Makerere University College Research Articles

Editorial introductions

Editorial introductions

Knowledge about the research and ethics committee at Makerere University, Kampala.

All research involving human participants should be reviewed by a competent and independent institutional research and ethics committee. Research conducted at Makerere University College of Health Sciences should be subjected to a rigorous review process by the ethics committee in order to protect human participants' interests, rights and welfare. To evaluate researchers' knowledge about the functions and ethical review process of the College of Health Sciences research and ethics committee. A cross sectional study. 135 researchers consented to participate in the study, but 70 questionnaires were answered giving a 52% response. Age ranged between 30 to 61 years, majority of participants 30-39 years. Most of the respondents do agree that the REC functions include Protocol review 86%, protection of research participants 84.3%, and monitoring of ongoing research. During ethical review, the RECpays special attention to scientific design [79.7%] and ethical issues [75.3%], but less to the budget and literature review. More than 97% of the respondents believe that the REC is either average or very good, while 2.8% rank it below average. Respondents knew the major functions of the committee including protection of the rights and welfare of research participants, protocol review and monitoring of on going research, and the elements of protocol review that are given more attention include ;scientific design and ethical issues. Overall performance of the REC was ranked as average by respondents. The committee should limit delays in approval and effectively handle all functions of the committee.

Doctoral training in Uganda: evaluation of mentoring best practices at Makerere university college of health sciences

BackgroundGood mentoring is a key variable for determining success in completing a doctoral program. We identified prevailing mentoring practices among doctoral students and their mentors, identified common challenges facing doctoral training, and proposed some solutions to enhance the quality of the doctoral training experience for both candidates and mentors at Makerere University College of Health Sciences (MakCHS).MethodsThis cross-sectional qualitative evaluation was part of the monitoring and evaluation program for doctoral training. All doctoral students and their mentors were invited for a half-day workshop through the MakCHS mailing list. Prevailing doctoral supervision and mentoring guidelines were summarised in a one-hour presentation. Participants were split into two homogenous students’ (mentees’) and mentors’ groups to discuss specific issues using a focus group discussion (FGD) guide, that highlighted four main themes in regard to the doctoral training experience; what was going well, what was not going well, proposed solutions to current challenges and perceived high priority areas for improvement. The two groups came together again and the note-takers from each group presented their data and discussions were recorded by a note-taker.ResultsTwelve out of 36 invited mentors (33%) and 22 out of 40 invited mentees (55%) attended the workshop. Mentors and mentees noted increasing numbers of doctoral students and mentors, which provided opportunities for peer mentorship. Delays in procurement and research regulatory processes subsequently delayed students’ projects. Similarly, mentees mentioned challenges of limited; 1) infrastructure and mentors to support basic science research projects, 2) physical office space for doctoral students and their mentors, 3) skills in budgeting and finance management and 4) communication skills including conflict resolution. As solutions, the team proposed skills’ training, induction courses for doctoral students-mentor teams, and a Frequently Asked Questions’ document, to better inform mentors’, mentees’ expectations and experiences.ConclusionSystemic and infrastructural limitations affect the quality of the doctoral training experience at MaKCHS. Clinical and biomedical research infrastructure, in addition to training in research regulatory processes, procurement and finance management, communication skills and information technology, were highlighted as high priority areas for strategic interventions to improve mentoring within doctoral training of clinician scientists.

Historical Archaeology in the East Midlands and East Africa: Personal Reflections

After obtaining his doctorate in archaeology at Nottingham University in 1956, Merrick Posnansky conducted research and taught in Ghana, Kenya, and Uganda for twenty years. He served in a succession of positions, including Curator of the Uganda Museum, Director of the African Studies Program at Makerere University College, Uganda, and Professor of Archaeology at the University of Ghana. Posnansky joined the faculty of the University of California at Los Angeles in 1977. He has conducted research in fourteen African countries and trained generations of Africanist researchers. Author of numerous publications, Posnansky prepared this article for a symposium at the 2013 annual conference of the Society for Historical Archaeology to provide a brief overview of the development of the fields of historical archaeology of British, African, and African diaspora sites over the last half century.

Abstract 2651: Nestin expression in tumor cells is associated with the basal-like phenotype and aggressive features in breast cancer.

Abstract Background: Nestin, neuroepithelial stem cell protein, is an intermediate filament protein originally described as a neuronal stem cell/progenitor marker during central nervous system development. Nestin is also expressed in immature or progenitor cells in non-neural tissues, including the basal/myoepithelial layer of the mammary gland and immature blood vessels. Recently, nestin positivity has been reported in different cancer types, and on this background we wanted to evaluate nestin positivity in breast cancer. Materials and methods: Immunohistochemical staining of nestin was done on tissue microarray slides from two independent series of breast cancer. Series 1 was a nested case-control study of interval and screening detected breast cancer based on the Norwegian Mammography Screening Program in Hordaland County during 1996-2001, giving a series of 190 patients with invasive breast cancer. Series 2 included 192 cases of invasive breast carcinoma from 1990-2002 identified in the Kampala Cancer Registry, and at the Department of Pathology, Makerere University College of Health Sciences (MakCHS), Kampala, Uganda. Evaluation of staining was done using staining index, where the staining index (values 0-9) was obtained as a product of staining intensity (0-3) and proportion of immunopositive cells (<10%, 1; 10-50%, 2; >50%, 3). A staining index above 0 was regarded as positivity for nestin. Results: In both series, nestin positivity in tumor cells was significantly associated with higher histologic grade; grade 1-2 vs. grade 3, (p<0.0005), negativity for estrogen receptor (p<0.0005) and progesterone receptor (p=0.001 in series 1 and p<0.0005 in series 2), high tumor cell proliferation by Ki-67 (p<0.0005 and p=0.005 in series 1 and 2, respectively), positivity for p53 (p=0.001 in series 1 and p=0.010 in series 2) and increased activation of angiogenesis estimated by vascular proliferation index (VPI)(p=0.035 in series 1 and p=0.001 in series 2). Concerning basal cell markers, nestin positivity in tumor cells was significantly associated with cytokeratin 5/6 and p-cadherin, with p-values <0.0005 in both series. Further, strong associations were seen with the triple negative phenotype (p<0.0005) and with five immunohistochemical profiles for the basal-like phenotype (1-5), with odds ratios from 7.1-18.3 and 10.7-18.1 in series 1 and 2, respectively. Conclusion: In these two series of breast cancer, nestin expression in tumor cells was significantly associated with features of aggressive breast cancer disease such as higher histologic grade, negativity for estrogen and progesterone receptors and high tumor cell proliferation by Ki-67. Further, nestin positivity was significantly associated with basal cell markers, the triple negative phenotype and the basal-like phenotype. Citation Format: Kristi Krüger, Hawa Nalwoga, Karin Collett, Jarle B. Arnes, Turid Aas, Lars A. Akslen. Nestin expression in tumor cells is associated with the basal-like phenotype and aggressive features in breast cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2651. doi:10.1158/1538-7445.AM2013-2651

Unrecognised tuberculosis at antiretroviral therapy initiation is associated with lower CD4+ T cell recovery

To investigate whether an unrecognised diagnosis of tuberculosis (TB) at the start of antiretroviral therapy (ART) influences subsequent CD4+ T cell (CD4) count recovery in an urban HIV clinic in Uganda. In a retrospective cohort study, a multivariable polynomial mixed effects model was used to estimate CD4 recovery in the first 96 weeks of ART in two groups of patients: prevalent TB (started ART while on TB treatment), unrecognised TB (developed TB within 6 months after start ART). Included were 511 patients with a median baseline CD4 count of 57 cells/mm(3) (interquartile range: 22-130), of whom 368 (72%) had prevalent TB and 143 (28%) had unrecognised TB. Compared with prevalent TB, unrecognised TB was associated with lower CD4 count recovery at 96 weeks: -22.3 cells/mm(3) (95% confidence interval -43.2 to -1.5, P = 0.036). These estimates were adjusted for gender, age, baseline CD4 count and the use of zidovudine-based regimen. Unrecognised TB at the time of ART initiation resulted in impaired CD4 recovery compared with TB treated before ART initiation. More vigilant screening with more sensitive and rapid TB diagnostics prior to ART initiation is needed to decrease the risk of ART-associated TB and sub-optimal immune reconstitution.

A first insight into the genotypic diversity of Mycobacterium tuberculosis from Rwanda

BackgroundMycobacterium tuberculosis complex (MTC) is the causative agent of tuberculosis (TB). Globally, increasing evidence shows that in M. tuberculosis, transmission varies from strain to strain and that different strains exhibit a range of geographical and host specificities, pathogenicity, and drug susceptibility. Therefore rapid and accurate differentiation of the members of MTC is critical in guiding treatment and public health decisions. We carried out a study at different health units and the National Reference Laboratory in Rwanda identify Mycobacterium tuberculosis complex species prevalent in TB patients in Rwanda. We further characterized the isolates using spoligotyping in order to gain an insight into the strain diversity of drug resistant and susceptible isolates of M. tuberculosis in this setting.MethodsA total of 151 isolates from culture positive sputum samples were harvested, heat killed at 80°C for two hours, and then shipped to Makerere University College of Health Sciences, Uganda, for speciation and typing. Species identification was achieved by regions of difference (RD) analysis, while Spoligotyping was done to identify strain types.ResultsRegion of difference analysis identified all the 151 isolates as M. tuberculosis. Spoligotyping revealed predominance of the T2 family (58.3%, 88/151), with SIT 52 being the most prevalent strain (31.8%, 48/151). Among the 151 isolates, 64 (42.4%) were multidrug resistant (MDR) with 3 cases on mono-resistance. Of 94 retreatment cases, 48 (51.1%) were MDR and of 46 newly presenting cases 14 (30.4%) were MDR. There was a significant difference (p=0.01) in anti-TB drug resistance between new and retreatment cases in the sample. However, there was no significant relationship between HIV serostatus and the two major strain types SIT 52 (p =0.15and SIT 152 (p = 0.41).ConclusionMycobacterium tuberculosis is the most prevalent species of Mycobacterium tuberculosis complex in Rwanda, and SIT 52 (T2) the predominant strain. There is significantly more MDR in the retreatment cases but no significant difference was observed by HIV status in relation to any spoligotypes.

An imperial enterprise: The making and breaking of the University of East Africa, 1949–1969

This article examines the evolution of the inter-territorial university policy in East Africa that culminated in the establishment of the regional University of East Africa (UEA) serving Kenya, Uganda and Tanzania; it further explores the causes of the collapse of the regional university in the late 1960s. The inauguration of the UEA in June 1963 exemplified the determination by Britain to maintain its influence in East Africa as the region entered the independence era. Britain sought to use the UEA as a centre for intellectual and ideological indoctrination of the regional elites that it had started to forge in 1949 following the establishment of Makerere University College in Uganda as an inter-territorial institution for East Africa. Unlike the Makerere elites who were to serve as agents of the British in the colonial era, the products of UEA would become allies of Britain in the independence era and thus serve as crucial cogs in the emerging neocolonial relations between Britain and the East African nations. This article demonstrates how the transformed political landscape after independence undermined the UEA, signalling not only the weakening of the bonds of cohesion among the East African states but also the waning fortunes of Britain in the region.

Developing Pre-service Teachers’ Technology Integration Competencies in Science and Mathematics Teaching: Experiences from Tanzania and Uganda

This study investigated the ICT integration practices in pre-service teacher education in the School of Education at Makerere University (College of Education and External Studies) in Uganda and Dar es salaam University College of Education (DUCE), a constituent college of the University of Dar es salaam in Tanzania. Specifically, the study aimed at establishing ways in which ICTs were being deployed in pre-service teacher training in the two colleges. It also investigated the factors constraining integration of ICTs in pre-service teacher education as perceived by the pre-service teachers and lecturers at the colleges. Using questionnaires and interview, data were collected from both the lecturers and final year pre-service teachers during the academic year (2009/2010). The findings revealed that, limited access to ICTs, limited lecturers’ knowledge of ICTs and limited use of the available ICTs affected usage of the technologies. Thus, it emerged that there is a need to explore models situated in a more encompassing theoretical framework like Technological Pedagogical Content Knowledge (TPACK) so as to realise sustainable pedagogical practices in classrooms proliferated with technology.Keywords: TPACK; Professional development; Science education

Influence of HIV infection on women's resumption of sexual intercourse and use of contraception in the postpartum period in rural Uganda

International Journal of Gynecology & ObstetricsVolume 116, Issue 2 p. 171-172 Brief communication Influence of HIV infection on women's resumption of sexual intercourse and use of contraception in the postpartum period in rural Uganda Michael O. Osinde, Michael O. Osinde Kabale Regional Hospital, Department of Obstetrics and Gynecology, Kabale, UgandaSearch for more papers by this authorDan K. Kaye, Corresponding Author Dan K. Kaye dankkaye@yahoo.com Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, UgandaCorresponding author at: Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda. Tel.: + 256 414 534361; fax: + 256 414 533451.Search for more papers by this authorOthman Kakaire, Othman Kakaire Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, UgandaSearch for more papers by this author Michael O. Osinde, Michael O. Osinde Kabale Regional Hospital, Department of Obstetrics and Gynecology, Kabale, UgandaSearch for more papers by this authorDan K. Kaye, Corresponding Author Dan K. Kaye dankkaye@yahoo.com Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, UgandaCorresponding author at: Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda. Tel.: + 256 414 534361; fax: + 256 414 533451.Search for more papers by this authorOthman Kakaire, Othman Kakaire Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, UgandaSearch for more papers by this author First published: 16 November 2011 https://doi.org/10.1016/j.ijgo.2011.09.018Citations: 7Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume116, Issue2February 2012Pages 171-172 RelatedInformation

Mentorship needs at academic institutions in resource-limited settings: a survey at makerere university college of health sciences

BackgroundMentoring is a core component of medical education and career success. There is increasing global emphasis on mentorship of young scientists in order to train and develop the next leaders in global health. However, mentoring efforts are challenged by the high clinical, research and administrative demands. We evaluated the status and nature of mentoring practices at Makerere University College of Health Sciences (MAKCHS).MethodsPre-tested, self-administered questionnaires were sent by email to all Fogarty alumni at the MAKCHS (mentors) and each of them was requested to complete and email back the questionnaire. In addition to training level and number of mentors, the questionnaires had open-ended questions covering themes such as; status of mentorship, challenges faced by mentors and strategies to improve and sustain mentorship within MAKCHS. Similarly, open-ended questionnaires were sent and received by email from all graduate students (mentees) registered with the Uganda Society for Health Scientists (USHS). Qualitative data from mentors and mentees was analyzed manually according to the pre-determined themes.ResultsTwenty- two out of 100 mentors responded (14 email and 8 hard copy responses). Up to 77% (17/22) of mentors had Master's-level training and only 18% (4/22) had doctorate-level training. About 40% of the mentors had ≥ two mentees while 27% had none. Qualitative results showed that mentors needed support in terms of training in mentoring skills and logistical/financial support to carry out successful mentorship. Junior scientists and students reported that mentorship is not yet institutionalized and it is currently occurring in an adhoc manner. There was lack of awareness of roles of mentors and mentees. The mentors mentioned the limited number of practicing mentors at the college and thus the need for training courses and guidelines for faculty members in regard to mentorship at academic institutions.ConclusionsBoth mentors and mentees were willing to improve mentorship practices at MAKCHS. There is need for institutional commitment to uphold and sustain the mentorship best practices. We recommend a collaborative approach by the stakeholders in global health promotion to build local capacity in mentoring African health professionals.

Patient satisfaction with services in outpatient clinics at Mulago hospital, Uganda

To identify factors associated with general satisfaction among clients attending outpatient clinics in a referral hospital in Uganda. Cross-sectional exit survey of patients and care-givers in selected outpatient clinics. Seven outpatients' clinics at Mulago National Referral and Teaching Hospital. Mean score of clients' general satisfaction with health-care services. Overall the clients' general satisfaction was suboptimal. Average satisfaction was higher among clients with a primary or secondary education compared with none, those attending HIV treatment and research clinic compared with general outpatient clients, and returning relative to new clients. Conversely, satisfaction was lower among clients incurring costs of at least $1.5 during the visit, and those reporting longer waiting time (>2 h). Client's perceived technical competence of provider, accessibility, convenience and availability of services especially prescribed drugs were the strongest predictor of general satisfaction. This study highlights the important findings about outpatient services at Mulago hospital. The sub-optimal satisfaction scores for outpatient care strongly suggest that more could be done to assure that services provided are more patient centered. Significant factors including category of clinic visited, waiting time, costs incurred, accessibility of services and perceived providers' technical competence at this hospital should be explored by the Makerere University College of Health Sciences and Mulago hospital for potential improvements in quality of the health service delivered.

Mid Morning Moon

I first heard about the map from one of my teachers. It was not the kind of information he was supposed to be giving us, but I think he was bored with what he had to do and sometimes drifted away t...

Building the national memory in Uganda: the role of legal deposit legislation

The paper presents the role of legal deposit legislation in building the national memory in Uganda. It defines the concepts of legal deposit and national memory and how they relate to each other. The historical background of legal deposit is outlined. This is followed by the development of legal deposit Acts in Uganda, namely the Makerere University College (Deposit Library) Act, 1964, the Deposit Library and Documentation Centre Act, 1969 and the National Library Act, 2003. The article discusses the roles played by Makerere University Library, the Deposit Library and Documentation Centre and the National Library of Uganda in building the national memory. The differences and similarities between the three legal depositories are analysed. Finally the challenges faced by these institutions are discussed and suggestions given.

An assessment of Makerere University College of Health Sciences: optimizing health research capacity to meet Uganda’s priorities

BackgroundHealth research is critical to the institutional mission of the Makerere College of Health Sciences (MakCHS). Optimizing the alignment of health research capacity at MakCHS with the health needs and priorities of Uganda, as outlined in the country’s Health Sector Strategic Plan (HSSP), is a deliberate priority, a responsibility, and a significant opportunity for research. To guide this strategic direction, an assessment of MakCHS’s research grants and publication portfolio was conducted.MethodsA survey of all new and ongoing grants, as well as all publications, between January 2005 and December 2009 was conducted. Research, training, and education grants awarded to MakCHS’ constituent faculties and departments, were looked for through financial records at the college or by contact with funding organizations. Published manuscripts registered with PubMed, that included MakCHS faculty authors, were also analyzed.ResultsA total of 58 active grants were identified, of which 18 had been initiated prior to 2005 and there were an average of about eight new grants per year. Most grants funded basic and applied research, with major focus areas being HIV/AIDS (44%), malaria (19%), maternal and child health (14%), tuberculosis (11%), mental health (3%), and others (8%). MakCHS faculty were identified as Principal Investigators (PIs) in only 22 (38%) active grants. Grant funding details were only available for one third of the active grants at MakCHS. A total of 837 publications were identified, with an average of 167 publications per year, most of which (66%) addressed the country’s priority health areas, and 58% had MakCHS faculty or students as first authors.ConclusionsThe research grants and publications at MakCHS are generally well-aligned with the Ugandan Health Ministry priorities. Greater efforts to establish centralized and efficient grants management procedures are needed. In addition, greater efforts are needed to expand capacity for MakCHS faculty leadership of grants, as well as to continue to expand the contribution of MakCHS faculty to lead research publications.

Building partnerships towards strengthening Makerere University College of Health Sciences: a stakeholder and sustainability analysis

BackgroundPartnerships and networking are important for an institution of higher learning like Makerere University College of Health Sciences (MakCHS) to be competitive and sustainable.MethodsA stakeholder and sustainability analysis of 25 key informant interviews was conducted among past, current and potential stakeholders of MakCHS to obtain their perspectives and contributions to sustainability of the College in its role to improve health outcomes.ResultsThe College has multiple internal and external stakeholders. Stakeholders from Uganda wanted the College to use its enormous academic capacity to fulfil its vision, take initiative, and be innovative in conducting more research and training relevant to the country’s health needs. Many stakeholders felt that the initiative for collaboration currently came more from the stakeholders than the College. External stakeholders felt that MakCHS was insufficiently marketing itself and not directly engaging the private sector or Parliament. Stakeholders also identified the opportunity for MakCHS to embrace information technology in research, learning and training, and many also wanted MakCHS to start leadership and management training programmes in health systems. The need for MakCHS to be more vigorous in training to enhance professionalism and ethical conduct was also identified.DiscussionAs a constituent of a public university, MakCHS has relied on public funding, which has been inadequate to fulfill its mission. Broader networking, marketing to mobilize resources, and providing strong leadership and management support to inspire confidence among its current and potential stakeholders will be essential to MakCHS’ further growth. MakCHS’ relevance is hinged on generating research knowledge for solving the country’s contemporary health problems and starting relevant programs and embracing technologies. It should share new knowledge widely through publications and other forms of dissemination. Whether institutional leadership is best in the hands of academicians or professional managers is a debatable matter.ConclusionsThis study points towards the need for MakCHS and other African public universities to build a broad network of partnerships to strengthen their operations, relevance, and sustainability. Conducting stakeholder and sustainability analyses are instructive toward this end, and have provided information and perspectives on how to make long-range informed choices for success.

Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study

BackgroundGeographical inaccessibility, lack of transport, and financial burdens are some of the demand side constraints to maternal health services in Uganda, while supply side problems include poor quality services related to unmotivated health workers and inadequate supplies. Most public health interventions in Uganda have addressed only selected supply side issues, and universities have focused their efforts on providing maternal services at tertiary hospitals. To demonstrate how reforms at Makerere University College of Health Sciences (MakCHS) can lead to making systemic changes that can improve maternal health services, a demand and supply side strategy was developed by working with local communities and national stakeholders.MethodsThis quasi-experimental trial is conducted in two districts in Eastern Uganda. The supply side component includes health worker refresher training and additions of minimal drugs and supplies, whereas the demand side component involves vouchers given to pregnant women for motorcycle transport and the payment to service providers for antenatal, delivery, and postnatal care. The trial is ongoing, but early analysis from routine health information systems on the number of services used is presented.ResultsMotorcyclists in the community organized themselves to accept vouchers in exchange for transport for antenatal care, deliveries and postnatal care, and have become actively involved in ensuring that women obtain care. Increases in antenatal, delivery, and postnatal care were demonstrated, with the number of safe deliveries in the intervention area immediately jumping from <200 deliveries/month to over 500 deliveries/month in the intervention arm. Voucher revenues have been used to obtain needed supplies to improve quality and to pay health workers, ensuring their availability at a time when workloads are increasing.ConclusionsTransport and service vouchers appear to be a viable strategy for rapidly increasing maternal care. MakCHS can design strategies together with stakeholders using a learning-by-doing approach to take advantage of community resources.

Research translation to inform national health policies: learning from multiple perspectives in Uganda

BackgroundResearch and evidence can have an impact on policy and practice, resulting in positive outcomes. However, research translation is a complex, dynamic and non-linear process. Although universities in Africa play a major role in generating research evidence, their strategic approaches to influence health policies and decision making are weak. This study was conducted with the aim of understanding the process of translating research into policy in order to guide the strategic direction of Makerere University College of Health Sciences (MakCHS) and similar institutions in their quest to influence health outcomes nationally and globally.MethodsA case study approach using 30 in-depth interviews with stakeholders involved in two HIV prevention research project was purposively selected. The study sought to analyze the research-to-policy discourses for the prevention of mother-to-child transmission (PMTCT) and safe male circumcision (SMC). The analysis sought to identify entry points, strengths and challenges for research-to-policy processes by interviewing three major groups of stakeholders in Uganda – researchers (8), policy makers (12) and media practitioners (12).ResultsAmong the factors that facilitated PMTCT policy uptake and continued implementation were: shared platforms for learning and decision making among stakeholders, implementation pilots to assess feasibility of intervention, the emerging of agencies to undertake operations research and the high visibility of policy benefits to child survival. In contrast, SMC policy processes were stalled for over two years after the findings of the Uganda study was made public. Among other factors, policy makers demanded additional research to assess implementation feasibility of SMC within ordinary health system context. High level leaders also publicly contested the SMC evidence and the underlying values and messages – a situation that reduced the coalition of policy champions.ConclusionsThis study shows that effective translation of PMTCT and SMC research results demanded a “360 degree” approach to assembling additional evidence to inform the implementation feasibility for these two HIV prevention interventions. MakCHS and similar institutions should prioritize implementation research to guide the policy processes about the feasibility of implementing new and effective innovations (e.g. PMTCT or SMC) at a large scale in contexts that may be different from the research environments.

Assessing community perspectives of the community based education and service model at Makerere University, Uganda: a qualitative evaluation

BackgroundCommunity partnerships are defined as groups working together with shared goals, responsibilities, and power to improve the community. There is growing evidence that these partnerships contribute to the success and sustainability of community-based education and service programs (COBES), facilitating change in community actions and attitudes. Makerere University College of Health Sciences (MakCHS) is forging itself as a transformational institution in Uganda and the region. The College is motivated to improve the health of Ugandans through innovative responsive teaching, provision of service, and community partnerships. Evaluating the COBES program from the community perspective can assist the College in refining an innovative and useful model that has potential to improve the health of Ugandans.MethodsA stratified random sample of 11 COBES sites was selected to examine the community’s perception of the program. Key Informant Interviews of 11 site tutors and 33 community members were completed. The data was manually analyzed and themes developed.ResultsCommunities stated the students consistently engaged with them with culturally appropriate behaviour. They rated the student’s communication as very good even though translators were frequently needed. Half the community stated they received some feedback from the students, but some communities interpreted any contact after the initial visit as feedback. Communities confirmed and appreciated that the students provided a number of interventions and saw positive changes in health and health seeking behaviours. The community reflected that some programs were more sustainable than others; the projects that needed money to implement were least sustainable. The major challenges from the community included community fatigue, and poor motivation of community leaders to continue to take students without compensation.ConclusionsCommunities hosting Makerere students valued the students’ interventions and the COBES model. They reported witnessing health benefits of fewer cases of disease, increased health seeking behavior and sustainable healthcare programs. The evidence suggests that efforts to standardize objectives, implement structural adjustments, and invest in development of the program would yield even more productive community interactions and a healthcare workforce with public health skills needed to work in rural communities.

Taking down ‘the Ivory Tower’: leveraging academia for better health outcomes in Uganda

ivory tower, noun (1) an impractical often escapist attitude marked by aloof lack of concern with or interest in practical matters or urgent problems; (2) a secluded place that affords the means of treating practical issues with an impractical often escapist attitude; especially a place of learning [1]. Sub-Saharan Africa (SSA) is home to less than ten percent of the world’s population but bears nearly a quarter of the world’s disease burden. At the same time, the region has limited financial resources to invest in solutions [2]. The international community has commonly responded with narrowly focused, short term, technical approaches or relatively simplistic aid programs. The absence of a comprehensive strategy or “systems approach” has resulted in a patchwork of well-intended but often poorly coordinated initiatives. While academic institutions in the North (i.e. North America and Europe) have sought opportunities to be helpful, concerns have been raised regarding the focus of their initiatives and misalignments with the priorities of host countries. Funding for such initiatives typically originate outside of the region and while academic institutions in the North have clearly benefited from these opportunities, the value to the host institutions or to health systems in SSA is often much more difficult to determine. Another concern pertains to the relevance of academic institutions in the face of dire global health challenges. What role can academic institutions play in creating practical solutions to tackle pressing societal problems? By their nature, institutions of higher learning are concerned with the creation of new knowledge, while often leaving the application of their findings to others. They rarely evaluate the relevancy of their training programs to the current needs of the health care system. Implementation has not traditionally been considered as part of the academic agenda. In addition, stakeholders who are most familiar with the problems that hamper improvements in health are usually not members of academic communities. As a result, civil society and government agencies, such as the Ministries of Education and Health, often view academicians as intellectuals who are cloistered in their Ivory Towers, seemingly uninterested or unwilling to deal with the pressing problems of the day. In the case of global health, an ever growing number of non-governmental organizations have stepped forward to work on solutions, with academic institutions watching from the sidelines. This collection of papers, focused on work conducted at Makerere University College of Health Sciences (MakCHS) in Uganda, challenges the Ivory Tower notion with a set of approaches and findings that are a testimony to the relevance of a leading academic institution to the health problems of SSA. The papers range from assessments of the educational approaches and ability to provide health services, to policy and strategic analysis needed for sustainability of the institution, to research projects that demonstrate the practical role of the University in the health sector. Furthermore they demonstrate a new model of collaboration between universities in lowand high-income countries; a model that emphasizes local leadership and ownership. Most of the papers in this supplement are based on work that was funded by the Bill and Melinda Gates Foundation (BMGF). With the belief that health science schools have a critical role in improving health care in SSA, the BMGF initiated their Collaborative Learning Initiative in 2008 with two-year learning grants designed to demonstrate and incentivize the accountability of health professions schools to the problems of society [3]. These grants brought together leading health science schools in SSA with partner schools in the U.S. to explore the value proposition that academia could bring to the pressing health problems in the region. To be sure, these relationships have existed for many years, long preceding the initiation of these learning grants. Correspondence: jckolars@umich.edu Professor of Medicine, Senior Associate Dean of Education and Global Initiatives, University of Michigan Medical School, Ann Arbor, MI 48109-5624, USA Kolars BMC International Health and Human Rights 2011, 11(Suppl 1):S1 http://www.biomedcentral.com/1472-698X/11/S1/S1