CHDC responds to the health needs of children, women and communities through multi-disciplinary research, community based training and publications aimed at informing health and social policies.

The CHDC provides expertise in research and data analysis aimed at informing and influencing policy and other aspects of development. Priority research areas for the CHDC include: child health; nutrition, public health, primary health care and service delivery; reproductive health (with special reference to adolescent sexual development); sexually transmitted infections; health systems development policy research and community health financing. Research by the CHDC range from simple research by novice researchers to large commissioned research national and international studies by senior researchers conducted in form of baseline, evaluations, surveys, and interventions. This has enabled the CHDC to attain experiences in handling multiple variable research projects.

Since inception in 1989, CHDC has been involved in more than 200 research studies, and below are some of most recent research undertaken categorized as either on-going or completed. For full reports of completed consultancies go to: PUBLICATIONS AND REPORTS.

On-Going research

Four PhD research studies are being conducted building on the foundation of a baseline study that provided baseline information on medicines use for children in Uganda both national and district all of which were part of a bigger project (CHILDMED Project under Child Health and Development Centre, MUK and the University of Copenhagen, Denmark) collaboration and implemented in Jinja District. The four on-going PhD projects are:

1. HIV+ Children's Perspectives and Communication Practices Regarding their Health and Medicines (by Phoebe Kajubi)
This study will explore HIV positive children's perspectives and communication practices regarding their health and medicines. The study will be implemented in two closely inter linked phases. The formative phase of the study will be a survey involving HIV+ children aged 8-17 years enrolled on ART and their caregivers who will be accessed through selected treatment centers that provide ART treatment to HIV+ children in Jinja District. The survey will generate data on the children's socio-demographic characteristics, family situations, communication practices and preferences. The second phase is designed as an ethnographic study. In-depth interviews and participant observation will be the main methods of data collection. This phase will focus on a smaller sample of HIV+ children aged 8-17 years enrolled on ART who will be followed up for a period of one year) to explore their perception/understanding and communication practices about their health and medicines, their challenges and concerns and how best they can be supported to live on ART.

2. Asthma and acute lower respiratory infections among children aged 2 to 59 months in Mulago hospital: approaches to diagnosis and management (by Rebecca Nantanda).
Asthma and acute lower respiratory infections among children less than five years have overlapping clinical presentation, making it difficult to diagnose and subsequently treat the two conditions appropriately. Many times this leads to under-diagnosis of asthma and over-diagnosis of pneumonia resulting into over-use/inappropriate use of antibiotics. The aim of this study is to develop algorithms for diagnosis of asthma and pneumonia among under-fives. This would contribute towards improved diagnosis and treatment of asthma and pneumonia and subsequently rational medicine use in children.

3. Evaluation of alternative strategies for improved uptake of preventive treatment for intestinal schistosomiasis among primary school children in Jinja district, Uganda (Dr Simon Muhumuza)

Objectives: To evaluate the effectiveness of strategies for improving uptake of preventive treatment for intestinal schistosomiasis in Jinja district, Uganda with an overall aim of improving strategies for morbidity control.
Methods: This will be a 3 phased study: In phase I (baseline), the factors influencing uptake of preventive treatment for schistosomiasis will be identified and the prevalence and intensity of S. mansoni infection determined through a cross sectional survey involving 1,236 children in 12 primary schools in Jinja district. Phase II (intervention phase) will be a factorial cluster-randomized controlled trial during which, the 12 primary schools studied in phase I will be randomized into 4 groups to; i) receive specific messages for schistosomiasis control and prevention (IEC arm) or ii) receive a pre-treatment snack (snack arm) or iii) receive both interventions (IEC plus snack arm) or iv) receive neither intervention (comparison arm). In phase III (evaluation phase), the effectiveness of the interventions will be evaluated. The strategies for improved uptake evaluated in this study, if efficacious, may be considered for integration in mass drug administration at all levels

4. Towards appropriate medicines for children in Uganda: Analysis of relevant policies (by Mr. Xavier Nsabagasani)
There is lack of medicines specifically designed for children and hence the WHO's campaign of "make medicines child size". Policies and guidelines regarding use of medicines for the major childhood illnesses in Uganda have evolved over time. Despite the changes, there has been no systematic documentation of how the different policies have evolved and been implemented. A study was needed to answer the question of whether these policy changes have translated into children's improved access to quality medicines. The purpose of this PhD study is to identify and analyze policies relevant for improving quality and access to medicines for children in general followed by an in-depth study of IMCI policy in Uganda. The specific objectives of the study are to : identify and document the existing policies on children's medicines; analyze the process of initiation and development of IMCI policy in Uganda; investigate factors that affected implementation of IMCI policy in Uganda�

Other studies:

Utilizing the Wayo-Nero (“Aunt-Uncle”) Strategy as a Vehicle for Improving Access to Mental Health Services in Post-conflict Northern Uganda: Effectively Bridging Indigenous/Traditional and Modern/Biomedical Therapy Systems

(Investigators: Herbert Muyinda, James Mugisha, Dennis Willms, Catherine Abo, Justin Student, and Eugene Kinyanda)

This 3 year (October 2012 – October 2015) implementation research project is a response to the global challenge of providing effective and affordable community-based mental health care in post conflict settings. The main objective is to reduce the treatment gap among people with mental illnesses by increasing access to care and utilization of mental health services for people with common mental illnesses (depression, PTSD, suicide behaviour and anxiety disorders). The project also aims at reducing stigma among people with mental illnesses and their families, and to assess the effectiveness of indigenous institutions (Wayo-Nero model) in enhancing access to and utilization of mental health services in low income and under-served settings.

CHDC will implement the proposed project in collaboration with researchers from Butabika Mental Hospital, Salama SHIELD Foundation (SSF)-Canada and SSF-Uganda, and the Department of Psychiatry, Makerere University.

Men, health and illness: masculine identity and treatment seeking for HIV/AIDS in Uganda (Principal investigator: Godfrey Siu, PhD; Prof Daniel Wight, Prof. Janet Seeley) 
There is evidence that the health seeking behaviour of men and women differ. The under-representation of men in most ART delivery programmes in Africa is an example in case. It has been postulated that cultural notions of masculinity may in part be at the heart of the problem. To explore the relationship between local notions of masculinity and men's response to symptoms of HIV in a rural cultural context of Busia district, eastern Uganda, The study explores how masculinity is constructed, maintained and experienced by men in their private spaces (homes) and in common or public spaces and how these ideas of masculinity influence access to and use of antiretroviral therapy (ART). The study was designed as an ethnographic study using in-depth interviews, participant observations paying attention to the everyday life of men as it relates to their ideas of manliness and response to HIV/AIDS.

Determining HIV related vulnerabilities among war - affected populations in Gulu and Amuru districts, Northern Uganda (by Herbert Muyinda) 
This is a 5 year project aimed at assessing temporal trends, and characterizes the effects of war associated trauma on HIV/STI related vulnerability. The study will also identify socio-cultural and structural factors associated with barriers to access and utilization of HIV care services in populations resettling from camps to their home villages. The study is part of the collaboration between MakCHS (CHDC) and University of British Colombia, and funded by the Canadian Institutes for Health Research (CIHR).

The supply side of ART - Users, drugs, and technologies in organizing the supply of mass HIV treatment programmes in Uganda (By Herbert Muyinda)
This is initially a one-year project starting in September 2011 in Northern Uganda. The aim is to study the supply chain of medicines in Uganda, as it translates ARVs to a therapeutic option in Uganda. In particular, the researchers are interested in how the current efforts in standardizing the distribution of these global pharmaceuticals shape users and the institutional contexts of HIV/AIDS. The project aims at providing answers to pressing questions related to the instabilities and uncertainties regarding ARV availability in Uganda, an issue that presents serious challenges to ART users. The project will be carried out with support from the German Research Foundation.

Luwero Community Nutrition project in Nyimbwa Sub County, Luwero district (Dr Jessica Jitta; Sekiwunga, R.)

The Child Health and Development Centre (CHDC) is implementing a 3 year (2009-2012) community intervention implementing and building capacities of pregnant mothers at family and community level, with key preventive interventions in a rural sub county (Nyimbwa S/C) in order to improve nutritional literacy and behaviors with clinical interventions provided at ANC services. The project is aimed at establishing factors that are associated with low birth weight in the district and to come up with strategies of its prevention. The specific objectives of the project findings are:

1

To achieve optimal birth weight using a combination of simple interventions at community and family level.

2

To explore critical capacities and structures that can ensure sustainability of community based strategies to reduce Low Birth Weight.

The project works through community health workers and health workers particularly on issues related to prevention and treatment of malaria during pregnancy.

Completed research

Evaluation of the ABY Project (2010) - with funding from Children AIDS Fund (CAF) an evaluation of the (ABY) project that was preserving the African Family in the Face of HIV/AIDS through Prevention was conducted. This evaluation was after implementing this behavioral change project for 5 years by Children's AIDS Fund (CAF) in conjunction with Uganda Youth Forum (UYF) and it started in 2005 with funding from PEPFAR/USAID. The evaluation was conducted in 2010 in 5 districts namely Kampala, Mpigi, Luwero, Wakiso and Mukono. Both qualitative and quantitative methods were employed.

An Assessment of the Readiness for Introduction of Cervical Cancer Vaccine in Uganda was conducted and completed Feb. 2008. CHDC was contracted by PATH to evaluate the feasibility and cost of the two delivery strategies, health systems impact and the acceptability of the vaccine among key stakeholders. The assessment explored the perceptions, understanding, knowledge and attitudes of primary and secondary decision makers regarding cervical cancer as a problem, its severity, vaccination/immunization and the cervical cancer vaccine, the nature of information needed by parents and by other influential community and national leaders and health professionals in order for them to make informed decisions and to give informed advice regarding the cervical cancer vaccine, it assessed the vaccine delivery system options for delivering the cervical cancer vaccine, including relevant structures, processes, and capacities available in the relevant ministries and reviewed current health policies, the policy environment and processes relevant to policy formulation for vaccine introduction and adoption. It was a cross sectional descriptive formative study, where qualitative research approaches were adopted to facilitate a broad in depth understanding of social cultural, vaccine delivery, policy and advocacy issues for the introduction of a cervical cancer vaccine. On the basis of the formative research a communication and advocacy strategy was developed together with IEC materials for a two year demonstration project that tested the feasibility and cost of delivering the vaccine to girls aged 10 to 14 years using two different strategies.

A Situation analysis of Newborn Health in Uganda (Completed, 2008) - It focused on the prevailing health and care practices for the newborn. This study was in line with the Health Sector Strategic Plan (HSSP II, 2005/10), which aims to develop and implement an effective comprehensive and responsive health system to reach all newborns and their mothers, to reduce the unwanted deaths and improve newborn health within a continuum of care. The overall objectives of the study were; to carry out a situational analysis of newborn health and care in the country, determining levels and trends of newborn mortality and morbidity, risk factors for ill health; reviewing current practices regarding newborn care at facility and community level; reviewing existing services, policies and programs; determining existing levels of skill and capacity of health providers and community-based workers; highlighting gaps in policies, programs and services and identifying essential information needed to improve newborn health in Uganda. The study was conducted through review of literature complemented by a field study in eight rural districts; Iganga, Kumi, Kayunga, Rakai, Kabarole, Bushenyi, Arua, Lira) and two urban divisions of kampala City, to give a regional representation.

Client Satisfaction with Health Services in Uganda - 2008. In collaboration with the Ministry of Health and with funding from the Belgium Technical Cooperation (BTC), this study was to establish the level of users' satisfaction and to understand client experiences that are important in satisfaction as part of the HSSP II mid term review and to generate baseline data for future performance assessments. The study was conducted in the rural districts of Arua, Gulu, Kasese, Masaka, Tororo and Nakapiripirit and Moroto and an urban district of Kampala. The study used both qualitative and survey methods.

Nutrition and Early Childhood Development Project (NECDP - CHILD Project) - was a consultancy to CHDC by Government of Uganda and World. The project builds capacity by providing technical assistance to six Southwestern districts of Uganda from 2000 to June 2005. It was a Community and Home Initiatives for Long-term Development as an input into the 1993 Uganda National Program of Action for Children (UNPAC) and the 1997 Poverty Eradication Action Plan, whose overall goal was to improve the quality of life of children less than six years together with the people who provide them the necessary care. The Primary target group was children under six years of age and those who influenced their growth and development on a day-to-day basis, such as their parents and other childcare givers. Implementation of the project was to a large extent, based at the community level, with the full participation of families and communities.

A Review of Child Days Plus strategy in Uganda, (Completed 2007). 
Funded by UNICEF / Ministry of Health, the CHDC evaluated Child days plus to provide recommendations for improving its implementation. Employing mainly a qualitative methodology, the review collected data from almost all districts in the four regions, to get a deeper understanding of how different stakeholders, perceive CDPS so as to inform policy and program for improving process and results of the Strategy.

The USAID Micronutrient Program (MOST - Micronutrient Opportunities, Strategies and Technology) was a micronutrient project funded by USAID. The project dealt with implementation of strategies to improve nutritional status of mothers and children. The main focus was on micronutrients and communication about good nutrition. This was a national wide project that stated in 1999 and was completed September 2005.

 

School Sanitation - 2005. The Ministry of Education and sports commissioned the CHDC to review the situation of sanitation, hygiene and access to water, mainly in primary schools and giving some insight into that of secondary schools. The overall objective of the survey was to carry out a situation and trend analysis with a view to inform policy and programmes geared towards improvement of water and sanitation in primary schools with a regional focus of four (4) traditional regions - Northern, Eastern, Western, Central as well as Kampala. It was a cross-sectional descriptive survey using a triangulation of both quantitative and qualitative approaches to data collection.