RESEARCH AND INNOVATION

A Grants and Contracts Committee set up to Streamline Coordination of Grants Application and Management
The Grants and Contracts Office was established and operationalised at the beginning of May 2011, to contribute to the sustainability of the College activities through resource mobilization, capacity building, and grants and contracts management. The office will help to promote and cultivate a culture of transparency, equal opportunity, team approach to application for funding and conducting of research. In addition, the specific granting capacity needs of individuals, departments and schools will also be addressed through this office.
Electronic systems have been designed to meet the unique needs of the college in this work, especially in tracking pre and post grant management activities and milestones.

 

The College of Health Sciences Sets its Research Priorities
The College of Health Sciences held its final Research Agenda setting meeting on 1st July 2011 and identified its research priorities. The meeting was attended by staff and faculty from the different Schools in the College, Ministry of Health representatives, civil society and NGOs, and was facilitated by Cole Dodge; an experienced facilitator based in Nairobi. The research priorities were determined using well-laid out pre-determined criteria that the participants used in their groups. At the end of the meeting, the five top-most priority areas identified were as in the table below based on their total scores in 3 critical areas, namely; public health benefit, feasibility and relative cost:
Get to know the priority areas on our website at:
http://chs.mak.ac.ug/content/college-health-sciences-sets-its-research-p...

THRiVE Intensifies efforts to Strengthen Capacity of Researchers in the Region
With funding from the Wellcome Trust, the Training Health Researchers into Vocational Excellence (THRiVE) in East Africa consortium exists to develop and empower academic institutions for full participation in the march of science. In the last one year, the consortium which is hosted by MakCHS held a number of trainings and registered other capacity building achievements as elaborated below;

  • Hand-on GIS Training conducted by ICIPE, Kenya, in the use of Geographic Information Systems (GIS) and Global Positioning System (GPS)-based data sampling and mapping from December 6-10 2010 at ICIPE. Thirteen participants were drawn from THRiVE institutions (ICIPE, KCMC, NIMR & UVRI), and other institutions.
  • Supporting masters, PhD and Post-doc trainees at Makerere University, Kilimanjaro Christian Medical College and Gulu University.
  • Purchase of a LC-MS which has improved ICIPE├ö├ç├ûs capacity to analyse and resolve both small and large organic molecules (such as odours and small peptides) and to accurately determine their masses, fragmentation and quantities. It also allows the Centre to accurately identify metabolites in biological samples, impurities in authentic synthetic or commercial samples, and to assist in screening for pesticides and toxicants.
  • A 3-week introductory research methods course delivered at National Institute for Medical Research (NIMR) from 7th-25th February 2011, to enable researchers develop expertise in section and use of different research methods. Thirty three participants attended the course, including 13 THRiVE PhD fellows and 2 THRiVE post-docs.
  • With partial funding support from THRiVE, NIMR Mwanza purchased a fully automated Applied Bio-systems 3500 genetic analyser, to analyse samples from an ongoing HIV genome study undertaken by NIMR in Mwanza and Moshi research sites.

├ö├ç├│    Four other short courses on statistics were developed by staff at KCMC in collaboration with NIMR and LSHTM; covering Linear Regression, Logistic Regression, Poisson Regression and Likelihood analysis and were held from March 7th through May 13th 2011.
├ö├ç├│    KCMC also completed a 60 sitting capacity M.Sc classroom, making a great improvement in the quality of teaching and the general learning environment for masters├ö├ç├û students.
├ö├ç├│    The Cambridge University THRiVE team managed to secure the ├ö├ç├┐Wolfson College Honorary Fellowships├ö├ç├û for all the THRiVE fellows matched to Cambridge mentors. The fellows can hold Wolfson College Fellowship in conjunction with their THRiVE fellowships, until their THRiVE Fellowships end and they will be recognised as members of Wolfson College and enjoy certain benefits.

School of Biomedical Sciences Research

The AIDS and Cancer Specimen Resource (Uganda) ACSR-U
The purpose of the AIDS and Cancer Specimen Resource Uganda is to establish a cancer tissue bio-repository in the Department of Pathology. The specific aim is to provide high quality HIV/AIDS-related malignant specimens with associated clinical data to qualified, funded researchers to conduct high priority research studies.

During the period October 1st 2010-December 30th 2010, a collection of 180 paraffin blocks of KaposiÔÇÖs sarcoma specimens were added to the bio-repository.
In addition there has been continued support to build local capacity by provision of current pathology reference textbooks and literature to pathologists in the Department of Pathology. The project is implemented in partnership with Mid Region AIDS and Cancer Specimen Resource (MR-ACSR).

Microbiology Research Supports Several PhD Students
The Department of Microbiology was involved in the following research projects and activities, some of which are still on-going; 

  • ├ö├ç┬úMycobacteria tuberculosis (MTB) strain working group├ö├ç├ÿ funded by TBRU. This project is investigating the role of different genotypes of MTB in transmission, treatment response, clinical and radiological presentation of MTB. A PhD student is supported and doing his research under this project.
  • ├ö├ç┬úCell to Cell signaling in Mycobacteria├ö├ç├ÿ- funded by a NIH grant. This project has two graduate students in advanced stages of their PhD and Msc studies. 
  • A multicentre comparative trial of efficacy and safety of sodium stibogluconate (SSG) versus paromonycin (PM) versus a combination of SSG and PM as the first line treatment for visceral Leishmaniasis in Ethiopia, Kenya, the Sudan and Uganda
  • A TB Microbiology Sida/SAREC-funded project, with three PhD students attached to it.  Evaluation of slide drug susceptibility testing for rapid diagnosis of MDR-TB in Mulago Hospital.
  • Characterization of immune response to Cryptococcus neoformans antigens among HIV Infected Patients Initiating Anti-Retroviral Treatment (ART) in Uganda.
  • Determination of fluconazole resistance profile of Cryptococcus neoformans among HIV- cryptococcal meningitis coinfected patients initiating HIV therapy in Uganda

 

Anti-malarial, Anti-diabetic Plant Activity Dominates Pharmacology Research

This year, the Department of Pharmacology and Therapeutics focused on 3 research areas; Traditional medicines, Health systems research and Clinical Pharmacology of anti-malarials and Antiretroviral drugs.
The department is focused on the validation of traditional/indigenous health practices and anti-malarial practices, screening plants for antibacterial activity and anti-diabetic activity. This year professor Jasper Ogwal-Okeng won the Gates Foundation Grant to investigate how carnivorous plants can be used to control mosquitoes. This project is being implemented together with the Department of Botany, Makerere University College of Natural Sciences.

Medical Illustration Provides Support to Research Projects
Throughout the year, the Department of Medical Illustration continued to offer photographic services to the ARKS study in IDI; which has been examining the behavior of KaposiÔÇÖs sarcoma in HIV positive patients with exposure to different ART regiments. The DepartmentÔÇÖs role was to record the patients from screening through randomization to follow up, for a year.

  

School of Medicine Research

Medicine Moves to Embrace Non-Communicable Diseases Research
Beginning 2011, the Department of Medicine focused on extending its collaborative research and training to include research on non-communicable diseases, which includes the following two projects:
├ö├ç├│    Cardiovascular Diseases Linked award- The Department is a key player in the Medical Education Partnership Initiative (MEPI) funded by the National Institutes of Health (NIH), USA. This is a cardiovascular disease (CVD) linked award to the bigger programmatic award. The MEPI-CVD project├ö├ç├ûs major objective is to build capacity in CVD research and training.
├ö├ç├│    The effect of peer support on treatment outcomes among patients with diabetes mellitus in Iganga and Bugiri hospitals

Other research projects by the different staff members in the Department of Medicine included:
├ö├ç├│    Optimal timing of antiretroviral therapy (ART) after Cryptococcal meningitis
├ö├ç├│    Utility of urine lipoarabinomanan (LAM) for the diagnosis of tuberculosis
├ö├ç├│    T-cell immune dysfunction among sub-optimal responders to ART
├ö├ç├│    Intravenous (IV) artesunate plus artemisinin based therapy (ACT) versus IV quinine plus ACT for severe malaria and pharmacokinetics of lumefantrine and piperaquine
├ö├ç├│    Hepatic diseases among HIV-infected patients
├ö├ç├│    Novel Strategies to Prevent Malaria and Improve HIV Outcomes in Africa
├ö├ç├│    International Centers of Excellence in Malaria Research- Program for Resistance, Immunology, Surveillance & Modeling of Malaria in Uganda

 

Trial Results Challenge the use of Fluid Resuscitation as Emergency Treatment for African Children with Shock from Severe Infections

The Department of Paediatrics and Child Health participated in a clinical trial that came up with surprising findings showing that a long-standing treatment, called Fluid Resuscitation, does not confer the expected benefits when given to African children suffering from severe infections including malaria and septicemia (bloodstream infection).                                                                                                                                        The study was conducted by scientists from MakCHS and institutions in UK and Africa.

The trial known as FEAST (Fluid Expansion as Supportive Therapy) set out to evaluate the impact of Fluid resuscitation, which consists of giving children large volumes or ÔÇ£bolusesÔÇØ of intravenous fluids through a drip to try to reverse the deadly effects of shock. A child in shock becomes pale, cold to the touch and has a weak pulse which, often results in death within hours of admission and before effective medicines are administered.

The FEAST Trial studied 3170 critically ill children at six hospitals in Uganda, Kenya and Tanzania who were randomly divided into three equally sized groups. Two groups were given emergency doses of 20-40 mls per kilogram of bodyweight in the first hour of arriving in hospital; one group was given albumin, the other saline whereas the third group did not receive a bolus but received fluids slowly, to replace the amounts needed by a sick child who cannot drink. After the first hour, children in all groups were then given replacement fluids slowly.

For more information about the FEAST Trial findings, please visit our website atwww.chs.mak.ac.ug / content/feast clinical trial third expansion supportive therapy
Formative research on parent-child communication on sexual and reproductive health
This research was conducted by the Child Health and Development Centre (CHDC) between August 2010 and March 2011.  The study examined: adolescents├ö├ç├û and parents├ö├ç├û perceptions and experiences regarding communication on sexual and reproductive health. It also assessed school administrators├ö├ç├û and teachers├ö├ç├û perceptions and experiences with parent-child communication and the potential role of schools in enhancing this. The study also identified factors fostering and hindering parent-child communication and how best to address these issues. The findings from the formative study have informed the development of an intervention which will be implemented in 2012 in several schools and subsequently evaluated in 2013.

 

An assessment of the cost of providing cervical cancer vaccine through schools and Child Days Concluded
Since 2006, in collaboration with the Ministry of Health and Program for Appropriate Technology for Health (PATH), Child Health and Development Centre (CHDC) has undertaken a number of evaluations aimed at gathering evidence regarding the feasibility, acceptability and cost of introducing HPV vaccines into the primary health care system in Uganda. The study estimated the average financial cost per HPV dose delivered per girl fully vaccinated when delivering the HPV vaccination as part of the Child Days Plus program. The study also estimated the MOH/UNEPI financial requirements for scaling up the HPV vaccine after the PATH demonstration project and bridging activities were completed at the end of 2010.

 

Second line ART /EARNEST Study Cohort reaches a High 800
IDIÔÇÖs second line ART cohort has steadily grown to the current population of 830 clients (one of the largest 2nd line single-centre cohorts in the region). The IDI clinic is one of the main sites for the Europe-Africa Research Network for the Evaluation of Second-line Treatment (EARNEST). This study seeks to determine the best choice of ART regimens in resource-limited settings. The study enrollment target of 1200 participants was achieved and IDI contributed 221 participants (representing the 3rd largest group of participants from a single site).
The study has provided additional viral load tests that have facilitated timely switching of antiretroviral therapy. This has been a critical contribution to patient care given the lack of routine virologic monitoring within the programme. Additionally, IDI is leading two out of the five active sub-studies of the EARNEST study. These are the; 1: bone mineral density and body composition (BMD) study; and 2: the sexual behaviour study. These 2 studies are also critical opportunities to build the research capacity of IDI staff.

School of Public Health Research

A Post-Conflict Health Systems Research Program Launched at the School of Public Health
ReBUILD is a partnership research program to support health system development in post conflict countries or areas.  ReBUILD is a consortium of Southern and Northern research and training partners mainly involved in (health) system research. These include; 1) Makerere University (School of Public Health and School of Women and Gender Studies); 2) College of Medicine and Allied Health Sciences, Sierra Leone; 3) Biomedical Research and Training Institute, Zimbabwe; 4) Cambodia Development Resource Institute, Cambodia; 5) International Health Group, Liverpool School of Tropical Medicine; UK and the 6) Institute for International Health and Development at Queen Margaret University, Edinburgh.  
In Uganda, the research program is led by Makerere University College of Health School of Public Health and the College of Health Humanities and Social Sciences School of Women and Gender Studies; and was launched on July 27th 2011 at a ceremony presided over by the Director General of Health Services, Dr. Jane Ruth Aceng.
ReBUILD will focus on health financing, human resources and their interaction.
The purpose of this partnership is to generate research evidence that responds to the challenges that policy makers are facing in rebuilding health systems in Northern Uganda. Researchers will therefore engage with stakeholders from government, development partners, academia and civil society throughout the research process to ensure that REBUILD activities are relevant and support processes to develop the health system in post conflict Northern Uganda. The North of Uganda, especially the Acholi Sub region is facing particular health system challenges as a result of emerging from nearly two decades of conflict.

 Assessing the Feasibility and Acceptability of the Implementation of TB Infection Control Measures in Health Facilities of Mukono and Wakiso Districts
This study that just concluded assessed the feasibility and acceptability of implementation of TB infection control measures in resource limited settings like Uganda with health workers and patients as the key beneficiaries. Examples of such measures are; improving timeliness in TB diagnosis, attitudes of patients towards some of the measures like wearing masks, and how feasible it is for health workers to test for HIV and be provided with other prevention and care services.
It was a one-year comparative cross-sectional study with Mukono district as the intervention and Wakiso district the control district.
Preliminary findings show that: Some patients understand that there in need to prevent TB transmission with majority mentioning that TB patients should be separated. Some patients donÔÇÖt like being separated or be made to wear a mask as they feel this makes them look infectious. Others say that they can accept to wear a mask or be separated if the health workers communicated well and made them understand why they have to practice these measures. Health facility challenges of lack of staff and space in addition to lack of community awareness about TB were also mentioned as problems in trying to implement masking and separation of TB patients.

MakCHS staff have generated well over 300 articles from this research, published in peer reviewed journals of national and international repute. Some of these are archived at: http://dspace.mak.ac.ug/handle/123456789/12