Makchs 7Th Annual Scientific Conference Report Final.Pdf

MAKERERE UNIVERSITY COLLEGE OF HEALTH SCIENCES

7th MakCHS ANNUAL SCIENTIFIC CONFERENCE, 19th UNACOH ANNUAL SCIENTIFIC CONFERENCE,

10th WHO DR. MATHEW LUKWIYA MEMORIAL LECTURE

DATES: 20th – 22nd September 2011

VENUE: SPEKE RESORT MUNYONYO

Executive Summary The key note address was delivered by the Director General of The Makerere University College of Health Sciences 7th Annual Health Services in the Ministry of Health, Dr. Jane Ruth Acheng; Scientific Conference and 19th UNACOH annual scientific the opening ceremony was presided over by Minister of State for conference were collaboratively held between the 20th -23rd Health, Dr. Richard Nduhura, while the closing ceremony was September 2011, at Speke Resort Munyonyo, Kampala. The performed by the Permanent Secretary in the Ministry of Health conference focused on the theme “All for Health –One Health”. Dr. Asuman Lukwago. The sub themes were;

• Health Systems, Health Policy & Healthcare Certificates of recognition were awarded to the best two presentations in both oral and poster categories, while general • Non Communicable Diseases certificates of participation were given out to all delegates. • Maternal & Child Health This report presents highlights of the conference proceedings. • Capacity Building, Health, and Environment

• Infectious Diseases, Drug Resistance, and Emerging

Tropical Diseases

• Vaccines

This conference also marked the UNACOH 19th Annual Scientific Conference and the WHO 10th Dr. Mathew Lukwiya Memorial Lecture, which was delivered by Hon Dr. Christopher Baryomunsi, MP

The conference drew over 300 participants from within the country (Ministries, academia and programs) and foreign countries such as Ethiopia, Denmark and Nigeria among others.

Acronyms and Abbreviations ECG - Electrocardiography

ECHO - echocardiogram

AFENET – Africa Field Epidemiology Network FP - Family Planning

AIDS - Acquired Immunodeficiency Syndrome GDP - Gross Domestic Product

ANC – Antenatal Clinic GS - Gleason Score

ARE - Androgen receptor expression HC II – Health Centre II

ART – Antiretroviral Therapy HCT – HIV Counselling and Testing

ASD - Atrial septal defect HCWM - Healthcare Waste Management

CHS – College of Health Sciences HF – Health facility

CMEs – Continuing Medical Education HHD – Health and Human Development

COBES – Community Based Education and Service HIPS - Health Initiatives for the Private Sector

CPR – Contarceptive Prevalence Rate HIV – Human Immune Virus

CTCA – Centre for Tobacco Control in Africa HSR – Health Service Research

CVDs – Cardiovascular Diseases HSSP II – Health Sector Strategic Plan II

DPT – Diphtheria, Pertussis, Tetanus HSSPIII - Health Sector Strategic Plan III

DM - Diabetes Mellitus HSV2 – Herpes simplex virus 2

DNA - Deoxyribonucleic acid HUMCs – Health Unit Management Committees

ICCM – Independent Community Care Management MIRU-VNTR – mycobacterial interspersed repetitive units- variable number of tandem repeats IDI – Infectious Diseases Institute MNH – Maternal and Newborn Health IHFAN - International Health Facility Assessment Network MoH – Ministry of Health IMCI –Integrated Management of Childhood Illnesses MRSA - Methicilin-resistant Staphylococcus aureus IMR – Infant Mortality Rate MUST – Mbarara University of Science and Technology KAP – Knowledge, Attitude, Practices MU-WRP –Makerere University Walter Reed Project KCR - Kampala Cancer Registry NCD – Non-Communicable Diseases KIU – Kampala International University NEJM – New England Journal of Medicine KS – Kaposi’s sarcoma NGOs – Non Governmental Organisations LIC – Low Income Countries NNRTI - Non-nucleoside reverse transcriptase inhibitors MakCHS – Makerere University College of Health Sciences RAMs - resistance-associated mutations MakSPH – Makerere University School of Public Health NY – New York MDGs – Millenium Development Goals OSH – Occupational safety and Health MDR – Multi-Drug Resistant PBL – Problem Based Learning MEPI- Medical Education Partnership Initiative PCR - polymerase chain reaction MESAU – Medical Education for Equitable Services for All Ugandans PDA - Patent ductus arteriosus

PEPFAR- President's Emergency Plan For AIDS Relief

PHAs – Persons having HIV SURE – Supporting the Use of Research Evidence

PI – Principal Investigator TB – Tuberculosis

PMTCT – Prevention of Mother To Child Transmission UDHS – Uganda Demographic and Health Survey

PNFP – Private–Not-For-Profit UK – United Kingdom

PPP – Public-Private-Partnership UN – United Nations

PTSD - Posttraumatic stress disorder UNCST – Uganda National Council for Science and Technology

QA – Quality assurance UNFPA – United Nations Family and Population Agency

RFLP - restriction fragment length polymorphism UPE/USE – Universal Primary Education/Universal Secondary Education RH/FP /CS –Reproductive Health/Family Planning/ USA – United States of America RHD - Rabbit haemorrhagic disease USAID – US Agency for International Development RRH- Regional Referral Hospital USD – United States Dollar RRS – Rapid Response Service UVRI-IAVI - Uganda Virus Research Institute- International SCD - Sickle cell Disease AIDS Vaccine Initiative SDST - slide drug susceptibility test VSD - Ventricular septal defect SNPs - Single nucleotide polymorphisms VVF – Vesicovaginal Fistula STAR EC - Strengthening TB and HIV&AIDS Responses in East WHO/TFI – World Health Organisation/Tobacco Free Initiative Central X-DR _Extensively Drug Resistant STD – Sexually Transmitted Disease

Acknowledgements: Health, Dr. Asuman Lukwago and the Hon Dr. Christopher The organizing committee, on behalf of the College of Health Baryomunsi who delivered the Dr. Mathew Lukwiya Memorial Sciences, would like to thank all delegates that dedicated their Lecture. Thanks also go to our invited presenters who so time to attending and actively participating in the 7th MakCHS willingly shared their work and wisdom generated over the Annual Scientific Conference, the 19th UNACOH Annual Scientific course of their work. Conference and the 10th Dr. Mathew Lukwiya Memorial Lecture. Thanks go to our sponsors as listed in Annex 2. Without their The time, contribution to debates and the financial contributions financial commitment and support, the conference would have you all made, was the bedrock to the success of this conference. been difficulty to organise. The conference was organised by the Makerere University

College of Health Sciences in collaboration with the Uganda National Council for Science & Technology (UNCST) to coincide with their Science week; the Uganda National Association of Community and Occupational Health (UNACOH) – to coincide with their 19th Annual Scientific Conference; and the 10th Dr.

Mathew Lukwiya Memorial Lecture sponsored by the World Health Organization (WHO).

In a special way, we would like to thank all those that delivered rousing key note addresses; the Director General of Health services, Dr. Jane Ruth Aceng, the Minister of State for Health, Dr. Richard Nduhura, the Permanent Secretary in the Ministry of

7.1 Parallel Oral Session A: Non-Communicable Diseases ...... 22 TABLE OF CONTENTS 7.2 Parallel Oral Session B_21: Capacity building, Health, and Environment ...... 24

7.3 Parallel Oral Session C: Capacity Building, Health, and Executive Summary ...... 2 Environment ...... 27

Acronyms and Abbreviations ...... 3 8.0 Plenary 2_21: Health and Environment ...... 30

Acknowledgements:...... 6 Thursday 22nd September 2011 ...... 36

1.0 Introduction and Background: ...... 8 9.1 Parallel Oral Session_1_22_A: Infectious Diseases & Drug Resistance ...... 39 Tuesday 20th September 2011 ...... 9 9.2 Parallel Oral Session 3_22 C: HIV, TB, Malaria, & Other IDs ..... 41 2.0 Plenary 1_20: ...... 9 10.0 Plenary 2_22: Vaccines ...... 42 2.1 Key note address: ...... 9 11.0 Plenary 3_22: Closing Ceremony ...... 44 3.0 Plenary 2_20: Health Systems, Health Policy & Healthcare I ...... 10 11.1 The 10th Dr. Mathew Lukwiya Memorial Lecture ...... 44 4.0 Plenary 3: Official Opening Ceremony: ...... 14 11.2 Closing Speech by the Permanent Secretary Ministry of Health, 5.0 Plenary 4_20: Plenary Session 4_20: Health Systems, Health Dr. Asuman Lukwago ...... 45 Policy, & Health care II ...... 17 ANNEX 1: Conference Organising Committee ...... 46 6.0 Plenary 5_20: Health Systems, Health Policies and HealthCare Delivery III ...... 18 Annex 2: Conference Sponsor Organizations ...... 48

Wednesday 21st September 2011 ...... 20

7.0 Plenary 1 _21: Non Communicable Diseases I: ...... 20

research, education and training, program implementation and policy formulation and implementation. 1.0 Introduction and Background:

The Annual MakCHS Scientific Conference is a significant annual event in the life of the College of Health sciences at Makerere University. The first conference was held way back in 2005 and since then, the significance of this annual event has grown stronger attracting international attention and participation, along with policy interest and attention.

The annual scientific conference is the College of Health Sciences’ flagship research dissemination and stakeholder engagement event that attracts stakeholders in academia and research, health policy formulation and implementation, health service delivery, health advocacy and civil action and students.

Within the College, Schools are selected to organise the conference on a rotational basis, while themes are chosen after a thorough assessment and analysis of prevailing health developments and challenges. This year’s conference was organised by the School of Biomedical Sciences and Chaired by Dr. Freddie Bwanga. The theme; ‘One Health: Health For All’, was selected in response to the emerging and re-emerging pandemic threats and the need for all sectors; health and non- health to work together.

The conference has both oral and poster presentations from a wide range of individuals and institutions involved in health

Tuesday 20th September 2011 2.1 Key note address: The key note address was delivered by the Director General of 2.0 Plenary 1_20: Health Services, Ministry of Health, Dr. Jane Ruth Acheng. She thanked the College of Health Science for organizing the The Chairperson Organizing Committee, Dr. Freddie Bwanga conference which brings together different stakeholders in welcomed delegates to the MakCHS 7th Annual Scientific health. She analysed international and national perspectives on Conference and 19th UNACOH annual scientific conference. He health, and expressed concern on Uganda’s poor performance said the conference’s theme: “All for health-One health”, with regard to most health indices e.g. low life expectancy recognizes health’s trans-boundary nature, therefore requiring (<54years), high maternal mortality rate 435/100,000 and high team efforts of all academic disciplines; medical doctors, infant mortality rate 76/1000 among others. She attributed the veterinarians, politicians, nurses, agriculturists and poor performance to a number of factors; most notably human environmentalist. He also introduced dignitaries from resources for health. She noted that of all the trained health international agencies, ministries and foreign countries and workers, 8,978(24%) are nurses, 4,535 (12%) are midwives, thanked all participants for choosing to be part of the and only 1,118 (8%) are doctors majority of whom are urban conference. based. She also noted that only 54% of health workers posts are currently filled.

As far as investment for the health sector is concerned, she informed participants that it currently stands at 9.6% and yet about 15% is required. Donor support goes mainly to HIV/AIDS, Malaria and TB programs while the significant portion of government funds goes to salaries. Regarding the MDGs, the DG noted that Uganda will not achieve the targets except for MDG 8D. She called for more resolve from all concerned. She also noted that indicators on service utilization such as ANC attendance, delivery in health facilities and immunization coverage are also equally poor. She deplored the lack of Dr. Bwanga

professionalism/ethical erosion among health workers majority include; fragmentation of services, too much verticalisation, of who have forgotten their call and are driven by money. attrition of health workers to neighboring countries that pay much better and poor coordination. She reminded participants to always think about the WHO building blocks (Leadership and governance; Health information systems; Medical products, vaccines and technology; Health financing and research) as far as health systems are concerned. She concluded by re-echoing the ministry’s resolve to take seriously their stewardship role as they move to improve health services in the country. The DG concluded that 'All for Health: One Health' can be achieved through evidence based policy formulation, inter-sectoral collaboration, and supporting the country’s health plan by development partners through the Ministry of Health.

3.0 Plenary 2_20: Health Systems, Health Policy & Healthcare I

The Director General of Health Services, Dr. Jane Ruth Aceng Freddie Ssengooba of MakSPH used the analogy of an orchestra

in his discussion on health systems, governance and health She called upon the College of Health Sciences to put emphasis outcomes. He explained the different models of health systems on quality in pre-service training so as to produce graduates governance (Hippocratic, Business and Social models) giving with adequate skills to respond to health challenges faced by the their pros and cons. He noted that like an orchestra, governing people they serve. This she noted will save government a lot of health systems requires interdependency, networking and a resources used for in-service training which is not very effective. relational approach among the different players. He Other challenges highlighted by the DG in the health care system recommended that there should be a coordinating body (MoH)

to ensure that all players feed into a single desired outcome Robert Basaza of the MOH, discussed challenges and future (improved health outcomes). He told participants that systems in Uganda to ensure delivery of quality care. He used misgoverned health systems are wasteful and that there is need, the World Health Organization’s building blocks for health therefore, to orchestrate the orchestrators to build shared systems strengthening to explain the current status in Uganda systems governance at all levels as depicted below; regarding; health financing, Human resources, Medicines and Health infrastructure. Uganda’s health financing is currently at USD 27 per capita and yet USD40 is needed if the country is to achieve the MDGs. As far as human resources are concerned, staffing levels is at 56% and most districts have vacant positions. There is particularly a shortage for medical doctors with 54% medical doctor positions at regional referral hospitals being vacant. For medicines, the level of funding is 0.87%, with most medicines and health supplies’ expenditure private. He also mentioned that pricing for medicines varies and is not regulated which leaves consumers exposed to exploitation by the dealers. For Infrastructure, approx. 80% of Ugandans live within 5km

from healthcare facility, but <25% health care facilities have essential equipment. While private sector provides 40% health care, it is not integrated with public sector to fully take advantage of each other. Quality of care: quality assurance (QA) schemes for improvement are ongoing but with no QA managers in public sector. He updated participants about the proposed insurance scheme for all Ugandans and used the examples of Rwanda and Ghana as some of the African countries that have particularly been successful in implementing public health insurance for their population. He identified the following as priorities for improving services; motivation of HR and performance based financing, regional tier of governance,

effective use of donor in flaws, national health insurance, ring embarked on the process to address these through PBL fencing health sector financing of healthcare, PPPH policy and curriculum at MakCHS. But this now needs to transition to the Staffing houses. Lastly, he analysed the role of universities in Systems-based learning, which is competence based. However service delivery and noted that besides the traditional role of for a Systems framework to work, structures and process must training health workers and research, universities could change. Structures imply institution design; transformative consider engaging in Capacity building programs like supportive learning and leadership attributes. Interdependence involves supervision. He also mentioned the Ministries plan to work with paradigm shifts; from isolated to harmonized health systems. He the MakCHS to establish a Health Economics and System advocated that training for medical professionals should be Institute. inter-dependent in order to generate teamwork for better service delivery. David Serwada of MakSPH analysed the education of health professionals for the 21st century to Strengthen Health Systems. Ling Wong explained to participants the Bill & Melinda Gates He discussed the history of Health education from their recently research grants for Africa which is based on one great idea. She published findings in the Lancet based on work of a 2 year introduced the Gates foundation, based in Seattle WA, whose independent commission to examine medical education. He firm belief is that all lives have equal values. Gates foundation highlighted the status of institutions, graduates and workforce has global locations in Seattle, London, Washington DC, New in Africa, which are appalling in comparison with other Delhi and Beijing. They are currently looking for a location in continents. He identified some of the problems with medical Africa. She said that the gates foundation aims at accelerating training including but not limited to; mismatch of competencies innovation, and improving quality of life to those with greatest to patient and population needs, Poor team work, Persistent need and innovation can be from anyone, anywhere. Under the gender stratification of professional status, narrow technical Grand challenges explorations scheme, groups or individuals focus without broader contextual understanding, eepisodic with great ideas in Infectious Diseases will be funded. The grants encounter rather than continuous care, Predominant hospital have low burden of entry, an Idea can be on two pages, which orientation at the expense of primary care, Quantitative and turns into fundable questions. The scheme employs a champion qualitative imbalances in the professional labour market and based peer review, in which a reviewer picks one good idea to Weak leadership to improve health system performance. These fund with an open path to success. So far they have received are all challenges to Health Systems and there’s need to redesign >20K applications from 145 countries; 313 from Uganda, of healthcare education to meet them. He noted that Uganda had

which three were funded (included a PI from MakCHS). They are institutions, he justified the existence of private institutions as accepting application till Nov 17. those that provide alternatives often with specialized services and high technology which clients can access at a cost. He also Nelson Kawalya discussed the role of cultural institutions in mentioned that private institutions indirectly supplement public healthcare delivery. He explained that cultural institutions can institutions through increased incomes for the health workers supplement government strategies especially with regard to many of whom have part time jobs in the private sector. He mobilisation using their structures and leverage of trust that deplored the lack of professionalism in the private sector by many cultural leaders enjoy. He cited examples of programs those whose main goal is to make money other than providing where they have worked with the government such as services, common in the small clinics. He identified a number of immunisation campaigns which turned out to be very successful. innovations by the private sector; Standardization of procedures, He also gave examples of cultural practices that can undermine standardization of pricing, classification of clinics and hospitals or support good healthy which can only be addressed using according to standards and facilities, different rates for different cultural institution. He mentioned that cultural institutions can grades of facilities, HMIS, billing systems, capitation fees for a collaborate with scientists to promote research which could basket of services and medical insurance all of which contribute to benefit people. health systems strengthening. He mentioned that the standards Samson Kironde shared the experience of STAR EC project in of medical practice in Uganda have been low, compared to its providing technical assistance to the district as a strategy to neighbor Kenya and many other countries such as South Africa, improve and scale out HIV/AIDS services. The project has with the result that patients who could afford have often gone registered a number of successes including delivery of services out of the country for treatment. He concluded by saying that to the hard to reach populations and ensuring a steady chain of private and public sector should be looked at as two arms for the supplies which has resulted in increased uptake of services. same body whose role is to complement each other. Some of the challenges encountered include the high costs involved in service delivery every to the islands which is unsustainable in the event that the project closes.

Ian Clarke discussed the impact of private for profit institutions in healthcare delivery and health systems strengthening. Using examples from both government and private not for profit

4.0 Plenary 3: Official Opening Ceremony:

In this plenary, a number of presentation were made before the official opening ceremony by the Minister of State for Health Dr. Richard Nduhura who represented the minster for health. Below are summaries of the presentations;

James. K Tumwine discussed the topic translating research into policy and healthcare delivery. He shared some child survival strategies with sufficient evidence to deal with problems such as diarrhea, pneumonia, measles and neonatal sepsis. He emphasized that research provides the necessary evidence on Dr. Ian Clarke making his presentation which policy should be based, with several illustrations from infant mortality rates (IMR) studies, which improved as a result of breast feeding. He said that we need knowledge; and we should “do and evaluate”. In order to implement we need materials and money; and moments of time; and motivated educated workers; and a will to change/paradigm shift; and commitment. He used findings from a study in Mbale where peer mothers were used to promote breast feeding and the findings at five weeks indicated a significant difference in the rates of exclusive breastfeeding between the intervention and control groups (87% against 47%). Yet simple evidence is usually not taken by policy makers. He advocated for a change of mindsets; from failure to success; form artificial to natural options, from the disease palace to communities, from research to policies.

Julius Ecuru gave remarks on professionalism, ethics and significantly to the training of heath workers; out of the 48 research. He thanked the CHS for partnering with the UNCST to health workers training institutions in Uganda, 20 are private organize the conference and was grateful for the continued not for profit. NGO’s also help government to serve the most partnerships with MakCHS which has resulted in the CHS hard to reach areas and through the Joint Medical Stores conference being one of the activities for the science week contribute to the availability of drugs and other medical whose theme was; “Science, Technology and you”. He reiterated supplies. He advocated to the government to pass the Public that professionalism, ethics and research is about professional Private Partnership bill which will further strengthen the sector. conduct in research and is characterized by good conduct, Celestine Obua gave an overview of the conference theme and integrity, trustworthy, being not money minded and recent developments in training health professionals to improve commitment to duty. He noted that there is need to re-build healthcare. He explained the concept “All for health one health”, professionalism and ethics in Uganda. Knowledge production stating that Team work is key at the every step. He announced has become diverse and widely distributed; there is a growing the new collaboration by all medical training institutions in demand for knowledge. He emphasized the need to ensure Uganda, “MEPI-MESAU” an education scheme at MakCHS, which scientific quality and relevance, and guard against plagiarism strives to bring medical education services to all Ugandans. The and falsification of data. Progress in these is being made. overall goal of MEPI-MESAU is to improve medical education, MakCHS was recognized for setting up IRBs, three of which were increase health workers and enhance retention. In this accredited by UNCST. However, they were also encouraged to be innovation the students became the expert in the learning and exemplary on research integrity, encourage teamwork, improve they are trained together to enhance teamwork. -Stakeholders peer review systems and culture of publishing. Lastly, he include MakCHS, MUST, KIU, Gulu, Busitema, and John Hopkins. implored training institutions to teach professional values. This collaboration will be useful in enhancing the improvement Joseph Herman Kyabaggu discussed the involvement of NGOs in of health care in Uganda. the health sector. Focusing on the private not for profit, he noted Nelson Sewankambo, welcomed all participants and thanked that NGOs (Nongovernment organizations) have been key to contributors; organizing committee and funders. He Uganda’s healthcare system since introduction of modern summarized earlier presentations for the chief guest and called medicines in the country. They supported and maintained the upon the MoH and government to fulfill their mandate in the healthcare system during turbulent times in the country and process of improving quality services. He then introduced and continue to be major stakeholders. PNFPs contribute

welcomed the chief guest: Dr Richard Nduhura to give his • He congratulated Makerere University for the good remarks and open the conference officially. performance that has seen the university ranking improve both globally and on the African continent which he attributed to research • He mentioned that research has increasingly become relevant to solving real challenges in the society unlike in the past when research was so alien to address health challenges • He thanked the organizers of the conference and particularly those that made contributions such as the Uganda National Council of Science and Technology • He informed participants about some of the recent developments at policy level, the draft bill on traditional and complementary medicine was drafted, the bill on the private public partnerships for health is before cabinet awaiting input from other sectors and clearance from ministry of finance before it is presented in parliament. • Ministry of health has already approached the College of Health Sciences to see areas where they can collaborate. • He discussed the lessons learnt from China and Singapore Professor Sewankambo speaking at the opening ceremony where the Ministry of Health works closely with the training institutions in areas such as supportive supervision using the training institutions technical In his remarks, the Chief Guest the Minister of State for Health, capacity to improve services. There are plans at MOH to adopt this strategy Dr. Richard Nduhura, who represented the Minister for Health, • At policy level, there is appreciation of research as Dr. Christine Ondoa, expressed gratitude to officiate at such an articulated in the National Development plan and health important occasion where all stakeholders in health come policy. together to share challenges, successes and forge a way forward • There are arrangements with CHS for knowledge sharing as far as health services are concerned. The following were some and the CHS-MOH collaboration will be strengthened of the major highlights from his address;

5.0 Plenary 4_20: Plenary Session 4_20: Health Systems, Health Policy, & Health care II

Rhona Mijumbi shared the experience of SURE (EU) using findings from the rapid response Services to meet policymaker’s needs for urgent research evidence. The SURE project supports the use of research evidence for policy in Africa. It supports improvement of health policy in low income countries and provides a Knowledge translation platform. The Rapid response services were set up to provide research evidence for decision

makers to make timely decisions. The current barriers for policy

implementation from current research include too much Dr. Richard Nduhura opening the conference research; and there is no mechanism to overcome barriers in

LIC. Sure Objective is to design and implement a rapid Minister Nduhura also officially opened the exhibition that was evaluation service. She concluded that RRS is feasible and part of the conference necessary in a LIC like Uganda yet 2/3rd of children who die can

be saved by available methods but information on which to formulate policy may not be available.

Aggrey Mukose shared with participants the goals, objectives and progress about the Master of Science program in Health services research (HSR) offered at the Makerere University School of Public Health. He said that the program’s mission is to improve health of Ugandans, it is open to students with diverse training backgrounds and a two year work experience is an added advantage for those seeking to enroll. He shared with participants the costs for both local and international students.

Aloysius Mutebi, presented findings from a project aimed at can provided the necessary information. improving delivery in health facilities using transport vouchers in a rural community in Uganda. This was a non randomized trial with four districts (2 intervention & 2 control). Intervention, expectant mothers were given transport vouchers 6.0 Plenary 5_20: Health Systems, Health Policies for local transport systems (motorcycles and bicycles). The and HealthCare Delivery III project increased community awareness, participation and support from local leaders. The intervention resulted in increased deliveries at health facilities in the intervention area Geoffrey Kabagambe; discussed the one health approach as an compared to the control. The main challenge is sustainability opportunity to strengthen inter-sectoral collaboration for given that the project is dependent on donor funds. improved health. He identified related sectors towards achieving one health; agriculture; veterinary and communication. He said Rogers Ayiko, presented findings from a comprehensive health that the perception that the health sector is expected to provide facility functionality assessment for the Karamoja region. 101 health to public is a challenge in that the Health sector expects facilities were assessed to investigate the functionality of health inputs from other sectors. He said that the health sector should facilities in Karamoja with reference to nationally set standards to facilitate evidence based planning, investment and embrace other sectors. A One health approach is gaining management of health service delivery in the Karamoja region. momentum due to; increase in global population; animal The assessment methods and tools were adapted from the production; land use and agriculture; natural habitat IHFAN network guidelines. The results were poor across encroachment; natural resources demand which all have different standards; governance and leadership; staff meetings implications for human health. The increased interaction not held regularly, less than 30% HUMCs involved in annual between humans and wild life; new diseases emerge as well as planning. Human resource; 60% health worker positions old ones; disease spread easily. He concluded that the one health covered, at HC II only 14% for midwives and 69% nurses and high staff absenteeism at 28.9% and 27% for hospitals. As far as approach proactively involves sectors that impact on Health; for infrastructure is concerned; new born care corners were absent the approach to succeed, it is necessary to expose the personnel in 33% of referral hospitals, ddelivery rooms were only involved to the skills required to work with other sectors; this available in 22% HCIIs and absolute need for staff housing in sets ground for addressing the challenges of implementing 10% health facilities. He concluded that some of the challenges Inter-sectoral Collaboration in Karamoja can only be solved locally and assessments like this

animals and humans. Human health can no longer be cocooned as used to be. The environmental health also affects human wellbeing. She said there are 3M to achieve one health 1) Man; he needs skills and right attitude and connections 2) Money, to finance the change; 3) Materials, tools, etc. The best Model for one health is one where there is No re-invention, but ensuring professionals interact with some added skills. She discussed that the 2008 plague, was tackled from a one health perspective. Multiple sectors were brought together and there has been no plague outbreak.

Geoffrey Kabagambe speaking at the conference

Monica Musenero from AFENET shared AFENET’s experience with the one health approach. She discussed some of the achievements of AFENET. She said that one health requires a paradigm shift; since the focus now is one world; one health; one medicine. One health should address all that affect man’s welfare. Public Health is achieved thru multidiscipline, requires communication; teamwork; standardized tools; yet basic skills are still necessary. The goal of one health is human health, and this includes Man’s interaction with animals, since this affects health. She said that 60% of pathogens are shared between

Wednesday 21st September 2011 planned and a pilot study on NCDs and risk factors is being conducted in Kasangati among other efforts. 7.0 Plenary 1 _21: Non Communicable Diseases I: Charles Mondo made a presentation on the epidemiology,

prevention and management of cardiovascular diseases in Mangeni Wabwire discussed the emerging burden of Non- Uganda. He highlighted the patterns of CVDs using data from the Communicable Diseases in Uganda. He explained that the Uganda Heart Institute which showed the highest being HHD. country has a double disease burden for both communicable and For surgical cases in 2010 at the UHI, the highest cases were non communicable diseases. NCDs account for about 25% of all PDA followed by VSD and ASD respectively. Regarding deaths annually many of whom are below 70 years. In fact management, there are no national guidelines for dealing with adjusted for age NCD mortality in Uganda is twice that of USA. NCDs and yet international guidelines may not be entirely This means that many victims of NCD in Uganda are younger applicable to the Ugandan situation. Like in other parts of the compared to their counterparts in developed countries. Sub- world, management of NCDs is driven by economic standards Saharan Africa is ranked second to Asia as far as the highest (the rich get better services). He noted that CVDs are very cases of NCDs are concerned. In Uganda, the risk of NCDs has expensive to treat and that given the poverty levels, primary increased due to changes in life style as a result of improvement prevention is the way to go in Uganda. He projected that at the in the economic situation. This has resulted in many people current prevailing rate, CVDs will be the leading killing in Sub- living sedentary life styles with adverse health consequences Saharan Africa because of the rapid epidemiological transition. such as obesity which is a risk factor for NCDs. Other risk factors He recommended health promotion among the population to for NCDs include; smoking and alcoholism. There are a number increase awareness as a strategy for primary prevention. of challenges as far as dealing with NCDs is concerned; inadequate surveillance system which means that available Emmy Okello presented findings from an ongoing cohort study information has high uncertainty and limited knowledge and to profile complications among adult patients presenting with awareness in the population. Wabwire shared with participants Rheumatic Heart Disease in Mulago Hospital. The 233 patients some initiatives by MOH to deal with the challenge of NCDs; a are followed up every three months focusing on their history team is conducting a desk review to come up with a report on and exam, ECG, ECHO, aso, titres and Anti DNAse. Preliminary the status of NCDs, a health facility inventory for NCDs has been results indicate that the disease is common among 15-30 year olds and females. Heart failure is the commonest complication

for RHD. Atrial fibrillation and acute rheumatic fever recurrence She gave statistics of road traffic fatalities and injuries around account for the majority of HF cases. Atrial fibrillation accounts the globe where Africa and the Eastern Mediterranean region for about 70% of cases of stroke, and is the commonest cause of emerge with the highest rates at 32.2%. For Uganda in heart failure. He recommended aggressive treatment of atrial particular, she noted the high increase in motorcycle fibrillation and Scaling up secondary prophylaxis efforts with importation which was estimated at over 100,000 in 2009. This Benzathine penicillin to reduce admission rates and improve the she noted, however, is not matched with infrastructure quality of life for RHD patients. development to support heavy traffic. The country has also not moved to enforce the necessary laws such as that for helmets to Jackson Orem gave an overview of the cancer epidemiology in regulate the motorcycle industry. Yet, helmet wearing reduces Uganda. From his presentation it emerges that the commonest the risk of dying and severe head injury by about 40% and 70% cancers are infection related (over 60%), AIDS related cancers respectively. The big numbers of motorcycles have other have increased over time and cancers associated with consequences such as crime, pollution and rider training which westernization have also shown an upward trend in Uganda. need to be tackled. She concluded that there was no boda boda The rates for cervix and breast cancers have more than doubled epidemic but it was a small part of a much bigger problem: over the last twenty years. In particular, breast and prostate transport policy and management, mobility in a rapidly growing, cancers showed marked Annual percentage changes of about rapidly urbanizing, and rapidly motorizing country. Public 4.5%. Prostate cancer is now the most common cancer in men Health can make a major contribution to finding sustainable and for reasons not very clear, black men seem to be more at solutions. risk compared to their counterparts from other races. Some cancers (tobacco related and esophagus) are noted to be stable. Ssegane Musisi made a presentation on the epidemiology of Overall, the incidence of adult and KS has declined. He said that depression in Uganda. He informed participants that depression lycopene in tomatoes and watermelon helps in fighting cancers is a major public health problem worldwide and is very common while corrosives such as cigarettes and alcohol are risk factors. in Uganda. There are three classifications of depression; Bipolar, He also noted that Uganda has the oldest cancer registry in the Primary Unipolar and secondary Unipolar. Some of the world. symptoms associated with depression include; sad mood, pressure, low appetite and low concentration. Worldwide, Olive C. Kobusingye contextualized road traffic accidents in depression contributes to 12% deaths and accounts for several Uganda into the general development patterns in the country. illnesses resulting in reduced productivity. Depression is highest

21 among females than males and it also affects children. He analysed several studies that have tried to quantify depression rates in Uganda showing that it varies according to many factors such as gender, age and culture among others. He concluded that depression is preventable and treatable.

7.1 Parallel Oral Session A: Non-Communicable Diseases

Ssegane Musisi explored possible relationship between Nodding Disease in Uganda and psycho-trauma. Nodding disease is He elaborated on the recent cases identified from Northern defined as a progressive disease in children characterized by Uganda that included 180 cases (2-20 years) with an equal male head nodding, mental retardation and is triggered by attempts to female ratio. The multidisciplinary team had no successful to eat food. diagnostic or treatment attempts. However, the team identified some common significant symptoms among these cases that He noted records of similar presentations in other parts of the could point to a psychiatric aspect of the condition e.g. absent- world, including Uganda (Nakalanga syndrome reported by Kipp mindedness, visual hallucinations and mental retardation. This et al, 1996). In December 2009, there were some reported cases prompted a more detailed focus on a psychiatric evaluation of in Northern Uganda (Pader and Kitgum districts). A some of the cases. Prof S Musisi and other psychiatrists in multidisciplinary team was instituted by the Ministry of Health Mulago reviewed 8 cases and clearly demonstrated that all the to investigate this condition. These reported cases in Uganda, cases had suffered severe trauma, severe social deprivation, just like other reports, were noted occur in war conflict areas. complex PTSD, chronic depression and anhedonia. They had also Previously, there have not been any identified causes or cures. been exposed to conditions that made them more susceptible to repeated illness that could lead to brain insult e.g. malaria, meningitis etc.

He also highlighted the possibility that Nodding disease is a The risk factors also showed similar age and gender differences: cultural manifestation of severe inescapable and repeated alcohol and smoking predominantly among males but among psycho-trauma, the role of cultural manifestations and females presence of hypertension and obesity were the interpretations of the traumatic experiences of these children. strongest risk factors. The study also demonstrates the There is reported culture bound PTSD syndromes. He reiterated increasing prevalence of hypertension with age. the need to understand this condition considering the cultural She concluded that it is feasible to set up hospital based background and the need for further research in this field, surveillance systems for NCDs and the need to expand NCD especially long term impact of psycho-trauma on children in surveillance to other parts of the country. Some Uganda. He noted that following psychiatric interventions, this is recommendations are that there should be gender sensitive the first time there is reported improvement in clinical among strategies for health interventions, citing the gender specific cases of nodding disease. differences demonstrated by this study. She reiterated the need Olivia Namusisi Kasenge presented preliminary findings on an to involve MOH and other partners in NCD surveillance. on-going pilot surveillance project on ‘Risk factors for Non- Denis Katanku presented findings on surveillance on communicable Diseases in rural Uganda’ citing results from consumption of vitamin A rich foods and other vitamin A Mbarara RRH. She noted the increasing prevalence of NCDs in deficiency associated factors among children in Kiryandongo Uganda, but the lack of systematic surveillance systems and very County, Masindi. In this survey, there was high knowledge about few Ugandan studies on prevalence and risk factor profiles. The vitamin A deficiency among the population (85%), with 66.7% study assesses the feasibility of setting up an NCD surveillance having knowledge on foods rich in Vitamin A, and 40% were system in the health care facilities, determines the prevalence able to identify locally grown foods rich in Vitamin A. They were and risk factors of DM in Mbarara RRH. The results show gender able to identify the importance of Vitamin A in the diet. 70% of and age specific differences: higher DM prevalence among the children received Vitamin A capsule at 6 months. Majority of females (61%) compared to males (39%). 50% of the patients the study population were noted to be economically stable are in the 41-60yrs age bracket. She also demonstrated a younger age at diagnosis of 41-60yrs and most patients had a (75%). strong family history of DM. He recommended continued nutrition education and the development of income generating activities to enable more people grow their own Vitamin A rich foods. There is also need

23 to teach people on good cooking practices to preserve Vit A in with a low GS were more likely to have ARE (+). She however the foods. recommended the need for a larger, prospective study that would determined ARE status, GS prognostic score and patient Innocent Mutyaba from the Uganda Cancer institute presented a su review of the Kampala Cancer Registry (KCR) to estimate the short term and medium term risk of cervical cancer in Uganda. Ruth Mukiibi, Chairperson of Uganda Sickle cell Disease He reported that cervical cancer contributes about 21% cancer association, presented information on the growing and alarming burden among women. He pointed out that the levels of trend of SCD in Uganda. It is estimated that 2% of the population organization of screening programs determine how effective in Uganda have chances of having a baby with SCD and an screening will be among the population. He noted that a estimated 30,000 babies are born with the disease in Uganda, negative screening test provides at least 5 years of protection 80% of who die before 5 years. She noted the lack of prevalence and the need to. According to the KCR, he reported that there data in Uganda. She also challenged the NCD alliance to have not been any changes in disease trend over the past 20 incorporate SCD in their agenda, and the medical fraternity to do years, despite increasing prevalence. He demonstrated changes research on SCD. Other recommendations were that SCD in absolute risk of cancer over time over the first 69yrs. There is diagnosis and management should be to be scaled down to demonstrable difference in short term risks between younger lower health units (as planned in HSSPIII), newborn screening, and older women, but no difference in medium term risk of family / genetic counseling and formulation of policies. She developing cancer. noted the importance of mass awareness campaigns as key to fighting stigma about SCD and decreasing its prevalence. Florence Ajok presented preliminary findings on a study in Mulago Hospital on the Androgen receptor expression (ARE) in cancer of the prostate, which is an androgen dependent tumor. ARE is responsible for disease progression and survival. Of the 7.2 Parallel Oral Session B_21: Capacity building, Health, 93 samples analyzed, there was low ARE (55 %) compared to and Environment studies from outside Uganda. The Gleason score (GS) ranged from 4-10% (mean 8.47%) implying that most patients (73%) Henry Katende shared the experience of strides using presented with advanced stages of disease, therefore the need performance based contracting to expand family planning for continued population sensitization. In this study, patients service delivery in Uganda. The USAID funded project is

implemented in 15 districts with the goal to Strengthen capacity At the end of the intervention, there was an increase in the of health system to make them fully functional and able to uptake of services with the number of clients tripling those that deliver quality integrated RH/FP /CS, malaria and nutrition had been reached through regular family planning services at services. Contractors apply and get evaluated by stride staff, the health facilities. The researchers concluded that access to USAID and MOH before contracts are awarded. Once contracts permanent F/P methods can be improved by training health. have been awarded, contractors are followed up by strides staff Justus Barageine Kafunjo explained the model of using to ensure that that performance is in line with agreed upon outreaches to reduce the backlog of Obstetric Fistula patients’ in targets and indicators. Strides motivate performing contractors Mulago Hospital. A VVF unit was created at Mulago to help by renewing their contracts while contracts for non performers reduce the backlog of patients who need surgery. The VVF is are terminated. Through this undertaking, there has been poorly equipped with only 14 beds where patients stay for an increased ANC attendance, increased delivery at health facilities average of 18 days. Services are often interrupted due to lack of and the demand and utilization of FP services within the supplies and the number of surgeons is also small to effectively intervention districts have all improved. The lessons learnt so reduce the backlog. Against this background and coupled with far are; Contractors use innovative approaches to improve child, the big numbers of patients on the waiting list, an outreach maternal and RH, which are expanded once proven successful program was started. The objectives of the outreach were to; and the model fosters PPP Fosters PPP and brings the private screen for and repair genital fistula in outreach sites, update providers into the formal health sector, allowing improved staffs in the units on advances in fistula care and prevention and regulation. use the outreach camps to reduce on the existing backlog. Ramathan Lukoda presented the outcome of an intervention to Trough the outreaches using 11 hospitals and 1 health Centre IV, enhance demand for long term and permanent family planning many patients have been screened repaired and CMEs methods through capacity building using a case study of two conducted. Some units have also been provided with fistula care districts in south western Uganda. He explained that uptake of and treatment equipments. Many patients are worked on in the long-term family methods is hindered by a number of factors; outreaches compared to the VVF unit and patients are receiving limited skills among health workers, stock outs of supplies and care from nearby health facilities. The model can be used to misconceptions in the communities. This intervention used a scale out fistula services and other reproductive health services multi thronged approach; training health workers, supporting in the country. improvement of the supply chain and mobilizing communities.

Geoffrey Kagwa gave the progress of implementing ICCM in include; slow process, community misconceptions and Mpigi district. He explained that the major aim of village health resistance and negative advocacy among others. She concluded teams is to strengthen health services delivery at house hold that if MDGs can’t be achieved nationally; let it be done in the level. Their tasks include health promotion for disease communities across the country. prevention, community mobilization for health services and Peter Dyogo presented findings of an assessment of male drug distribution among others. Villages are mapped out and involvement in maternal health care services in Jinja district. In attached to a health centre in the zone. It has focal persons from this study, the factors that influence male involved include the villages to the districts. Access to adequate health care is education and number of spouses. It was also established that insufficient. Continuous community sensitization on ICCM by men who escort their spouses for ANC are most likely to attend radio can help access to health care services. It’s possible to deliveries as well. Some of the reasons that hinder male reduce child mortality and morbidity through involving the involvements include but are not limited too; absence of waiting communities. space and delay at the centre. It was recommended that Christine Nabiryo discussed the topic “Achieving the Millennium community leaders need to be sensitized male involvement to Development goals by 2015 or thereabout; Reality or Rhetoric” champion change in the communities. using information on some of the indicators for the MDGs; she Susan Babirye explored cultural practices during post partum noted that the country will not be able to achieve the targets among mothers in Buwaya Community, Mayuge district. unless the approach and strategies are changed. She shared Childbearing is associated with many myths and misconceptions lessons from a community initiative in Jjumbi village, Gomba and hence the many practices during post partum; post natal district, aiming to transform the community. Without a lot of mothers bath at least 3 times a day using banana leaves, external funding, community members through mobilization are mothers with virginal tires use salt, tea leaves and local herbs, working towards transforming their lives in the different placenta disposal depend on different clans i.e. others burry in sectors; health, education and sanitation. The initiative has the sitting room, front door or behind the house. Mothers eat indicated that community engagements and ownership are a more food during the period but some are prohibited because of critical step for community transformation and that for any cultural beliefs. For any maternal and child health intervention community initiative to be successful there is need for at the community level, it is important to put into consideration meaningful involvement of community members in the whole cultural practices and beliefs. process. Some of the challenges associated with this approach

7.3 Parallel Oral Session C: Capacity Building, Health, and gender analysis. Discussing findings from a KAP study in Bolivia, Environment he indicated that overall both males and females exhibited poor knowledge and handling of pesticides. Female were less Peter Kiwumulo highlighted the water, hygiene and sanitation educated about handling of pesticides, rarely used protective situation in schools based on a study conducted by the Uganda devices and reported more symptoms associated with pesticide association for social economic progress. He said that the handling compared to their male counterparts. The female increase in enrollment due to UPE/USE has not been matched farmers scored poorly on all parameters of knowledge and with similar increase in amenities. The situation is particularly practice regarding pesticide use; wearing protective devices appalling in government schools. Latrine structures are not child such as gloves (females 3%& males 42%), burning/burying friendly; there is no privacy, no wash rooms, they are very dirty empty pesticide containers (females 3%& males 37%) and and in some cases boys and girls use same structures. Some knowing the colour on the container for most toxic pesticides schools do not have toilet facilities and in others structures are (females 15%& males 46%) among others. He recommended very far from the classes. gender recommendations to improve pesticide handling and use among female farmers; conducting trainings in the villages and Regarding access to water, it is fetched from unprotected places making separate trainings for males and females among others. and consumed un-boiled. The effect of all these is that diseases are common and school attendance is poor particularly for girls, Freers Juergen reported that air pollution is not described as a which affects their performance. He gave the following cause of cardiovascular diseases. Risk factors for pollution recommendations; water should be provided with cost effective include traffic jam in which Ugandans spend considerable time; means like rain harvesting. Child friendly latrine should be open fire smoke; and road-traffic pollution; and inhalation of constructed preferably with small holes. There should be fine dust. Air pollution is now linked to shortened life and separate latrines for girls and boys. Teachers should be provided negative emotion. Physicians should pay more attention to for and changing rooms provided. Train peer educators. Health modifiable factors, and where exercise is done. Uganda has no clubs; train teachers. Government and other development regulation via air pollution and waste burning was mentioned as partners should increase funding for sanitation. a disaster due to dangerous plastics.

Erik Jørs from Denmark examined the risks of pesticide Daniel Kiiza shared experience of the COBES approach to intoxification among farmers in developing countries using a community health education using the case study of Masafu

District Hospital a MakCHS COBES site: COBES is a program the country, assessed the conditions of service of midwives and under the problem based learning (PBL) curriculum designed to established the roles of Nursing and Midwifery help students acquire skills and experience at different levels of Council/Associations and PNFP facilities in midwifery training their professional training. Community based training prepares and services. students for an effective professional life through the acquisition As far as training is concerned, there are two typologies of of skills such as critical thinking, problem-solving and midwifery training; traditional vs. comprehensive. In the former, innovation as they experience the realities of health care in the trainees graduate as specialists in midwifery while in the later, community. This exposure enables them to easily link the trainees graduate as multi skilled with the ability to perform theoretical knowledge with practice, via experience gained in many functions. In the traditional approach training takes 19-29 the community & an appreciation of community needs, while comprehensive training takes 5.5-7.8 weeks. Some of the concerns, resources, interventional measures & strategies. challenges associated with midwifery training include; shortage Although COBEs is beneficial to both the students and the of tutors, crowded training facilities and poorly equipped labs communities, there are a number of challenges such as language among others. The coordination of midwifery training which is barrier for the students and poor understanding of COBES in the currently a prerogative of ministry of education is also viewed community where students are perceived as professionals as problem that could undermine the quality of training. raising a lot of expectations for improved services. He Concerning services, the main challenges are; heavy workload, recommended that communities should be sensitized about low pay and lack of CMEs tailored to midwifery among others. COBES. These affect the quality of services by the midwives. He Christopher Garimoi Orach discussed the constraints and recommended that coordination of midwifery training be placed opportunities of Midwifery Training and services in Uganda back under the ministry of health for technical reasons. using findings from a nationwide survey. The baseline survey Irene Kambonesa shared the experience of Mildmay about commissioned by UNFPA was meant to identify gaps and needs building Capacity of Health Care Workers in the Private Sector to in midwifery training, service and practice as a basis for deliver comprehensive HIV & AIDS Services. In this project, developing interventions to increase capacity of midwives to Mildmay works in collaboration with Health Initiative for the integrate the full continuum of maternal health in the national Health Sector (HIPS) and Ministry of Health to build skills of health system. The survey assessed the quality of midwifery health workers and upgrade sites where they come from for training, documented outputs of midwifery training schools in

accreditation by MOH to offer HIV and AIDS services. Through human resources, supply chain for drugs especially morphine the project over 1250 health workers (medical officers, and funds. clinicians and midwives among others) have been trained and MOH has accredited 100 sites to offer comprehensive HIV and AIDS services. The outcome of this initiative has contributed to increased access to HIV/AIDS services through the private sector. It is recommended that clinical practicum’s should be integrated in trainings for health workers and that funding opportunities should be extended to the private sector service providers. Training for the private sector, however, should take into consideration the unique circumstances in the sector.

Jane Nakawesi presented about strengthening HIV and AIDS Pediatric Palliative Care systems based on the lessons from Mildmay Uganda, HIV/AIDS care and Training Centre. She gave an overview of what pediatric palliative care entails and discussed both the traditional and modern concepts. Modern approach in pediatric palliative care requires that health providers evaluate and alleviate a child’s physical, psychological and social distress. To be effective, palliative care requires a broad multidisciplinary approach that includes the family and makes use of available community resources; it can be successfully implemented even if resources are limited. She also gave the status of pediatric palliative care in Uganda and noted that; it is less focused on compared to that for adults, has limited funding and there is limited literature about the subject matter. To strengthen HIV and AIDS Palliative care, there is need for

8.0 Plenary 2_21: Health and Environment Goals: Smoke free environment in 4-5 yrs; High taxes on tobacco: 60%; 50% cigarette package should be warning; Ban

adverts direct and indirect In this plenary, many presentations focusing on health and the Deo Sekimpi, presented findings from a baseline survey on the environment were made as summarized below. use of pesticides giving the implications for health and the Possy Mugyenyi gave an overview of the Center for Tobacco environment. The KAP survey was done in Pallisa and Wakiso control In Africa (CTCA). Housed by the Makerere University district as a baseline for the Health and the Environment project College of Health Sciences, School of Public Health (MakSPH), revealed, that extension workers believe that the amount used is CTCA will initially target five countries in Africa (Uganda, Kenya, excessive and that reducing them would not affect yields. S. Africa, Mauritania & Angola) as a systematic approach to Pesticides are poorly handled especially by the agro dealers who tobacco control. The center is funded by the Bill & Melinda Gates re-package them yet very few (33%) use protective clothes Foundation through a grant to WHO/TFI to provide capacity while a big number (75%) eat or smoke from places where support to countries in five areas; Technical, Institutional, cross pesticides are kept. The health workers also exhibited limited sector and cross country networking. The is guided by the knowledge about pesticides based on their inability identify following; common pesticides in use or the colour coded for toxicity levels. Vision: To be a sustainable, leading centre of excellence in The findings from the survey will be used to evaluate the impact empowering and facilitating tobacco control to achieve a of the project at the end of the implementation period. tobacco-free Africa and serves to achieve its mission;

Mission: To pool evidence, build partnerships, mobilize resources, build capacity, and create tools to advance tobacco control in Africa

Aim: To reduce the consumption of tobacco by supporting governments in implementing evidence-based tobacco control strategies in Africa. The Bill & Melinda Gates Foundation has provided funding thru a grant to WHO/TFI.

Victoria Masembe made a presentation on Healthcare Waste advocating for more resources to support HCWM and Management (HCWM) in Uganda using the experience of the documenting lessons learn to guide future plans. AIDS Support and Technical Assistance Resources Project Margaret Nanyonga shared the outcome of an initiative to funded by PEPFAR through USAID. She highlighted the dangers improve community water crisis in Buhembe village, Kyegegwa of poor practices in waste management which can compromise district. Using participatory Rural Appraisal Methods (transect the health of community members and health workers alike. walk, village mapping, preference ranking, small group Some of the current poor practices in HCWM identified include; discussion and seasonal calendar, community members were lack of segregation, ineffective efforts in addressing the problem mobilized to form water source committees, improve 6 water and unsafe storage of sharps among others. She noted that with sources formulate and pass by laws to govern community water the scale out of HIV/AIDS services, (HCT, PMTCT and ART) a lot sources. The initiative showed that with proper coordination of HCW is generated and yet plans for management have not and leadership, community members can be a resource to been fully catered for by the partners. This she emphasized has implement cheap and effective projects with positive outcomes. serious consequences as already established in some countries (India, Romania and Libya) where cases of HIV/AIDS among children whose mothers were HIV negative could be linked to Ezekiel Mupere discussed the status of nutrition in Uganda. He poor HCWM. The AIDS Support and Technical Assistance indicated that malnutrition is a major development and social Resources Project has already made some progress at National concern affecting all regions and segments of society. This has level; policy for HCWM formulated, multiyear plans have been implications for the larger development agenda including and guidelines have been developed. At district level; technical achieving the MDGS; reduce child mortality and improve teams have been formed, focal persons for HCWM identified at maternal health including combating HIV/AIDS, malaria and health center level guidelines/job aids distribute to service other diseases. He focused his discussion on the magnitude of providers. Despite these achievements a number of challenges malnutrition, causes, impact of maternal and child malnutrition were identified including but not limited to; inability to quantify and identified gaps in the strategies and made recommendations HCW to plan for its management, poor coordination of existing for the way forward; efforts and inadequate budgets at the district level. Sustainability strategies for the project include; coordination Magnitude; He indicated that in Uganda high levels of mechanisms have been established at district and national level, malnutrition co-exist with a growing prevalence of overweight and obesity, levels of chronic malnutrition are high and

31 macronutrient deficiency especially Vitamin A and Iron On the causes of malnutrition, he classified them as intermediate deficiencies. Also indicators for malnutrition (stunting, which include inadequate dietary intake and high disease underweight and wasting) have remained persistently high with burden, underlying causes include; household food insecurity minimal changes over several decades. Obesity and overweight and poor access to healthcare while interactive causes are; poor in women is increasing especially in urban areas, central and funding for nutrition programs and lack of political commitment western Uganda. There are no regular assessments for among others. Regarding impact of malnutrition, it kills many malnutrition. Ugandans, increases poverty levels and undermines intellectual performance among school going children. He recommended that the design of nutrition programs and services should be improved to prevent, reduce and control malnutrition at all levels and to promote coordination and resource mobilization for nutrition programs.

Isaac Okullo discussed oral health in Uganda. He defined oral health as being free of all oral health related illnesses such as oral and throat cancer, oral sores and tooth decay. Poor oral health and untreated oral health diseases has implications for general wellbeing of human beings. Risk factors of oral diseases include; unhealthy diet, tobacco use and poor oral hygiene among others. Giving an overview of oral health in Uganda, he noted that 73-85% of school children have dental cavities, Periodontal disease is found in over 60% of middle-aged adults Ezekiel Mupere and the incidence of oral cancer ranges from 1 to 10 cases per 100 000 population. HIV/AIDS is linked to poor oral health given that 73% of HIV PHAs have oral, fungal or bacteria or viral infections. He also highlighted the structure of oral health

services in the country, curative dental care allocated less than 0.1% of the total Health budget (9% GDP), the number of dentist

32 is very small, approximately 350 Dentists (1:150,000) yet WHO district supportive supervision and strengthen reporting recommends 1:7,500. In order to improve dental health in mechanism; injuries and fatalities. Uganda, he recommended advocacy for dental programs, Peter Waiswa gave an assessment of newborn health in Uganda meaningful integration into other health services, promotion of as the ultimate test for health systems performance. Discussing preventive programs and training more dental health global statistics, he indicated that most of the under five deaths practitioners. take place in Sub-Saharan where 1 in every 8 children die before Joseph Byonanebyeye made a presentation about occupational their fifth birthday which is 17 times higher than that of health in Uganda. Using examples of many cases of people who developing countries (1 in 143). He indicated that rate in decline have been injured and disabled in the course of their worker of the under-five mortality has accelerated from 1.9 between (builders, drivers and factory workers) with no/limited 1990-2000 to 2.5% between 2000-2010; the progress will not compensation, made a case that occupational health is not given lead to attainment of the MDG 4, particularly in Sub-Saharan the emphasis that it duly deserves. Yet, a health workforce is the Africa. Citing contradictions on maternal and neonatal rates in backbone of development in a country. He defined occupational Uganda from different data sources (UDHS, Lancet and UN health as a cross disciplinary area concerned with protecting the group); he questioned the reliability of available statistics to safety, health and welfare of people in employment. He also guide planning. He also discussed some of the policy gaps that highlighted the main sections of the occupational safety and have undermined targeted response to addresses neonatal health act, 2006 which among others things emphasize; Duties, health; safe motherhood initiative of 1990, IMCI left out Rights and Responsibilities of Workers, General Safety newborn health, HSSP I (2000/1-2004/2005) developed in Requirements and General Duties, Obligations and 1999 included MCH without specific mention of newborn Responsibilities of Employers. Some of the challenges hindering health and HSSP II 2004/5-2009/10 was first to priorities implementation of occupational health strategies include; newborn as a policy issue but was not followed with appropriate limited information on OSH in Uganda, OSH not decentralized funding. As a result of the failure to implement policies and and inadequate funding. In light of the aforementioned guidelines regarding newborn health, children still die of challenges and general overview on OHs, the following preventable causes. As a way forward, he proposed the need to recommendations were made; increase public awareness on OH operationalise the healthcare system as planned using the especially the regulations, improve coordination more focus on continuum of care structures as depicted below.

The continuum of care

Pre/ANC Interventions Comparative fertility rates Folic acid T. Toxoid IPTp Immediate Care Syphilis screening/ Resuscitation of newborn, Prevention &Mgt of treatment Hypothermia, Kangaroo mother care Prevention of pre- Immediate & exclusive breast feeding eclampsia/eclampsia 8 6.7 7 6.2 6.1 6.0 Labour & Immediate 5.7 ANC Postpartum care for 6 delivery care Newborn Newborn & mother Care 5 4.6 Intra partum care Pre-labour ROM/Steroids/ Postpartum Care 4 Breech/ Partograph/Clean delivery Community based pneumonia mgt Exclusive breast feeding, warm care, cord care 3 Waiswa PhD defence 17th May 2010 18 2 1 0 Jennifer Wanyana discussed the status of Uganda’s family Uganda Zambia Rwanda Malawi Tanzania Kenya planning program implementation. She gave an overview of all (2006) (2007) (2005) (2004) (2004) (2007) 4 family planning indicators between 2001-2006 such as; the mid- year projected population which rapidly increased from 23.3/20.5 in 2001 to 27.6/23.8 millions in 2006, contraceptive Olive Sentumbwe- Mugisa discussed Global perspectives and prevalance rate (CPR) which increased moderately from 8/14 in current developments in Maternal & New born health with a 2001 to 24/18.5 in 2006 while Total Fertility rate stagnated at focus on Uganda. She explained facts and figures on maternal 6.9 in 2001 and 6.7 in 2006. She noted that if the current mortality, assessed the gaps in MNH interventions, explored situation is not halted, Uganda’s population size will double in effective interventions and highlighted priority actions. As far as 2034. She highlighted some of the initiative that government is facts and figures are concerned, she indicated that Africa has undertaking both at policy and programmatic level including; highest numbers of maternal and child mortality despite being putting in place supportive policies, procuring FP commodities, home to only 11% of the world’s population. The region is improving distribution mechanisms and supporting/facilitating showing no progress in achieving MDG 5 and there has been community FP services. Some of the outstanding challenges that very little change in maternal death in the last 20 years. were identified include; myths and misconceptions about FP Concerning gaps in interventions, she indicated that these cut methods fear of side effects and service access factors. The across all platforms from services, human resource and graph below shows comparative fertility rates of countries in coverage. Regarding priority actions, she identified the the east African region to emphasise uganda’s country status. following; provide long-term and predictable funding, target the

34 poorest and most marginalized communities and implement proven strategies.

hosts. He displayed images of TB they encountered in antelope meat at Lake Mburo National Park, where wild animals and Thursday 22nd September 2011 herdsmen frequently interact. In Uganda, Primates fetch >11% 9.0 Plenary 1_22: Infectious Diseases, Drug GDP but they are reservoirs of viral pathogens. Antibiotic Resistance has also emerged in dairy animals, and drug residues Resistance, and Emerging Tropical Diseases form increased risk due to poor management. Due to David Serwadda discussed the emerging infectious diseases and urbanization, wild pathogens mingle with humans even in cities the future challenges for Africa, based on the report of the and this is exacerbated by water shortage. Several wild foresight project, UK. He identified and discussed six disease animals/birds including Owls are now linked to Marburg risks to humans in Africa: new pathogen species and novel disease. The health sector must integrate other sectors such as variants; Pathogens acquiring greater resistance; Zoonotic veterinary and wild life for the way forward. diseases that cross between animals species to humans; Alex Coutinho discussed the Positive and negative Impact of HIV HIV/AIDS, tuberculosis and malaria; acute respiratory Programs on Healthcare Delivery in Uganda: Using the theme infections; sexually transmitted infectious diseases. He also has HIV funding been a boon or bane to human health in described drivers of epidemics as follows: Human activity and Uganda? He disclosed that PEPFAR funding has contributed social pressures; Climate change; Population growth; Legislation 300M USD to Uganda, and >40 districts in Uganda are covered and systems of government; Technology and innovation; with >100,000 beneficiaries. However, there’s variability from Conflict and law, and Economic factors. He decried the lack of country to country on whether funding is beneficial. The reference laboratories in Africa, and advised that Africa should Positive side of HIV funding has been increased utilization of adopt DNA-based technologies in diagnostics. antenatal care, vaccination, higher job satisfaction; and David Kabasa analysed animal-Human Health Interface and increased involvement of Private Sector. The negative side of explored opportunities for cross-disciplinary collaborations for HIV funding has been decreased skilled delivery; increased work Total Health. He noted that 58% of human pathogens are load; reduction in essential drugs. However for Uganda, there Zoonotic, and that Man’s interaction with animals has increased, has been Undisputable benefits; 300 000 persons are on HIV and animals have taken other roles from providing food. Africa treatment without which many would have died; 500 000 has been legislated as a global biorisk incubator. Uganda is Ugandans have been kept alive. Without intervention, indeed gifted by nature including pathogens which reside in prevalence of HIV infection would be 1% higher than it is

currently, implying that another portion of Ugandans has been Freddie Bwanga made a presentation on drug resistant bacteria saved from infection. and Laboratory detection in Uganda. He explained that drug Resistant bacterial infections are associated with high Mortality HIV funding has created 35,000 jobs and funding of up to 400- and Morbidity. He cited limited data on drug resistance in 500M USD per year to Uganda. However, there is no data on developing countries in general and Uganda in particular and health workers who are HIV+ kept alive but this is an area for noted that routine testing in hospitals does not occur. He thus more research. Many broad based system have benefited from reviewed evidence according to available scientific literature on HIV funding; labs, pharmacies etc. On the negative side of HIV Drug resistance on common pathogens in Uganda. The funding, there has been an increase in workload, especially commonest resistance include MRSA (Methicilin resistant where there is integration and decreased attention to other staphylococci), which in Europe, is discussed by politicians. He important diseases, and increased meetings or workshops tend discussed the burden of MRSA in Uganda as 31%, S. pneumonia distract workers. There has been complacency and donor Resistance, 70%; there was no data on drug resistance by Gram fatigue. HIV funding did not lead to creation of new medical negative bacteria, but they have high levels of resistance in institutions and infrastructure projects apart from renovation. Mwanza and Western Uganda according to preliminary data. For He described as myths beliefs that HIV programs are draining TB, there is Mono-resistance, MDR, X-DR, and Poly-resistance. competent staff from government; funding would better be used MDR-TB is common in Uganda, and 15% of MDR cases are re- for all heath conditions; other diseases are underfunded; treatment. He said that MDR treatment is expensive and drugs government is not encouraged to take on funding. All these need not very effective. MDR was mapped in Uganda and 300 research for conclusive evidence. He stated that prevention care detected but not treated. He said that all technologies are and treatment at IDI has increased; with IDI outreach available in the country to quickly detect resistant bacteria but programmes now country wide, many Ugandans are cared for. Health Systems make them difficult for routine use. He disclosed that Health centers IV were built in Kagadi and Hoima with HIV funding, and laboratory services were Moses Joloba discussed approaches to management of drug strengthened. Discussing the IDI Research to policy, he stated resistant microorganisms. He said that Drug resistance is on the that 50 peer review papers were produced by IDI staff in last 3 increase worldwide, and every antibiotic eventually gets months. In conclusion, he said that HIV funding strengthened resisted by bacteria. This implies that the organisms have higher health systems in Uganda. potential for Resistance than we have for developing new drugs. He stated that 90% of health problems are infectious disease,

37 with which we use antibiotics for treatment. Drug Resistance is with subtype A when treated with the same regimen. She the most important predictor for patient outcome, implying that recommended that patients should be regularly monitored for early detection is key. Healthcare workers ought to know Drug drug resistance. susceptible patterns of isolates yet Uganda lacks antimicrobial Samuel Nsobya analysed the detection of malaria drug susceptibility testing schemes. He suggested prevention would resistance. He noted that there are multiple determinants of be the best option; choosing the right drug; adherence; drug Resistance including parasite; host; pharmacogenomic; and restriction; combination therapy; minimizing transmission of compliance factors. He discussed methods of monitoring Drug drug resistant organisms; and ensuring correct prescriptions. He resistance in Uganda, which included ex vivo methods and Single said that two cases of XDR-TB have been reported in Uganda, nucleotide polymorphisms (SNPs), RFLP; PCR; luminex; one of which was manufactured in the clinic. He advised that public education; political awareness; avoiding substandard Microarray; sequencing, and others. drugs; monitoring use of drugs in veterinary and agriculture sector; addressing bio-security issues; vaccines would help. Laboratories are key to success in susceptibility testing yet labs are neglected in Uganda; 80% labs manned by microscopic who cannot adequately assist in management of drug resistance. The highest caliber worker in MOH is diploma holder. Uganda has Neglected infrastructure and labs rarely have budgets from policy makers.

Immaculate Nankya discussed HIV drug resistance and Lab detection using data from the Joint Clinic Research Center. She noted that with the unprecedented access to ART drug resistance has is increased. She highlighted some of the factors why drug resistance is inevitable including; virus mutations, poor adherence and poor retention of clients which is common in Africa. Patients with subtype D are more likely to fail treatment and develop resistance more frequently than those

9.1 Parallel Oral Session_1_22_A: Infectious Diseases & prolonged stay on a failing NNRTI –based ART. The majority of Drug Resistance viral Isolates with NNRTI resistance presented with multiple NNRTI-RAMs. The etravirine associated RAMs are most Within Parallel Oral Session A, many interesting papers were commonly seen in viral isolates with multiple NNRTI-RAMs. presented about infectious diseases and drug resistance. There is a need for early detection and switch from failing Highlights from all the presentations are discussed below; NNRTI-based ART so as to maximise the future benefit of ETR.

Christine Najjuko proved the high prevalence of oxacillin Patrick Musinguzi discussed findings of an assessment of resistant Staphylococcus aureu s in the surgical units of Mulago Quinolone- resistant gonorrhea among men with urethral hospital. MRSA prevalence was high at 41% in the burns unit of discharge in Kampala. He said that Neisseria gonorrhea is a Mulago hospital, with several isolates harboring virulence genes major STD pathogen which is resistant to several common including PVL, enterotoxins and super antigens such as tsst, drugs. He said that drug resistance to the pathogen is increasing; according. It was reported that CHROMagar did not perform ciprofloxacin used to be first line drug but no longer works due well for detection of MRSA, implying that it requires more to resistance. MDR strains have been reported, but the burden of research. MRSA was genotyped and the commonest was the quinolone resistance in Uganda is not known. He determined hospital SCCmec type I, followed by the SCCmec type V, which is drug sensitivity patterns on Neisseria gonorrhea from patients usually of community origin. Healthcare workers were at the STD clinic in Mulago hospital, and found Ciprofloxacin cautioned on the occurrence of potentially virulent S. aureus in Resistance at 32%; SXT, 83%. He concluded that drug resistant Mulago hospital and the need to improve infection control. Neisseria gonorrhea has emerged in Uganda, and recommended use of molecular methods to delineate resistance mechanisms. Beatrice Achen presented findings of an evaluation of slide drug susceptibility test for rapid diagnosis of multidrug resistant tuberculosis. Most MDR tests are cumbersome and have Francis Ssali demonstrated that NNRTI Resistance is highly limitations especially in peripheral settings. The authors associated with NNRTI mutations. Presenting findings from a described Slide DST, a very simple microscopy based techniques database query on all HIV-1 isolates sequenced between 2006 that rapidly detects drug resistant mycobacteria (MDR). It is and 2008 at the Joint Clinical Research Center, he indicated that direct and it is not necessary to isolate the organisms. She the most common NNRTI mutations found were K103 (51.8%) determined time to results; sensitivity, specificity for detecting followed by G190 (21.7%). Multiple NNRTI are a feature of

MDR-TB in Uganda, and found that SDST reduces results to 12 confirmed again as the predominant cause of Tb in Kampala, days, with high sensitivity and specificity. Uganda.

Claude Kirimuhuzya reviewed and discussed the need for Wampande ME analysed Genetic structure and phenotypes of developing new drug combinations for TB, stating that they Mycobacterium tuberculosis causing pulmonary tuberculosis. He require a new paradigm shift. New short treatment regimens are noted the complexity of TB strains with the host disease. He urgently needed and these should target mdr/xdr strains, listed six MTB lineages that cause TB worldwide. In Uganda, the simplify treatment by reducing daily pill burden, shorten dominant strain is called Mtb “Uganda genotype”, and he studied treatment duration and lower dosing frequency among others. why it is dominant in Uganda. He developed SNP markers and He further noted that there is need to shorten the period for genotyped >1000 samples, and re-confirmed that the strain drug development considering that the traditional process takes “Uganda genotype” was the most dominant. He also studied the about six years which is very long. He also gave an overview of data yearly and found that the strain has been dominant since the Critical Path to TB drug initiative funded by the Bill and 1992.The Genotypic data was analyzed statistically and found Melinda Gates which championing the paradigm shift aimed that cavities were associated with the a sub-family of MTB giving patients promising TB drugs without necessarily Uganda genotype called the purple family; which was also adhering to the lengthy processes associated with rolling out associated with age, lung infection; and virulence. He concluded drugs. This he noted is important given that TB claims nearly that Novel SNP markers were developed for delineating MTB two million lives each year. lineages, with high throughput since 500 samples per day can be genotyped. Uganda has three main lineages of TB, with the David P. Kateete presented findings on circulating purple family being associated with severe disease. Mycobacterium tuberculosis Strains and Transmission Patterns among Pulmonary TB Patients. This paper determined that MIRU-VNTR, a new genotyping technique, revealed a high strain diversity and transmission patterns among pulmonary TB patients in Kawempe Municipality in Kampala. Uganda. The technique is simpler than other TB epidemiology molecular techniques, and data can be shared between across laboratories.

Using MIRU-VNTR, M. tuberculosis strain Uganda genotype was

9.2 Parallel Oral Session 3_22 C: HIV, TB, Malaria, & Other IDs

Alice Ladur presented findings from an exploratory study to determine attributes of low male involvement in PMTCT services; Khayelitsha, South Africa. The authors determined enabling factors to include; peer support, health worker contact and disclosure of HIV status among others. Hindering factors include; stigma at the health facilities, focusing PMTCT programs entirely to women and long hours of waiting at the clinics. The authors recommended that PMTCT programs should increase involvement of men to achieve better results.

Mary Dutki analysed male partner support and PMTCT service uptake based on the evaluation findings of a community PMTCT program. Men perceive their support to be entirely financial and this is influenced by a number of factors; traditional gender roles, competing priorities and negligence among others. Areas identified by female partners where they require support include; household chores, planning for the household and communication. The authors recommended the need to review content for IEC materials to target male partners as well.

10.0 Plenary 2_22: Vaccines Anatoli Kamali analysed the recent developments on Microbicides. Microbicides were developed to protect women Pontiano Kaleebu discussed advances in HIV vaccines according against HIV focusing on their vulnerability. Microbicides work to the Bangkok highlights. He discussed HIV vaccine efficacy by inactivating the virus in the vagina or prevent viral rd trials: the 1st did not show efficacy; as did the 2nd step trial; replication. 3 generation of Microbicides offered 39% however, the 3rd, vaccine trial based on Rv144 was the first reduction in HIV acquisition; 51% reduction in HSV2 infection. vaccine to show some protection. He said that the 4th trial based Other studies involving Microbicides will use rings which stay on HVTN505, a DNA vaccine, is going in the USA. Although the up to four weeks, releases drug. Others are rectal Microbicides Thailand trial was published in NEJM, the mechanism of and combinational Microbicides. protection is still unknown. Case control studies have been performed to determine correlates of protection in which the Pauline Byakika-Kibwiika explored pharmacokinetic interaction first immune responses were immunoglobulin antibodies (IgG) between nevirapine and artemether-lumefantrine in HIV- that bind to V1/V2 loops. There was 71% reduction in infection infected Ugandan adults. HIV infection is a risk factor for but currently it is unclear how the vaccine prevents infection. malaria. Coartem is commonly prescribed in Uganda for malarial Studies have begun to use antibodies in passive protection in therapy, and HIV-Malaria co-infections are usually treated with nonhuman primates. both Nevirapine and Coartem, whose constituents can potentially interact with Nevirapine since both are metabolized Other Newer antibodies that neutralize virus were discussed; 17 by the same enzyme, causing reduced plasma concentration. In newer Abs were identified, which also bind V1/V2 loop. her study, 30 participants were enrolled who had no prior ART Vaccines have been designed with Neutrozing Abs, VRC01. or herbal medicine and blood samples taken at 2 hourly Current trials in Uganda; MU-WRP, will test 2 vaccines with two intervals to monitor pharmacokinetics at Month 1 and Month 2. subtypes, will use immunization with electroporation of the Participants were mainly females. She found 59% reduction in virus using DNA; will be conducted in 40 volunteers. UVRI/AIVI, artemether and 72% reduction in total exposure; even phase 1 trial in Masaka to look at immune responses; adeno 35 dihydroartemether had reduced; but lumefeanttrum was not vector + GSK. UVRI-AIVI; B0002 to start, electroporation. affected. Also, Nevirapine exposure decreased, concluding that Summary: for the first time, correlates in vaccine protection, but Alternative treatment should be devised for patients with both mechanism not clear. Neutralizing Abs promising HIV and malaria who are on Nevirapine.

Suzanne Kiwanuka used a health systems model to assess what influences immunization coverage. Systems model looks at inputs, process and expected outcome. There was a correlation between DDPT coverage with donor funding, in other words, donor funding increases coverage of DDPT. A number of factors influence immunization coverage, government funding improved vaccine supplies, this was in countries which had below 60% coverage at baseline, Overall supply was a positive driver, and physician densities had a positive influence on immunization coverage. Adoption of global strategies to local context improved coverage. A lot of literature documents the weaknesses not the positive strategies so data is limited on what actually drives success in immunization programs.

11.0 Plenary 3_22: Closing Ceremony As a physician, he was described as one who priorities the life of his patients above self, he loved his job and his spirit of service was unmatched. He told participants on the tragic moments that 11.1 The 10th Dr. Mathew Lukwiya Memorial Lecture culminated in his death following an Ebola outbreak in Northern The Dr. Mathew Lukwiya memorial lecture was delivered by Uganda. His bravery will always be a challenge to all health Hon Chris Baryomunsi. He described the late Mathew Lukwiya workers particularly in these times when the health sector is as a person who exhibited extra-ordinary performance in his faced by many challenges. He called on all medical workers to studies, personal life and career which culminated in his death remember their calling and be prepared to sacrifice just like the treating Ebola victims at Lacor Hospital. late Mathew Lukwiya. May his soul, rest in eternal peace.

Hon Dr. Christopher Baryomunsi delivering the 10th Dr. Dr. Juliet Bataringaya represented the WHO Country Mathew Lukwiya Memorial Lecture Representative at the memorial lecture.

11.2 Closing Speech by the Permanent Secretary Ministry He reported that an interface committee had already been of Health, Dr. Asuman Lukwago formed to work with the Ministry of Education to streamline the training of health workers.

In his closing remarks, Dr. Asuman Lukwago pointed out that Ugandan students need to be helped and guided to study courses that address the priority health needs of Ugandans. He noted that Uganda will not be developed through expertise only, but also needs ideological objectives to help strengthen attachment to the country. “Africa must build a critical mass of people not only driven by expertise but also ideological observation”, he emphasised.

Dr. Asuman Lukwago closing the conference

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ANNEX 1: Conference Organising Committee 5. Dr. Freddie Bwanga – Department of Medical Microbiology, MakCHS

6. Dr. Justine Bukenya - School of Public Health, MakCHS

7. Dr. Rhoda Wanyenze – School of Public Health, MakCHS Central Organizing Committee 7th ASC 2011 8. Mr. John Odda - Department of Pharmacology, MakCHS Chairperson: Dr. Freddie Bwanga – Department of Medical 9. Mr. Oyanga Benard - Department of Pharmacology, MakCHS Microbiology, MakCHS 10. Ms. Margaret Kaggwa - UNACOH Members:

1. Dr. Catherine Abbo – Department of Psychiatry, MakCHS Finance sub committee 2. Dr. Deo K. Sekimpi – UNACOH 1. Dr. Freddie Bwanga (Chairperson) – Department of Medical 3. Dr. Eziekiel Mupere– Department of Paediatrics, MakCHS Microbiology, MakCHS 4. Dr. Justine Bukenya - School of Public Health, MakCHS 2. Mr. Paul Apunyo – Office of the Academic Registrar MakCHS 5. Dr. Nazarius Mbona Tumwesigye - School of Public Health, 3. Mr. Paul Teefe - Bursar MakCHS MakCHS 4. Ms. Solomy Naluwuge – Secretary/Cashier 6. Dr. Rhoda Wanyenze – School of Public Health, MakCHS 5. Prof. Celestino Obua (Finance advisor) - Deputy Principal, 7. Mr. John Mukisa – UNACOH MakCHS 8. Mrs. Deborah Kasule – Uganda National Council for Science 6. Dr. Deo K. Sekimpi – UNACOH and Technology (UNCST)

9. Ms. Margaret Kaggwa - UNACOH Communications and Publicity sub committee 10. Ms. Noreen Muwanguzi (Chairperson) - Research 1. Dr. Deo K. Sekimpi (Chairperson) - UNACOH Coordination Office, MakCHS 2. Mr. Ash Luwambo - IT Specialist, Principal’s Office, MakCHS 11. Ms. Solomy Naluwuugge (Chairperson) - Research 3. Mr. Bob John – IT Specialist, Principal’s Office, MakCHS Coordination Office, MakCHS 4. Mr. Francis Mumbowa - Department of Medical

Microbiology, MakCHS Scientific sub committee 5. Mr. Sigiriya Hadson - UNACOH 1. Dr. Nazarius Mbona Tumwesigye - School of Public Health, 6. Mrs. Deborah Kasule – Uganda National Council for Science MakCHS and Technology (UNCST) 2. Dr. Catherine Abbo – Department of Psychiatry, MakCHS 7. Ms. Margaret Kaggwa - UNACOH 3. Dr. Damalie Nakanjako – Department of Internal Medicine, 8. Ms. Milly Nattimba (Co-Chair) – Communications Officer, MakCHS MakCHS 4. Dr. Eziekiel Mupere (Chairperson) – Department of

Paediatrics, MakCHS

Programs sub committee 1. Dr. Eziekiel Mupere (Chairperson) – Department of Paediatrics, MakCHS 2. Dr. Freddie Bwanga (Chairperson) – Department of Medical Microbiology, MakCHS 3. Dr. Rhoda Wanyenze – School of Public Health, MakCHS

4. Ms Milly Nattimba - Communications Officer, MakCHS 5. Ms. Margaret Kaggwa - UNACOH

Exhibition sub committee 1. Dr. Deo K. Sekimpi (Chairperson) - UNACOH 2. Mr. Francis Mumbowa - Department of Medical Microbiology, MakCHS 3. Ms. Khristine Namukose – Department of Medical Microbiology, MakCHS 4. Ms. Milly Nattimba – Communications Officer, MakCHS

Logistics/Welfare sub committee 1. Mr. Kenneth Mugisa - UNACOH

2. Mr. Michael Settimba - UNACOH 3. Ms. Noreen Muwanguzi (Chairperson) - Research

Coordination Office, MakCHS 4. Ms. Solomy Naluwuugge (Chairperson) - Research Coordination Office, MakCHS

Annex 2: Conference Sponsor Organizations 18. WHO – Dr. Mathew Lukwiya Lecture

1. Crane Survey Project MakSPH 2. Health Initiative for Private Sector (HIPS) 3. Infectious Diseases Institute (IDI) 4. MakCHS College of Health Sciences 5. Makerere University School of Public Health (MakSPH) 6. MBN Clinical Laboratories, 28 Nakasero Road 7. Medical Education for Equitable Services to All Ugandans 8. NORAD 9. Delegates’ Registration Fees 10. Rose B African Styles Ltd, Mabirizi Complex Kampala Road, Shop G42 11. Salin Construtori SPA 12. Sida 13. Systematic Reviews Project, MakSPH 14. Uganda Clays Ltd 15. Uganda National Council for Science and Technology (UNCST) 16. UNACOH - PHE Project 17. UNACOH Smoke-free workplaces Project