THR VE TRAINING HEALTH RESEARCHERS INTO VOCATIONAL EXCELLENCE IN EAST AFRICA NewsVol. 2 Issue 4 Sep. 2013

My one year experience Cambridge University Strengthens on an online Masters Links With African Institutions Program in Research Administration By Pauline Essah While in Uganda, the Cambridge By Harriet Nambooze group also took the opportunity t was great to be able to meet to link up with other research had for a long time desired to and interact with THRiVE units there. We visited THRiVE pursue postgraduate training researchers (both Africa- and partner UVRI to meet with Doctors in research administration IUK-based) and fellows face- Pontiano Kaleebu and Alison Elliot and management but such to-face during the 2013 AGM (plus a wide range of UVRI and Iopportunities had been very in Uganda. The University of MRC Uganda researchers from the rare. It was therefore a moment Cambridge was represented MRC Unit in Entebbe whom we by six delegates (Dr Jennifer unfortunately do not have enough of excitement when I received Barnes- Pro-Vice Chancellor for space to list here). We were very my admission into the two year International Strategy; Professor grateful for the warm reception we University of Central Florida (UCF) David Dunne- Director of the received there, and the opportunity Online Masters in Research Cambridge-Africa Programme; to discuss Cambridge’s current Administration (MRA). Little did I Professors James Wood and programmes (e.g. MUII and know what lay ahead of me I have Andrew Lever, Dr Pauline Essah THRiVE) and future engagements worked hard to keep up with the and Miss Jenny Mackay- all with UVRI and the MRC Unit. The reading, submit my assignments members of the Cambridge-Africa Cambridge delegation was given on time, while continuing with Committee). All delegates were a tour of the impressive facilities my day job and perform the daily excited to attend and contribute to at the Institute, and their clinics administrative functions, keep the various sessions, while also nearby. Professor Lever (who is a up with my hobbies as well as reinforcing Cambridge University’s Professor of Infectious Diseases) commitment to engaging with also gave a presentation titled maintaining contact with my family and friends. I must proudly say that African researchers. Ü page 2 I have been able to score highly on most fronts though this has come at the expense of few others. The MRA has taught me to manage my time, set priorities and appreciate the environment in which I live. Ü page 3 IN THIS ISSUE

THRiVE 2013 Annual General Pg.3 Meeting a Resounding Success Hypertension Risk Factors in Kibera Pg.4

Community prevention of Pg.5 postpartum hemorrhage Post-Doctoral Training Support Pg.7

Investigating Prevalence and Patient Pg.7 The Cambridge delegation visit Uganda Virus Research Institute Perspective of Schistosomiasis

uvri Uganda Virus Research Institute Ü page 1 Editorial Cambridge University Dear Reader,

THRiVE is well Strengthens Links With positioned to become major contributor in African Institutions enhancing research capacity in Africa with ‘HIV assembly and genomic during our visit (see photograph the view to impacting RNA encapsidation’ and had below). health improvements one-to-one discussions with in the region. THRiVE must take cognisance of major developments that provide the context for its future plans. The year 2015 is around the corner. We are in the race against time to achieve the Millenium Development Goals (MDGs) and Africa is the region showing the least progress towards the achievement of the MDGs. The UN Secretary- General’s High Level Panel of Eminent Persons on the post-2015 Development Agenda released its report on May 30, 2013. The Panel recommended that the “unfinished business of the MDGS cannot be swept aside and that the goals set 13 years ago are ripe for renewal and remodelling” to focus on sustainable development. In the same month of May the The Cambridge delegation visit Uganda Virus Research Institute Commission on the Future of Health in Africa some of the local HIV/AIDS had its first meeting in Accra Ghana. For four We are all back in the UK researchers during this visit. years now the Wellcome Trust has been funding now, and looking forward to a major research capacity building effort named hosting more THRiVE fellows the African Institutions Initiative (AII). In July this The Cambridge delegation in Cambridge over the next year the Trust announced its intent to provide a listening to a presentation by few months. In the time one year cost extension to the current five year Dr. Pontiano Kaleebu of UVRI being, we are very pleased to grants while the longer term plan and funding for The Cambridge team be supporting 16 academic the AII is being carefully decided upon. was also able to visit the research fellows and four All the above developments provide opportunity Infectious Disease Institute to critically reflect on the future direction for research management fellows and the Maternal Unit at THRiVE and its role in the new era of regional from Uganda (Makerere Mulago Hospital (thanks and global health development. What is our University) and Ghana to organisational support comparative advantage compared to the other (University of Ghana, Legon) to from our MUII colleagues research capacity building initiatives in the visit Cambridge for six months in Uganda). We were region? How do we through partnerships create each, between July 2013 synergies to add value to the above efforts? introduced to the Heads of and June 2014, sponsored There should be very porous boundaries these research/clinical units, by the CAPREx Programme. between networks in order to allow free sharing and were very privileged Two academic fellows from of ideas, innovations and creative experiences. to meet several of their Ghana have already arrived One of the urgent issues is how do we build exceptionally hard working in Cambridge to begin capacity for knowledge translation so that we and inspiring staff. We hope can maximally utilise the existing knowledge collaborating with Cambridge to maintain links long-term. An and bridge the know-do-gap? Initiatives like researchers and commencing unforgettable highlight for the THRiVE provide opportunity for Africans to their tailor-made training Cambridge team, though, was provide leadership in addressing global health programmes. We are expecting when we were presented with challenges that are of priority importance to more by December 2013! unexpected ‘Makerere’ gifts 10 the region. Finally, we have recently by the acting Deputy-Vice prepared (and are soon to Chancellor Professor Joseph launch) a new Cambridge- YT Mugisha (on behalf of Africa website (http://www. our CAPREx partners - a cambridge-africa.cam.ac.uk) Membership of the THRiVE Advisory Board new Programme which which incorporates all of the evolved out of the THRiVE 1. Prof. Wilfred Mbacham, Chair, Rest of Africa University of Cambridge’s Programme in Cambridge links with Africa, including 2. Prof. Hannah Akuffo, Outside Africa and is funded by the Carnegie the THRiVE Programme. We 3. Dr. JPR Ochieng’Odero, Other Consortia Corporation of New York will be publicizing our range 4. Prof. Jerome Kabakyenga, Uganda and the Isaac Newton Trust). of on-going Cambridge- 5. Prof. Florent Senyana, Rwanda The three Cambridge men Africa activities (and hence 6. Dr. Val Snewin, Wellcome Trust were very honoured to be the THRiVE Programme) 7. Prof. Dominic Makawiti, Kenya given Makerere University on this new website, across 8. Dr. Hassan Mshinda, Tanzania ties, which they proudly wore 9. Prof. Nelson K. Sewankambo, Director, THRiVE Cambridge and beyond….. 10. Dr. Saidi Kapiga, Deputy Director 2 Ü page 1 My one year experience on an online Masters Program in THRiVE 2013 Research Administration Annual General Meeting: . The funder did not delay in agreeing to the request from THRiVE for a ‘No-objection’ to a Resounding Success sponsor me for this course. a little more he 2013 THRiVE Annual General complicated for me. Meeting (AGM) was an absolute However, one year blast. Over 100 delegates traveled into the programme to Makerere University from Uganda, has taught me that TRwanda, Kenya, Tanzania, Cameroon, United no matter how full th your plate is, with Kingdom and Sweden. This was the 5 proper planning and anniversary of the THRiVE (Training Health focus, you can still Researchers into vocational Excellency) take on a little more. initiative, and the second AGM to be hosted by Makerere University. Opening the three day The MRA enables meeting, the Chancellor of Makerere University Harriet during one of her class sessions me to interact with – Professor George Mondo Kagonyera called strong network on researchers to prioritize research and An online program is doable of research administrators if one has easy access to tackle issues that are of great importance to who are ready to help out population needs. The opening ceremony was tuition fees, fast and efficient whenever i am are faced with instructors, peer-to-peer a problem. It provides one also attended by the University Secretary –Mr. support, fast and reliable with knowledge, skills, abilities David Kahundha Muhwezi. internet connectivity and and other characteristics that access to textbooks. The allow one to be in position to first three items came in a handle most of the delicate nicely knit package which did issues related to research not require any intervention. administration in the 21st The UCF instructors are century right from the pre- highly experienced in award stage to the post- handling online students, and award stage. As part of the are always available to offer requirements of the program help to whoever needs it.. students are required to post an assignment and also The courses offered in provide positive feedback to the program have all the any two classmates’ posts ingredients on which peer- each week. This provides one to-peer support hinges. with the opportunity to improve For internet connectivity one’s writing style and also I have to rely on our very critiquing other people’s work. own Makerere University I have been amazed by the server and of course way one is groomed into David Meya - a PhD Fellow discusses his progress with the very popular mobile developing a concept right THRiVE supervisors at the THRiVE 2013 AGM in Kampala. internet modems (dongles). from scratch to submission. Textbooks required for The MRA has indeed changed Given that it was now two to three years since the course can easily be my outlook to life. purchased from Amazon. the first THRiVE PhDs embarked on their com however the challenge I will forever be indebted to studies, there was a lot to share. Each PhD and of shipping to Africa my sponsors, the Wellcome post-doctoral fellow along with masters’ degree complicated the process. I Trust and the supportive students made brilliant presentations regarding have to rely on family and employers. There is something the research they were doing. Similarly doctoral colleagues from Makerere to celebrate when one’s fellows supported by another Wellcome Trust- University and the US and institution and funders support funded Makerere/UVRI Infection and Immunity largely my classmates to the growth and development (MUII) Research Training programme shared purchase books for me. of research administrators Adopting to the Blackboard the platform and showed amazing progress to advance professionally regarding their research work. What a rich Learning Management and academically. Many System (LMS) which has AGM it was and clearly there is outstanding programs support the research capacity building and knowledge since transitioned into the development and growth of Canvas LMS wasn’t a walk researchers while research creation in THRiVE and MUII. To add to the over either. The MRA is administrators are left behind. achievements, progress reports from concluded a fast-paced course with There is need to develop the and ongoing research funded through instructors and peers career path of such individuals THRiVE’s pump priming small grants and who are always on top of as a way to turn African the mini-sabbatical schemes, supplemented their game. My growing universities and research by administrative reports characterized this up and studying from an institutes into research page 5 environment where ‘Africa engines. I wish all THRiVE Ü Time’ rules made matters institutions would follow this path. THRIVE News Letter 3 The equipment that was bought using the grant money scale scientific evidence that will contribute in influencing and guide the development of Primary Health Care policy for control of hypertension in resource-limited settings.

The THRiVE Equipment Epidemiology and Grant The THRiVE Equipment grant Control of Risk Factors enabled us purchase Omron automatic blood pressure monitors, large and small for Hypertension among sizes of Omron blood pressure cuffs, Seca BMI calculators the Urban Poor in Kibera and Seca measuring tapes. All these equipment purchased Slum, Nairobi, Kenya are portable and allow for easy transportation from one household to another. The equipments also allow for Beatrice Olack, places them at a higher risk for measurement of blood pressure THRiVE PhD Fellow Non-Communicable Diseases like and other related risk factors hypertension. for hypertension that include Hypertension is one of the the Body Mass Index (BMI) and most important risk factors Tackling the problem of waist circumference. for cardiovascular (CVD) hypertension demands that morbidity and mortality. people are aware of their blood Currently all the equipment are Urbanization accompanied pressure status, risk factors being used for the collection of by changing lifestyles, has precipitating hypertension and take baseline information to establish contributed to rising prevalence necessary lifestyle modification the risk factors of hypertension of hypertension and other to slow down the rising trends of at the household level and cardiovascular risk factors. CVD mortality. It is anticipated shall be subsequently used In Kenya > 60% of the urban that results from our study for monitoring blood pressure, population reside in urban (Epidemiology and Control of Risk Body Mass Index, and waist slums. The urban poor have Factors for Hypertension among circumference at follow up the worst of both worlds; they the Urban Poor in Kibera Slum, visits. The instruments shall adopt less healthy lifestyles (e.g Nairobi, Kenya) will establish risk also be shared with the Tabitha sedentary lifestyles and diets factors for hypertension. Stage 1 clinic which is situated in Kibera high in saturated fat, salt and hypertensive patients will actively slums and used for taking vital sugar) and have poor access to engage in lifestyle modification to measurements of patients healthcare, partly related to their control hypertension. Ultimately, presenting at the clinic. poor purchasing ability which the study will generate larger

Equipment being used to collect data at household level

4 THRIVE News Letter

Hugh Reyburn and Rachel Manonge,

For the THRIVE Institutional Implementing Committee in KCMC Ü page 1 THRiVE 2013 Annual General Meeting a Resounding Success year’s August assembly. Each THRiVE fellow had an opportunity of presenting his or her work to THRiVE PhD committee members to assess progress – a process that further enriched the doctoral candidates’ work. “Perspectives from different committee assessors have helped me refine my ideas”, remarked one PhD fellow. A few months before the AGM, Wellcome Trust – the British charity that funds THRiVE made a decision to grant a one year extension to all consortia participating in the African Institutions Initiative. This AGM Participants at the THRiVE AGM pose for a group photo with accorded THRIVE partners the Chancellor Mondo Kagonyera unique opportunity to create consensus on what activities they intended to engage in during the one year extension. Commenting on the extension, the Trust officers at the meeting advised THRiVE partners to wisely exploit the one year extension to prepare for the upcoming African Institutions Initiative funding opportunity announcement. “We need to document our successes and learn from our failures”, remarked the THRiVE Director – Prof Nelson Sewankambo while stressing the need for THRiVE partners to prioritize proper reporting as part of our evaluation and learning. “This way”, he added, “we will have no trouble coming up with a winning proposal come next The THRiVE AGM involved a lot of strategic reviews and examination Wellcome Trust call”. of the consortium direction and achievements

Community prevention of postpartum hemorrhage using self- administered misoprostol: Role of village health workers in follow up

Dr. Sam Ononge, THRiVE PhD University. He mentors both The study is being carried out in Fellow the undergraduates and Mpigi District, about 36 km from postgraduate students. the capital city, Kampala. The Dr. Sam Ononge is lecturer in Dr. Ononge started this project study involves recruiting pregnant the Department of Obstetrics by asking; “How do we prevent women at the antenatal clinics, and Gynaecology Makerere excessive bleeding after child follow them at delivery and within University College of Health birth in mothers who do not the first week after delivery. This access skilled birth attendants”. includes doing a home visit on Sciences qualified with a rd th masters degree in Obstetrics He is exploring the role of a 3 to 5 day post partum. Dr and Gynaecology of Makerere self-administered misoprostol Ononge believes the wealth of University and a Masters in the prevention of excessive information he is gathering will Degree in Clinical epidemiology bleeding after child birth so that help partners in reproductive and Biostatistics of Makerere women’s lives can be saved. health design of programs that Ü page 6

THRIVE News Letter 5 Ü page 5 Community prevention of postpartum hemorrhage using self- administered misoprostol: Role of village health workers in follow up will meet the women’s needs Reproductive Health Division of October 2013. when it comes to scaling Ministry of Health Uganda, who During Dr. Ononge’s up prevention of excessive are interested in knowing more interaction with rural bleeding technologies. about the advanced antenatal communities, in particular In order to reduce loss to distribution of misoprostol for traditional birth attendants, follow up, Dr. Ononge keeps PPH prevention. He is in contact he was shown and told of on emphasizing to the with international research group more than 20 different herbal research assistants to get Gynuity Health Projects. Through remedies for the prevention the study participants’ correct the same research group, Dr of excessive bleeding after addresses and telephone Ononge has been nominated child birth. For his post- as well as the spouses’ to participate in PPH panel doctoral training he plans to telephone numbers. The discussion on prevention and investigate if any of these unforeseen challenge that treatment of excessive bleeding herbal remedies consumed by Dr. Ononge experienced after child birth in the African women have any contracting during the initial period of FIGO conference in Adis Ababa in effect on the uterus (Oxytocic study especially in follow effect). up was when the research assistants would reach the village and fail to locate the study participant. Some of the participants’ and spouses’ telephone numbers are not accessible for various reasons; and the local people in the area may not have heard of the names the research assistant is looking for. Dr Ononge had to be innovative on how to locate the study participants after delivery. He sought support from the village health teams (VHTs) who have records of almost all the pregnant women and they are very helpful and willing to guide the research assistant to participant’s homes. The Top and below; the researcher collecting data in the field VHTs now alert the research team when the mother delivers and they have helped the research assistants locate where the study participants reside. Dr. Ononge advises anyone planning a community study to engage VHTs; . They are a resource that needs to be utilised and Dr Ononge appreciates the support from THRiVE (financial, training and procurement). Through this PhD program, Dr. Ononge has learnt to network with others through local and international conferences. He has been doing joint work with Dr. Ononge during a follow up visit to one of the mothers

6 THRIVE News Letter Post-Doctoral Training Support Facili- Investigating Prevalence and tates my Contribution to Investigating Patient Perspective the Looming Problem of HIV Resistance of Schistosomiasis Prevention and to Antiretroviral Therapy Treatment in Kitgum and Wakiso Districts, Hakim Sendagire, THRiVE Post-Doc Fellow (2011-2013), Makerere University College of Health Sciences Uganda

Since 2004 there has been a transported to the laboratory under rapid rollout of antiretroviral ordinary conditions. I have had Grace Akello, MakCHS therapy (ART) providing treatment enriching experiences that I would for about 5 million people in like to share with you in this article. In March 2012, a THRiVE Pump Africa. Consequently, there Priming Grant was awarded to a were over 300,000 HIV infected A Little Background multidisciplinary team comprising individuals on ART in Uganda of a Senior Pediatrician, a by end of 2012. However, due My PhD thesis was on drug Psychiatrist, Microbiologist and to the uniquenesses of the HIV resistance of Plasmodium a Medical Anthropologist. The virus such as its high mutation falciparum strains in Uganda. This purpose of this grant was to rate and the need for lifelong PhD work was very useful to the investigate behaviour-related nation as it contributed to new challenges in control of bilharzia treatment, there is public health as identified by people at risk, concern about the potential for anti-malarial policy guidelines in 2006 when Uganda changed to including school-age children in rapid evolution and development Kitgum and Wakiso districts. Two of significant levels of HIV drug co-artem as first line therapy, from a combination of Chloroquine participating universities were resistance (HIVDR) in Uganda. Gulu University’s Department There is therefore an urgent and Sulfadoxine Pyrimethamine. of Mental Health and Makerere need to continuously monitor Shortly after words, I analyzed University’s College of Health and control the development of the molecular mechanisms of HIV Sciences. Schistosomiaisis is resistance. The WHO protocol resistance to anti-retroviral therapy both a biomedical and behaviour for monitoring HIVDR employs (ART) at the Infectious Diseases related problem. It affects mostly very expensive and cumbersome Institute (IDI) and published the children and people living in transportation of plasma samples work in 2012. So, I noted that high risk water bodies like Lake although ARTs have been widely Victoria and River Pager. Apart in liquid nitrogen. My post-doctoral from people at risk, stakeholders project is evaluating a cheaper available in rural settings for at least more than half a decade, including the District Health and simpler method of collecting Officers, the District Vector and storing dry blood samples evidence about the rate at which resistance occurs in the real field Control Officers, health workers, (DBS), blotted on filter paper, teachers, parents and officers dried at room temperature and Ü page 8 in the National Vector Control Division at the Ministry of Health were interviewed.

Findings suggest a high prevalence of Schistosomiasis in both Wakiso and Kitgum districts. This easily preventable disease affected mostly poor people who depended on infected water sources for their livelihood and recreation. Although there is adequate funding, we found challenges in the drug supply chain, and people at risk expressed dislike for the drug Praziquantel, sometimes renaming it ‘big chunks of cassava’ which they would rather not swallow due to its many side effect like diarrhea, Ü page 8 THRIVE News Letter 7 Hakim Sendagire (see arrow) in class 7 Ü page 7 DIVERSITY OF TABANIDAE IN Investigating the prevalence of THE LAKE VICTORIA BASIN IN Schistosomiasis and Patient perspectives UGANDA about the causes, prevention and treatment By Claire Mugasa, Makerere University College of Veterinary Medicine, Animal Resources and Bio- security

For this study, we set up and identification of Fly (F-) traps impregnated tabanids, and community with chemical attractant participatory approaches and geo-located around and science communication. the shores of Lake Victoria, Some of the samples specifically Wakiso district, collected have been used with the aim of capturing for teaching purposes and identifying the genera in Parasitology related and species of tabanids. In modules in the College addition, at selected sites, of Veterinary Medicine, flies were harvested every Animal Resources and Some of the school children 2 hours to give an estimate Bio-security (COVAB). At at risk on Bussi Island, and of the daily fly activity. The completion of the research, Inset; the tablets flies were identified and at least two publications dissected for physiological will be submitted; one dizziness, fainting. Taking aging of the females as focussing on farmer medicines also reduced fishermen’s productivity well as removal of the gut awareness and prevalence and regular administration for downstream laboratory of tabanids around Lake of the 6-monthly regimen analysis of the source of Victoria (Manuscript to people who were blood meal, to give an under preparation), and exposed to re-infections indication of the animals at the other describing the led to drug fatigue. greater risk of fly bite and blood meal source of possibly, the pathogens tabanids. This research Results from this they vector. is done in collaboration study were presented must be assessed with International Centre at an international through examining stool In order to investigate of Insect Physiology and conference for Medical and urine samples. The local farmers’ awareness Ecology (icipe), Kenya, with Anthropologists in Vienna, pediatrician was also Austria in November of the prevalence, health technical input from Wakiso interested in knowing impact of tabanids and District and Co-ordinating 2012. Another abstract the height and weight their control, focus group Office for Control of was accepted in an of school children in the discussions (FGDs) with international conference two districts. Although a Trypanosomiasis in Uganda on environmental health relatively small budget, farmers and local leaders (COCTU). Preliminary in Boston. In addition, we managed to do all were held in various findings from field survey a manuscript is being these assessments, parishes. have been used to win post- prepared for publishing in somehow. Interacting doctoral research funds a peer reviewed journal. with vector control Skills attained during the from The World Academy of The most remarkable officers was fascinating, process of implementing Sciences (TWAS). learning experiences as I could see resilient this study, include trapping of working in a people who are focused multidisciplinary team on doing what they include the realisation can with the little that each team member resources they have. wanted to make a The problem however, significant scientific seemed frustrating to all contribution to the study. stakeholders. Children, From the first discussions, teachers and fishermen the idea of investigating asked aloud: bilhazia only behaviour-related bamugema? Tukoye aspects of this illness agakkerenda! Meaning; was refuted. The is it possible to immunize microbiologist for instance against bilharzia viewed the illness as a instead? We are tired of purely worm-issue which the big tablets! A photo gallery showing the different activities that were undertaken during the study 8 THRIVE News Letter Post-Doctoral Training Support Facilitates my Contribution to Investigating the Looming Problem

of HIV Resistance to Antiretroviral Therapy Ü page 7 and health center settings been a THRiVE Post- mentioned that many have was not known and so was Doctoral fellow. Some of gone into management and it the wider HIV treatment the challenges I have met, was feared that some could policy implication for the turned out to be wonderful have left Africa again as part near future in Uganda and experiences. One thing I of the international brain drain, Africa. Currently, there are personally consider as a further crippling the already about 400 Ministry of Health major contribution of the fragile systems. I have used accredited facilities providing THRiVE post-doc to my this discussion to write a ART country-wide in line scientific career so far, has proposal to WHO to fund a with WHO guidelines. These been my ability to establish project aimed at identifying guidelines are not followed this collaboration and and documenting public routinely though, due to receive mentorship from health career opportunities inadequate resources. Prof. Pontiano Kaleebu and in East Africa, for PhD Viral load monitoring is the UVRI-MRC laboratory graduates and what could rarely done and long-term and research teams. This is entice physician scientists to virological data is therefore because, getting mentorship stay longer and have a career scarce. Consequently, ART during my previous work in Africa. is thought to be continued as a clinical scholar was I spent 3 months at the indefinitely in some persons very difficult. While as a London School of Hygiene with virologic failure, post doc, I was involved and Tropical Medicine providing a context for in the recruitment of study between Oct and Dec 2012, evolution of drug-resistant participants and training field working and doing courses viruses. As I did for malaria, staff. I have participated and in epidemiology. I spent time I joined the HIV field to help helped in competing for an with my mentors and had develop national guidelines NIH grant. I have helped chance to develop several on HIV management. my junior colleagues in the concepts and protocols that department of microbiology I am submitting for very So far, we have found to build their research skills. competitive grants. I feel I am that there is a significant At the 4th THRiVE AGM in a far better scientist than I emergence of primary HIV- was 2 years ago. 1 DR in Uganda after rapid June 2012. I was partially scaling up of ART. About relieved and energized to I thank so much the Wellcome 4.5% of the individuals hear other post-docs from Trust, the THRiVE consortium initiating ART already have all over East Africa raising and the secretariat, field resistance, raising concerns the same concerns I had; staff in the three research about the risk of early the dilemmas of African sites, Mbale, Nsambya and treatment failure in patients scientists who combine the Masaka, the Department of with primary HIV-1 DR. real problems of science Microbiology at MakCHS, the There is a need to explore with cultural issues that Ministry of Health, the MRC/ and identify drug exposure are inherently African. UVRI laboratory and support before initiating therapy Participants at icipe showed staff for all the support they and design interventions to growing concern about the have accorded me during prevent the transmission of plight of the physician and my post-doctoral training. HIV-1 drug resistance as a bio-medical scientists who I am really thankful to all way of preventing treatment complete their doctoral my mentors and sponsors failure and improving patient degrees, whether locally or namely; Prof Kaleebu outcome. abroad, and return to Africa Pontiano, Dr. Alison Grant, but quickly get frustrated Dr. Wilford Kirungi and The post doctoral by a multitude of factors Prof Moses Joloba for the experience that do not support career continued guidance. development in science I feel privileged to have and public health. It was

THRIVE News Letter 9 ALLEN KABAGENYI CHOSEN AS POPULATION REFERENCE BUREAU (PRB) 2013/14 POLICY COMMUNICATIONS FELLOW By Allen Kabagenyi, Makerere University programme. journals to which Makerere With the available data collected University has no full access. It is through THRiVE that my as part of my PhD programme, During my visit at the University dream of pursuing doctoral working with five other senior of Cambridge I had opportunity to studies and advancing my career researchers, I recently submitted access all journals through their is realised. As a THRiVE fellow a paper to BioMed Central- website, although access was I had an opportunity to present Reproductive Health. only limited to the period I was in the status of Uganda’s population the UK, which was brief. Though and harnessing the demographic I am also scheduled to present hectic, I mitigated this challenge dividend during a dialogue with a paper at the forthcoming by requesting for articles from my Members of Parliament on family International Population supervisor from the University planning, at the launch of the Conference organized by IUSSP- of Cambridge as well as from Family Health Research and International Union of the Scientific colleagues and friends attached to Development Centre-FHRDC Study of Population in Korea- other Universities. in Kasangati-Kampala. I was Busan, 2013. The paper to be After completing my PhD, I plan recently selected as a Population presented is “Perceived Partners’ to go ahead with a post-doc and Communications Fellow for Desire for More Children and follow up on the study population 2013/2014. The Population Modern Contraceptive Use among especially the men and carry out Communications Fellowship is a Married Women in Uganda” research to provide strategies of prestigious programme organized authored by me, Olivia Nankinga, engaging them in the promotion by Population Reference Bureau- Gideon Rutaremwa, James Ntozi and use of modern contraceptives. USA, that trains selected doctoral and Alice Reid. I was selected I wish to further explore the use students in dissemination of among the conference participants of traditional methods, their research findings to the global from Uganda to be supported for effectiveness and why people community. It is the THRiVE travel and some costs by UNFPA continue to use them. I plan to training workshops and skills country office. apply for research grants and gained that gave me an edge However, for my studies it has continue to inform policy through over other applicants and ensured been challenging to get published research. my successful admission to this papers from highly indexed

Latent tuberculosis infection among paramedical students in Uganda

By Isaac Okullo, MakCHS institutions. Technical input on data number of stakeholders, including The prevalence of latent TB collection was received from the the National TB Control Center, on infection among health workers in Makerere University-Case Western how to take it forward especially on Uganda has been found to be high; Reserve University collaboration the policy aspects. however, the magnitude of the on TB study. problem among students in health The study findings have also facilities who are equally at high Interesting study results have been been shared with the dental risk of nosocomial TB infection was generated and a draft research fraternity at the monthly scientific not known. We therefore set out to manuscript has been developed meetings, as well as disseminated carry out a study with the objective that will be soon be submitted to the nursing, dental and clinical of determining the proportion of to the BMC Infectious Diseases officer’s schools where data was paramedical students with latent Journal. The study indicates that collected from. The findings were TB infection in Mulago and Gulu up to 43% of the students are also presented at the Joint Annual teaching hospitals. at risk of developing TB. This Scientific Conference organized by information has been brought the College of Health Sciences in This project was jointly carried to the attention of the clinical September 2013. out by Makerere University instructors of the three training College of Health Sciences programmes so as to improve We are grateful to the THRiVE (MakCHS) and Gulu University infection control in the training consortium Makerere University Faculty of Medicine. It was an environment. for financially supporting this interdisciplinary undertaking study and we look forward to more involving the disciplines of There is need to carry out a bigger support in the future. dentistry, nursing, medicine study to confirm this worrying trend and public health from the two and we are in discussion with a

10 THRIVE News Letter STRENGTHENING THE VOICE IN THE FIGHT AGAINST HEPATITIS B IN UGANDA, THANKS TO THRIVE

Hospital and Lacor hospital, again strengthening collaboration between the two antenatal clinics, as well as the laboratories in the two hospitals. The institutions benefited from the partial payment/remuneration of the staff members involved closely in the study, as well as set up of some shelves that were used by the study. We are adding voice to the fight against Hepatitis B, a big problem in Uganda, but especially in Northern Uganda, hopefully towards provision of guidelines and treatment. Two abstracts have been submitted for presentation at Ugandan research fora, and we have written One of the nurses vaccinating a Hepatitis B exposed baby, at a manuscript for submission to a Lacor Hospital. peer reviewed journal. This should ultimately contribute to improvement in the care for Hepatitis B in Uganda. One study nurse lamented, “We had By Emmanuel Ochola, Pontius different skill sets. This had to many clients who tested positive and Bayo, Carolyn Oleo, Amos D. involve some level of personal I am worried about their health and Mwaka. knowledge, previous work children knowing that there is no together, or meetings in research clear treatment in Uganda”. The prevalence of Hepatitis related fora. Beyond the THRiVE B among pregnant mothers institutions, this grant gave us the The research has raised interesting was found to be 11.8% among opportunity to be more practical research questions that we are pregnant mothers attending in terms of research, and enrich planning to pursue. The most Antenatal clinics Gulu Regional the collaboration between Gulu important is, what happens to those Referral Hospital and Lacor University Faculty of Medicine who develop HBV after birth? We Hospital, and the potential to and its teaching hospitals at would like to know if a vaccine given transmit from mother to baby Lacor and Gulu. alone immediately after birth is as is high. This finding and many effective as immunoglobulins for others come from a study Most of us were first timers, and prevention of HBV transmission. supported by a THRiVE Pump the application process was both Priming grant. The researchers a challenge and an avenue for Some of the challenges met involved were Bayo Pontius, learning. Putting up a concept, included limited funding to support a Gynaecologist from Lacor and soon a proposal, within strict more frequent meeting of the study Hospital and Gulu University, time limits helped us to solidify team, as well as inability to import Emmanuel Ochola, Clinical our collaboration. We found Immunoglobulins for the babies born Epidemiologist from Lacor the THRIVE selection / review to HBV positive mothers. We had to Hospital, Carolyn Oleo, teaching process both critical and friendly. give them HBV vaccines immediately Assistant (now Postgraduate Weaknesses in our proposal after birth. OBSGYN student) from Gulu were highlighted and we had to University, and Mwaka Amos modify our protocol in order to We are grateful to THRiVE for the Deo, a Physician from Makerere fit the award requirements. The pump priming grant, which gave University. investigators have since applied us the opportunity for learning and for a few other grants, winning contributing to research, which Our experience through the at least one. “Working on this to us has been a stepping stone, process has been interesting… application has for me been a to improve both partnerships and from the application to the stepping stone to try even more research, not only in the THRiVE manuscript written thus far. challenging and bigger grants”, institutions, but even beyond. We First, we had to get a team. said Dr. Bayo Pontius, the recommend that THRiVE’s scope Forming this team had to involve Principal Investigator. is widened, budget increased, and people with related research more active follow up is made of the interests, but across different During the study, we had to study teams. institutions, and preferably with work with clinic teams from Gulu THRIVE News Letter 11 Mosquito Study Leads to Further Research and Collaboratives

By L. Nabyonga, S. Nalwanga prospective collaborative efforts blocking technology (advanced and F. Kironde have been initiated. Prof experimental Anopheles G. Christophides of Imperial gambiae rearing, infection with Lydia Nabyonga received College London (ICL) visited P. falciparum and genotyping). a THRiVE award to study Makerere University recently Dr Ndagire will transfer the insecticide susceptibility, and extension of the work technologies to colleagues knockdown resistance and in this THRiVE project was back at Makerere University. molecular form identification discussed. The visit of Lydia An insectary for transmission of Anopheles gambiae Nabyonga to the meeting in blocking work is being mosquitoes from Iganga Greece was partly supported constructed by the Malaria and Gulu. This work aimed through the TRANSMALBLOC Program at IHDSS and a grant at generating preliminary collaboration. Higher training proposal is being written to information on vector of Lydia at PhD level with support these collaborations. mosquitoes in Iganga Health thesis research in transmission Demographic Site (IHDSS). blocking immunity is proposed. The first manuscript out of this From February to June 2013, A member of the malaria sub- work is in preparation and will Lydia and her team collected program (Dr. Ndagire), working be submitted for review as soon mosquitoes (n = 1500) from with Lydia, visited at ICL for one as it is ready. Iganga, undertook genotyping month to learn transmission work and carried out survival experiments with insecticides. They found notable resistance to insecticides: DDT (25% resistant), and acyhalothrin Genotypic and Phenotypic (11% resistant). HIV Drug Resistance Capacity This work is a collaboration between MakCHS (Lydia Building in East Africa: Benefits Nabyonga and Fred Kironde) and Gulu University (Joseph from Pump Priming Grant Okello-Onen). A few presentations are By Chris Parry, MRC/UVRI produce and how to interpret phylogenetic trees, including already being made out of this th th th From the 30 April to the determining statistical support work and July 15 -19 2013, th Lydia presented findings in 11 May 2012 two scientists using bootstrap analysis. The to Kolymbari, Greece at the from NIMR Mwanza (Mr bio-informatics training was EMBO conference on Molecular Eric Lyimo and Mr Juma very successful and as a result and Population Biology of Mugambo) received practical HIV sequences generated in Mosquitoes and Other Disease training in HIV drug resistance Mwanza are being reviewed Vectors: From Basic Vector genotyping including RNA and analysed for potential Biology Research to Disease extraction, nested RT- publication. Control. In the same meeting, PCR, DNA sequencing Nabyonga attended a grant reactions and running on We have also carried out initial writing session. the sequencer. They also HIV phenotypic drug resistance were trained in sequence experiments. Our preliminary Contributions to bigger analysis, base calling, contig results show that some strains assembly and producing of HIV from patients in Uganda funding a good quality consensus that have no protease inhibitor The Malaria Sub-program sequence that can be used drug resistance mutations are at the Makerere University in downstream applications. less susceptible to protease College of Health Sciences Methods of determining HIV inhibitors than the standard (MakCHS) to which the drug resistance mutations reference strains used when Principal Investigator (PI) is were shown. While the PCR developing the drugs. Thus affiliated, collaborates with a reactions were running we more drug is required to inhibit group of molecular entomology also arranged training in the the replication of the Ugandan researchers in Europe under principles of phylogenetic strains to the same extent. the TRANSMALBLOC project. analysis, how to build a multiple Work on this is continuing. Through this interaction, several sequence alignment, how to

12 THRIVE News Letter THRiVE Seedling Sprouts from Gulu University Dr. Carolyne Oleo, Resident in Obstetrics and Gynaecology, Makerere University Education remains one of the world’s greatest investments. It forms the basis for quality health care, economic growth and development, guiding policy and decision-making. Education does not decay; it is modified and carried on from generation to generation. Training Health Researchers into Vocational Excellence in East Africa (THRiVE) has given young upcoming Ugandan researchers an opportunity to be mentored by committed teams of scientific advisors to become internationally competitive and self-sustaining scientific leaders, “seeding a regional research community with the critical mass to address Africa’s health priorities”; hence lifting the face of Africa through education. I am a resident, in Obstetrics and Gynaecology, at the College of Health Sciences, Makerere University, currently in my second year. I am honoured to be a beneficiary of THRiVE funding support. I got to know about THRiVE while working in Dr. Carolyne Oleo attending to a pregnant mother in Mulago Gulu University, as a teaching Hospital assistant, in the department of Obstetrics and Gynaecology. Pump priming grant. aspiring young researchers in the country. Perhaps arrangements As a beneficiary of this support, 3. I have been empowered I have had several privileges: - for alternative sources of funding with knowledge and skills to should be explored should the 1. I have been mentored, develop my own research present source of funding end. guided and inspired ideas and profile. I would sincerely like to thank by some of the best 4. The research that I am doing researchers in the THRiVE for their effort in grooming for my master’s dissertation professional researchers in country, both in Gulu is being funded by THRiVE. University and Makerere this country. I love my country, University. Uganda, and it has always been My dream is to be a part of a body my vision to see and be part of the of competent African professionals, process of Uganda evolve from 2. I am part of a research academics and researchers who team that carried out the a third world developing country “will take the lead in scientific to a first world country. THRiVE study titled, “Hepatitis research in Africa as well as mentor B virus infection among you have equipped us, and given and guide other upcoming young us the tools, the ball is in our pregnant women in researchers”. Gulu-Northern Uganda: hands as young researchers to use every opportunity, exercise Prevalence, Infectivity, It is my hope that the project will integrity, and work dedicatedly to and associated factors” be around much longer to provide see that vision is realized in our a study that THRiVE these wonderful opportunities to all supported through a generation.

THRIVE News Letter 13 How the THRiVE Post-doctoral Grant Changed my Mind about Working outside Uganda Kennedy Amone-P’Olak, Gulu was on and offers for attractive University positions from Southern Africa interview in London. Earlier in were trickling in. One day, as March 2012, I had submitted a Upon completing my PhD in 2009 I was coming to terms with 200 word synopsis following a call at the University of Groningen deciding where to go next, a for application for the Intermediate in the Netherlands, I wondered friend sent me an advert for Research Fellowship. I was where the wind would blow me postdoctoral research fellowship. subsequently invited to submit a full next. Uganda was last on my Armed with a postdoctoral application in May. In September list of possible destinations until research fellowship tenable in 2012, I was contacted to spruce my wife exerted more pressure Uganda and a break or two in up my application in areas found on me to get serious and head Cambridge, I declined all the juicy wanting and in December 2012; I home or else she would leave offers from down south. Indeed, I was invited for an interview at the without me.. As they say, the rest was beginning to thrive. Wellcome Trust offices in London. is history. We left the Netherlands I had to go to Cambridge a week and headed home to Uganda. Beginning with a research before the interview to prepare. Little did we know what awaited methods training in Mwanza, I had mock interviews with Prof. us in Uganda! From the airport to Tanzania in February 2011 to Peter Jones, my mentor and Kampala, courtesy of friends and the current position as a Visiting head of Psychiatry Department, relatives, we were welcomed by a Scholar at the University of Dr Richard Meiser-Stedman, blackout. My son had never had Bergen, Norway, the journey and Prof. Tim Croudace of the this experience in his life. “Uganda has been fruitful and iconic. University of York. Dr Pauline is full of darkness, Daddy”, he Within the two years, I was at the Essah arranged for a meeting with commented. At Gulu University, University of Cambridge a record Prof. David Dunne. I must say, I I was getting less than one sixth four times! I followed statistical drank deep from Prof. Dunne’s of what I was earning as a junior courses, made presentations experience. Although I was not researcher while pursuing my PhD! about my research, and attended successful in getting the grant, Infrastructure for any meaningful several lectures, workshops, and the feedback I received was very training, leave alone research, weekly scientific seminars with enlightening and I learnt a lot from was absent! Most colleagues only different research groups within it and my next grant application will talked about payments for extra- the departments of Psychiatry not be wobbly; it will thrive. workloads and the University did and Psychology. I enjoyed the not have any funding for research very academic atmosphere at The opportunity THRiVE gave me, or conferences! Welcome to Gulu Cambridge. To date, I have five my association with the University University! Welcome home, I said articles submitted for publication, of Cambridge, the network I built inwardly a letter published and the Cohort as a result, has not only made me Profile of my study participants thrive but also given me confidence Coming from the University of in press. and drive to pursue research with Groningen, where the infrastructure a renewed vigour. I am currently a for research and postgraduate My fourth and final visit to Visiting Scholar at the University of studies was enormous, one Cambridge was in preparation Bergen where I co-supervise two needed a big heart to continue at for the Intermediate Research PhD students in the area of mental Gulu University. Soon, the search Fellowship grant application health. My career is thriving!

NANODROP SETS NEW ERA AT NIMR MWANZA TANZANIA

By Humphrey D. Mazigo, PhD NanoDrop 2000c has shown us THRiVE-Wellcome Trust fellow that they contain what we want, this has assisted us to reduce Finally at NIMR, Mwanza, we costs and time compared to are able to measure DNA and previous experience, when we RNA quantities in the samples used to do it blindly on the PCR”. targeted for molecular analysis. With Dr Alphaxard Manjurano The arrival of the NanoDrop (specializing in molecular 2000c has opened a new way genetics of infectious diseases) of thinking as far as molecular joining the NIMR Mwanza, we studies are concerned. As Eric hope that, the machine will add its Lyimo (a molecular biologist at value in his research studies and NIMR) admits “We are now able other molecular and immunology to analyse DNA and RNA particles studies in the pipeline. from only samples which the

NanoDrop 2000c 14 THRIVE News Letter Epidemiology of Childhood Severe Pneumonia in Mwanza, Tanzania

By George PrayGod we collect stool for helminth co-infections and co-morbidity on health in examination. order to develop and test interventions that (National Institute for Medical might help address multiple health problems Research (NIMR)), Estee Torok This work is unique and in this population. (University of Cambridge and important to NIMR Mwanza and Jeremiah Kidola (NIMR) pediatric population in Mwanza Progress of the study: We are excited to Pneumonia is a major cause in at least three ways. First, it report that after long ethics and logistics is helping in building scientific delays, the study started recruitment on of child mortality in Tanzania. th Although, the availability of and laboratory capacity in 27 May 2013. To date we have recruited vaccines for Streptococcus carrying out research in the 20 children and are hoping to complete pneumoniae and Haemophilus field of respiratory medicine recruitment and report to THRiVE in the influenzae, which are the two and pediatrics at NIMR. Already next 4 months. main causes of pneumonia, two lab staff involved in this has boosted the fight against study have been locally re- pneumonia, these may help trained on isolation of bacterial to reduce only about 50% of and helminth infections from morbidity and mortality since samples collected from young there are no vaccines for children. Plans are ongoing other causes of pneumonia to further train these staff on like Staphylococcus aureus, isolation of respiratory viral Klebsiella pneumoniae pathogens using PCR-based and viruses. Thus, case techniques when more funds management will remain are available. Second, the lab an important strategy for results from samples collected preventing prolonged-morbidity are immediately sent back to and mortality which is mainly doctors managing recruited children and therefore unlike The study technician (Crispin Mukerebe) doing culture for due to severe pneumonia. different media for study samples at NIMR Lab Hence the need to be aware other studies, this study is of factors contributing to directly and immediately development of severe contributing to improving the pneumonia, and to poor care of young children with treatment outcomes among pneumonia in Mwanza, Third, children aged below five part of the data which is being years. We are conducting generated is on the interactions a case-control study among of respiratory infections with 150 patients with severe HIV, malnutrition and helminths pneumonia, non-severe among underfives in this setting. pneumonia and controls to With these data we are planning assess risk factors for severe to develop applications to further explore the role of childhood pneumonia and unfavourable The study technician (Crispin Mukerebe) doing malaria treatment outcomes among microscopy for study samples at NIMR Lab under-fives. Demography, socio-economic status, clinical symptoms and signs, treatment history, vaccination history and treatment progress and outcome are collected by interviewing the caretaker and by retrieving information from participant’s case files and postnatal clinic card. When the child is recruited we do anthropometric measurements and collect nasopharyngeal swabs for isolation of bacterial and viral pathogens. In addition, The severe pneumonia study team convening for a weekly study progress meeting at the NIMR we collect blood samples for lab mini conference room (from right: Dr George PrayGod (study PI), Crispin Mukerebe culture and drug susceptibility (technician), Dr Joyce Kilatu (study clinician), Sr Uyanjo Nkumbi (study nurse) and Emanuel testing and HIV serology, and Mfuta (laboratory assistant)) THRIVE News Letter 15 Collaboration in Capacity Building for Qualitative Data Collection Methods

Elialilia S. Okello, MakCHS using qualitative methods Second visit was made I was awarded a Mini- of data collection and in July 2013. During this Sabbatical grant by the THRiVE analysis visit, I provided support in Educational and Small Grants 3. identify core staff at qualitative analysis to MPH Committee (ESCG) on 30th KCMU that initiate students who had qualitative October 2012. The General discussion for future components in their MPH objective was to initiate research and training dissertations. KCMU College and foster collaboration in collaborations also requested me to be part of the facilitators’ team in a capacity building in the use I made the first visit in March manuscript writing workshop of qualitative methods of 2013 from 10th to 19th and which took place on 15-19 data collection and analysis participated in three main July 2013. I will also sit with for postgraduate students activities: at KCMU and Makerere my collaborators at KCMU i. Facilitated a one- week- University College of Health College to explore possibilities qualitative course in Sciences through training and of funding to sustain the collaboration with facilitators mentorship program. With capacity building activities from KCMU College, and this grant, I expected to make between the two institutions. University of Roskilde three short visits (March, June The third and final visit in Denmark and others. and September) to KCMU to was expected to happen Participated in one-on-one participate in; in September 2013. This mentorship activities for 6 visit aimed at among other 1. qualitative methods post-graduate students (1 things, planning for future course which was PhD student, two potential collaboration including writing offered in March 2013 PhD students and 3 MPH and submitting joint funding 2. mentoring postgraduate students). students interested in applications.

My Experience of and Benefits from THRiVE Funding

By Stella Kepha, MakCHS among school children; it’s health and education officials) largely a field based study with a to the parents. I have had A PhD undertaking is the laboratory component. Setting opportunities to give talks hallmark of any aspiring up a clinical trial is not an easy in local leader’s meetings, scientist; it gives one a or straight forward process, but churches and school meetings. ‘licence’ to do science; an it is very rewarding and with it Working and talking to a opportunity that THRiVE has comes numerous opportunities range of people from diverse accorded me. My biggest to develop new skills. During the cultures and backgrounds has interest was on the PhD proposal development I benefited boosted my confidence, and training process rather than from my supervisor’s scientific improved my public speaking the certificate; over the years network who critiqued my and presentation skills. I have I have learnt that some proposal and pointed out ideas organized and conducted skills are learnt through which helped seal loopholes and seminars with both head mentorship as opposed to make the study design better. teachers of the study schools lectures in a class room. and field workers (recruited This PhD process has been Along the way, I am learning what to carry out community a learning journey for me; I it takes to be an accomplished mobilization and consenting). In was previously a laboratory researcher and effective addition, my study is co-funded based scientist with no field communicator; both in writing and by the EU-IDEA consortium; experience. However, this speech. One of the key activities I bear the responsibility of project has plunged me into that I have been involved in is ensuring that both the THRiVE a new experience in science. community mobilization starting and IDEA financial statements My research topic addresses from the community gate keepers of the disbursed funds are up a public health question (local administrative officials, to date. Finally, conducting

16 THRIVE News Letter My Experience of and Benefits from THRiVE Funding

the study has given me that they can gain experiential and find the children are out competencies in organizing, training in conducting field studies. for another activity, which planning, negotiating and leads to delays. managing people; skills Some of the challenges I have important for an independent faced include, being relatively So far, I have selected 30 researcher that I am aspiring young and supervising older schools in Bumula district and to be. predominantly male technicians, conducted school meetings which I overcame by being where I enrolled 8000 I work in a very rural district in assertive, providing consistent children. Then I screened Kenya, with high (30%) school leadership with clearly defined 7100 children as per our dropout rates especially goals, identifying people’s inclusion criteria with the main among the girls. I have strengths and drawing from interest being infection with informal talks with the children their diverse personalities to any of the soil transmitted in my study schools to build concession. Secondly, worms. I am still doing data encourage them to complete since the study is school based, entry. school despite the challenges I work within the school term they face. In addition, I have dates and activities. To ensure After completing my PhD also organized mentorship seamless flow of activities without training I plan to undertake session at a local high school inconveniences, I work together post-doctoral studies in spatial with a focus on science and with head-teachers to draw a modeling and it’s relation to research. Recently I hosted schedule of activities at every immune- epidemiology. two newly registered PhD beginning of term. However, students at my study site so sometimes we may get to a school

THRiVE Mini_sabbatical Grant; a Welcome Support for that Extra Need

Joel Francis, NIMR review with the guidance of the the review and some other supervisors. PhD training requirements. In Working as a researcher in addition, the systematic review the developing world is very The review provided very useful and meta-analysis skills are challenging particularly due information for the on-going work important in my career and I will to inadequate funding from to describe the epidemiology transfer the knowledge gained governments. The creation of alcohol use among young to interested colleagues at our of North-South partnerships people in northern Tanzania. It research centre through training therefore, is an attempt to also emphasized the need to and hands-on support. address this anomaly. validate alcohol-screening tools/ instruments for Eastern Africa I wish to encourage the I am a beneficiary of the settings. The London School of donors to continue supporting THRiVE mini-sabbatical Hygiene and Tropical Medicine has these initiatives for they grants; this fund facilitated my a very stimulating research and help researchers/students in travel and accommodation academic environment; during my resource-limited settings to in London for three months. stay there I learnt a lot from fellow further their careers through During my stay there, I met students and faculty, through one- networking and access to with my PhD supervisors, on-one meetings and seminars state-of-the-art facilities in the which helped in shaping my in various departments. These developed world. PhD ideas. I immediately arrangements made it possible started work on a systematic for me to successfully complete

THRIVE News Letter 17 Pharmacoepidemiologic Assessment of Medication Errors and Adverse Drug Reactions among Inpatients in Uganda

By Ronald Kiguba, MakCHS A total of 1,345 out of a targeted draft the first manuscript from Since Feb 2011, I have been 1,500 healthcare professionals my work receiving grant support from were interviewed for this study. • Successfully applied for the THRiVE consortium One in 7 had not reported any USD 10,000 from the African for my PhD studies. My suspected adverse drug reactions Doctoral Dissertation Research research project is entitled (ADRs) in the previous 12 months Fellowships (ADDRF). This “Pharmacoepidemiologic while healthcare professionals grant offered additional training Assessment of Medication in private-for-profit health in Research Methodology in Errors and Adverse Drug facilities were less likely to report Nairobi in 20-24 May 2013 Reactions among Inpatients in suspected ADRs when compared and will also cover additional Uganda”. It is divided into 3 sub- to those in public health facilities. equipment (small scanner & studies; understanding the current This may be attributed to the mobile phone) and research state of pharmacovigilance in the current emphasis of the National costs previously not covered by country, understanding the risks Pharmacovigilance Centre on THRiVE of medication errors and adverse training of health workers in public drug reactions among inpatients, health facilities. • I received a THRiVE and assessing the reliability of Data collection for sub-studies 2 & Equipment grant worth GBP tools used to determine causality 3 commenced in June 2013 and is 1,000. I obtained a Desktop of adverse drug reactions. expected to take up to 6 months. computer and STATA software Makerere University granted which have improved efficiency me full registration as a PhD Over the past 12 months, I in data entry, management & student on 12th April 2012. I have applied for several small analysis have since commenced data grants, attended workshops, I intend to engage intensively collection for sub-study 1 which and registered varying levels of in grants writing and take involved interviewing of healthcare success; up postdoctoral studies in professionals across the country • Participated in a MESAU Pharmacoepidemiology and about the pharmacovigilance Scientific Paper writing Pharmacoeconomics. system in Uganda. workshop and managed to

However, I have encountered several challenges along the way including the following: THRiVE Award Offer Letter: Sub-study 1 data collection was expected to last a maximum of 3 the Perfect Antidote to my months but we eventually needed 9 months due to a number of Christmas Doldrums bottlenecks including; • delay by health facilities to grant the necessary By A.D Mwaka, MakCHS pint of blood on a drip stand by permission to access their the patient’s bed. There was an employees I clearly remember when a senior old drip line with blood from the • the ever-busy healthcare colleague with a very sick sister on patient’s clogged wound on the professionals in my ward in Mulago Hospital met me same drip stand. The old drip line understaffed health at about 7.15pm on 20th December unwound itself all of a sudden and facilities who were usually 2010 as I was preparing to head lashed out – releasing the blood difficult to recruit into the to Kitgum to join my family for onto my face and direct into my study coupled with the Christmas. I had to change course eyes too. Thanks to the genesis task of convincing them to and go with her to the ward because of the post exposure prophylaxis return filled questionnaires the intern doctors had failed to (PEP) which anyway worked quite • two unscrupulous research secure a functional intravenous (IV) well, despite the hallucinations assistants selected to site for blood transfusion, IV fluids from efaverenz. collect upcountry data and IV quinine. The patient had provided fake data/ severe anaemia, congestive heart While I struggled with the PEP, questionnaires but close failure and severe P. Falciparum painfully missing out on my monitoring of the data malaria. After twenty minutes favourite Christmas altar wine (red collection process ensured of search, I found an access; wine) sharing with the family this connected the pint of blood very time round, I checked my email on that we were able to catch th them and weed them out of quickly and ensured it was flowing 24 December 2010, and what did our research team smoothly. I moved on to hang the I find? A congratulatory message Ü page 19 18 THRIVE News Letter pageÜ 18 THRiVE Award Offer Letter pulls me out of a bad Christmas Experience and letter of award for a full THRIVE under the Carnegie Corporation My PhD project is to delineate the PhD Scholarship! That letter, dated of New York and from the HIV factors associated with patient- 22nd December 2010 completely Research Trust, UK, during 2012; related and socio-cultural barriers to transformed my life. Since the these grants supplemented my data early health seeking for symptoms THRIVE award, I have successfully collection and living costs in the UK of cervical cancer in low income managed my time and made great respectively. I completed two thirds countries. Upon completing my progress. The contributions of my of my data analysis and drafted three PhD project, and having clearly supervisors, doctoral committee manuscripts during my three and half documented the health seeking members and Cambridge mentors months in Cambridge. This was a barriers, I will seek a Post-doc are invaluable to my progress and great achievement. position during which time I will transformation. design and establish randomized I also made presentations of my community trials to test targeted th I undertook several essential short research work at the 6 International interventions to deal with the barriers courses both at Makerere University Conference on Cancer Awareness identified. and Cambridge; these courses have and Primary Care Research shaped my research orientations and International (CaPRI) held at I will seek to prevent disease th enriched my skill set. The qualitative Cambridge University from 14 to occurrences, late presentations th research courses taken at Makerere 16 April 2013. and complications. Patients with University and the selected courses late stage cervical cancer often in medical and social anthropology The major challenge faced has been present with severe anaemia; during my visit to Cambridge are the slow recruitment rate of patients cervical cancer is HIV-associated/ worth singling out as they filled a occasioned by the departure of one defining malignancy; encouraging major knowledge gap. of the resident gynaecologists which early health seeking and early stage resulted in delayed confirmation diagnosis when anaemia has not set I also obtained small grants from of cancer diagnoses. However, in might save another person. Makerere University’s Directorate corrective measures are being of Research and Graduate Training undertaken and the recruitment rate will hopefully improve.

THE THRIVE SUPPLEMENTARY GRANT: A STITCH IN TIME By Harriet Rachel Kagoya, MakCHS an MBA graduate with extensive or the likelihood of abandoning In April 2012, THRiVE offered me work experience in public health the course. The flights between a supplementary grant worth 2,000 and development work. I had a Windhoek and Entebbe, plus the GBP for my MPH research titled passion to better understand health tuition fees exhausted the family’s seeking behavior and public health “Awareness, responsiveness and financial reserves and dimmed my issues, and why they seemed to practice of patients` rights at public hopes especially as research drew persist in communities. This partially health facilities in Uganda: a case nearer. However, my commitment motivated me to apply for the MPH of Mulago Hospital”. The funds to the programme was galvanised by covered part of the data collection (DE) program at Makerere University the THRiVE research grant. costs and publication in an open School of Public Health in 2009. access peer reviewed journal; As a non-health sciences student, Today, I can look back and say ‘It The African Journal of Primary admission to the course meant was a dream come true’; I was able Health Care and Family Medicine more hard work to learn and apply to complete my MPH in the stipulated (PHCFM). This support was a great health sciences concepts. I was yet time and made a maiden publication boost to the timely completion to encounter more challenges in with THRiVE support. I look forward of my MPH research and getting completing the programme. to extensive dissemination of the published. findings and strategies identified Halfway through the programme for creating awareness, improving I am Harriet Rachel Kagoya; in 2011, my family temporarily responsiveness and practice originally a teacher by profession, relocated to Namibia for work, of patients’ rights in resource implying higher study related costs constrained Uganda.

THRIVE News Letter 19 Using information communication technology to enhance Higher Degree Supervision By Dickson Muyomba, THRiVE IT Officer

Supervisor - student interaction is supervisor in supervisor – student interaction key to a successful and rewarding form of chats, internal mail and how or what networks are higher education experience, and system and forum that can be sharing as part of their capacity helping new scholars become public or private. It allows fellows building efforts. independent researchers. Students develop an online personal The systems allows authorised stay in contact with the supervisors development plan (PDP) in which access to and sharing of content with during their academic career and they set their goals, objectives, other capacity building programs some even become life-long friends specify achievements and set such as the Malaria Capacity or collaborators. Having adopted targets. With the Learning Zone Development Consortium (MCDC) the joint supervision model where embedded into it, fellows can hence building and strengthening each PhD fellow is required to create/download and share collaboration between research have at least two supervisors, learning content in form of text or networks in Africa. one from the Northern institution videos. The alert function allows fellows and supervisors receive and the other from the African This platform can be customized timely notification on any ongoing institution, THRiVE has created an to individual needs making it activity within the platform. A online supervision platform (http:// easily adaptable by any academic PDP administrator is assigned the community.thrive.or.ug) to enhance and research institution. It is our role of overseeing the student/ the student - supervisor interaction hope and desire that with time supervisor relationship to ensure without being affected by the many African universities will that the two parties are actually geographical distance and the time adopt this online supervision in contact. This platform will difference barriers. The platform has model to supplement their existing facilitate the evaluation of been designed with collaborative approaches. functions between fellow and the frequency and content of

20 THRIVE News Letter