harm reduction symposium, standing outside the Makerere University School of Public Health Building in Mulago. Fore-front, 3rd left is Prof. Nazarius Mbona. On his right is Prof. Monica Swahn from Georgia State University.

Prof. Noah Kiwanuka, also from MakSPH made a presentation on the “Alcohol Attributed Fraction of HIV Incidence in Uganda.” Another presentation as made by Dr. Aloysius Rukundo who teaches Educational Foundations & Psychology at Mbarara University. It was titled, “Exploring Alcohol Consumption and Injury among Boda Boda Youth Motorcyclists in Kampala, Uganda.”

The Alcohol and Harm Symposium was a partnership between MakSPH and Georgia State University (GSU) together with the Alcohol Drugs and Addiction Research (ADARC) as the main organiser. It was attended by students from MakSPH, students on an exchange visit from Georgia State University, officials from the Ministry of health and other organisations that work in alcohol and harm reduction efforts.

On 30th May 2019, a team of researchers from Makerere University School of Public Health (MakSPH) urged policymakers and organizations to adopt the PHFS (Partnership for HIV-Free Survival) approach. Together with MEASURE Evaluation, the researchers arrived at this conclusion after conducting an outcome evaluation of PHFS in Uganda.

 

Speaking at the PHFS Dissemination Workshop at Kampala Serena Hotel,   Prof. Lynn Atuyambe, one of the lead researchers from MakSPH said the programme enhanced retention for of mothers and children into free HIV care.

Steven Ssendagire, one of the study coordinators of the PHFS Evaluation study from MakSPH having a discussion with other participants at the dissemination workshop.

One of the innovations that were adopted by the programme that led to its success according to the evaluation done was the mother-baby pairing model. In this model, the appointment of an HIV positive mother and that of her baby were synchronized to one day. Previously, they would be seen differently and most of the times, on different days.

Speaking about the benefits of the mother-baby pairing, a respondent from Namutumba who worked on the Quality Improvement (QI) aspect of PHFS said, “With integration, the waiting time reduced and someone would get all services under one roof and almost, at the same desk.”

‘The friendly nature of PHFS mentorship also made it easy for the participants to take responsibility. This enhances teamwork and collaboration for a national cause in line with HIV-Free survival projects implementation, Prof. Atuyambe explained during the workshop.

Prof Lynn Atuyambe making a presentation at the PHFS Evaluation Workshop


 
Brief background about PHFS

The PHFS Initiative was designed to reduce mother-to-child transmission of HIV and increase child survival, through improvements in breast feeding practices, antiretroviral therapy uptake, and coverage among HIV-positive pregnant women and mothers, and overall mother-baby care.

PHFS was implemented in the six districts of Jinja, Manafwa, Tororo, Kisoro and Ntungamo from 2013-2016.  It was implemented in 22 demonstration sites and it was scaled up in 56 scale-up sites. The programme used a quality improvement approach that included facility-level or department-level assessments of elimination of mother-to-child HIV transmission (eMTCT) services and outcomes, QI training for staff, on-site technical assistance, routine data collection and reporting, information sharing, and follow-up support.

Prof. Atuyambe explained that the evaluation of PHFS was done in 12 districts; in the 6 districts where the programme was undertaken and in six neighboring districts where it was not undertaken in order to get a comparison of its impact. The six neighnouring non-PHFS districts included Mbale, Iganga, Kamuli, Mbarara, Kabale and Bushenyi. A number of indicators were tracked and these included exclusive breastfeeding, 12-month retention into care, 18-month retention, feeding completeness and 18-month HIV test completeness.                                                   

The project team also had two other Principal Investigators from MakSPH in Prof. Freddie Ssengooba and Dr. Simon Kasasa. It was coordinated by Dr. Susan Babirye and Steven Ssendagire, both from MakSPH as well. This team collected data from health facilities using their records, did interviews with district coaches and with quality improvement (QI) teams.

 

Findings

While sharing findings at the PHSF workshop, Prof Valerie Flax noted that   PHFS increased exclusive breast feeding and a 12-month retention in care during the intervention period. Prof. Flax is a Senior Research Public Health Analyst with RTI international.

In addition, the percentage of children with positive HIV tests at 18months declined during PHFS, but not significantly. Data completeness also increased for 18month HIV test results but decreased for child feeding data recorded during first visit.

 

Left to right is Prof. Valerie Flax of RTI International, Emily Bobrow, a Senior Technical Specialist with MEASURE Evaluation at the University of North Carolina and Joyce Draru, an Independent PHFS Consultant

 

Sustainability of PHFS was equally good across all indicators in the demonstration sites but was more mixed in the scale-up sites, most likely because the scale up intervention period was short, and activities may not have been fully established by the time support ended said Prof Flax, a Senior Research Public Health Analyst.

 

Dr. Simon Kasasa (L) one of the Principal Coordinators of the project, at the evaluation study dissemination meeting. Right is Dr. Susan Babirye, a Study Coordinator on this project.

In Uganda, PHFS was implemented in 22 Demonstration sites and 56 scale-up sites in six districts (Jinja, Manafwa, Namutumba, Tororo,Kisoro ,and Ntungamo) in collaboration with Makerere School of Public and Measure Evaluation.

In her Presentation, Dr. Susan Babirye said, “to enable sustainability of the project, innovations (tested changes) were made during the PHFS implementation like mother follow up, new staff orientation and mobilization of funds to address project gaps.” She also mentioned that capacity building and retention of workers were key factors in sustainability of the project’s countrywide evaluation of PHFS. These innovations greatly contributed to the success of the programme.

The project coordinator also mentioned several issues that were a challenge in the PHFS study. These barriers include; the transfer of trained health workers working with the programme who are replaced (or not replaced) with those that have no idea about the programme and thereby require fresh training; the fading interest of leaders and implementers in fighting HIV/Aids; and insufficient funding to roll out programmes targeting the reduction of HIV.

A participant gives her contribution and asks the presenters some questions

 

More about the PHFS Project                                                                  

PHFS used a quality improvement (QI) approach that included facility-level or department-level assessments of elimination of mother-to-child HIV transmission (eMTCT) services and outcomes. QI training for staff, on-site technical assistance, routine data collection and reporting, information sharing and follow-up support.

The programme was implemented as a collaboration between United States President Emergency Plan For AIDs ,UNICEF and ,the World Health Organisation (WHO) to accelerate the uptake of WHO 2010 guidelines on HIV and infant  feeding in Kenya, Lesotho, Mozambique, South Africa, Tanzania, and Uganda.

In Uganda, key partners in the implementation of PHFS included University Research, Co.’s Applying Research to Strengthen and Improve Systems (ASSIST) Project, FHI 3600 s Food and Nutrition Technical Assistance (FANTA) project, the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF), JSI’s Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) program, The Aids Support Organisation (TASO), the Uganda Ministry of Health, and the United States Agency for International Development (USAID). The launch of PHFS activities coincided with the rollout of the Option B+ approach to prevention of mother-to-child transmission (PMTCT) in Uganda.

 

Participants who inclued District Health Officers in places where the evaluation study was done, in a brainstorming session on how the recommendations of the study can be adopted into policy.

This article was written by Joseph Odoi and edited by Agnes Namaganda

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