Research

The project is an applied interdisciplinary research project on the enhancement of competences of people with disabilities in the fields of transport, communication and rehabilitation.

Codenamed; Disability & Technology or D&T project, brings together researchers as PhD students from Uganda and and Switzerland. The project runs from February 2014 to February 2017.

The project conducts 2 schools every year, summer school and winter school. These schools help the researchers to read and discuss several academic papers and concepts for a deeper understanding of their work and developing logical arguments. Being an applied research project, stakeholders’ dialogues and meetings are held, to share with the practitioners on issues arising out of the studies, so as to identify possible practical gaps that can be bridged by the project.

Objectives of the Project

The overall objective of the project is to propose innovative, locally applicable and sustainable ways of enhancing the use of technologies and thereby have a positive impact on the lives of people experiencing disability through careful scrutiny of cases of local disability cultures in view of alternative technology application concepts.

The objectives are:

To produce genuine knowledge about how different kinds of technologies in the field of transport, communication and rehabilitation are appropriated or rejected and affect the social, economic and personal opportunities of people with disabilities in Uganda.

To develop new theoretical and applicable concepts and models of local technology integration for global development strategies.

To enhance the competences of people with disabilities in using technologies to their full potential and develop an accessible environment. In cooperation with stakeholders, research-based intervention strategies will be conceptualized.

PROJECT TEAM

Supervisors

Dr Herbert Muyinda –Supervisor

Dr David Kyadonddo – Supervisor

Gitte Beckmann- Supervisor

Students and their research topics:

Marie Schuler : “Disability in Refugee settlements”

Francesca Rickli ; “Disability and ageing in Switzerland”

Ambrose Murangira ; “Health communication among the Deaf”

Rehema Bavuma : “ageing, disability and technology”

This research is a collaboration between ICF/MACRO and CHDC. Uganda’s Option B+ Program initiates all pregnant and breastfeeding women on daily antiretroviral therapy (ART) for life, regardless of their initial CD4 cell count. Many women do not adhere to treatment and drop out of the PMTCT program. This research seeks to understand gender-specific factors that influence women’s non-adherence to treatment and participation in the PMTCT program. The research focuses on maternal, interpersonal, and programmatic/systemic factors that interplay with gender factors to influence attitudes and practices of HIV+ women who are in PMTCT programs and those who do not adhere to medication and have dropped out.

CHDC in collaboration with MUSPH and Karolinska Institute is conducting case studies and synthesized lessons learnt from the CODES intervention. CODES is funded by Bill and Melinda Gates Foundation through UNICEF. CODES is premised on the assumption that proven effective interventions recommended by WHO and UNICEF that are likely to prevent deaths from pneumonia, diarrhea and malaria among young children have not been adequately prioritized and implemented by local governments especially at district and community level partly due to poor management capacity. This is manifested in: lack of sufficient expertise to local data to select and contextualize interventions; district health management systems placing insufficient emphasis on results; lack of capacity for identification of bottlenecks; no financial leeway to initiate and carry out context specific solutions and failure to consistently involve communities as active proponents in helping overcome obstacles to effective coverage, identifying access barriers and helping stimulate better quality of services. CODES combines management, diagnostic and evaluation tools to: analyze bottlenecks hindering the scale up of locally prioritized child survival interventions and provides districts specific solutions to improve coverage; builds capacity among district health management teams to develop and implement context-specific solutions and foster community monitoring and social accountability to continue improving the delivery of services as well as increase community demand. CODES is premised on the hypothesis that implementing interventions that have been prioritized based on district specific epidemiologic profiles and bottleneck analysis, combined with quality improvement interventions to improve management, and appropriate community mobilization will lead to accelerated scale up of key protective, preventive and curative interventions against pneumonia and diarrhea mortality among children under five.

This is a 21 session community-based parenting programme jointly implemented by the Child Health and Development Centre, Makerere University, and The Medical Research Council/UVRI, for the early prevention of gender based violence and child maltreatment in Uganda. It addresses four familial processes associated with such violence: poor parental bonding and child attachment; harsh parenting; gendered socialisation; and parental conflict.

In 2013 we embarked on developing a manual to facilitate training of six parental groups in the formative phase in Kigungu near Entebbe and Bweya, Ssissa sub-county in Wakiso district. Kigungu is largely a fishing community and Bweya is peri-urban. In Kigungu two gender-specific groups comprising 15-20 parents were recruited and trained by an expert trainer, assisted by a trained local facilitator for 10 sessions, and mid-way through the programme, the men-only and women-only groups were mixed and trained for another 11 weeks on various aspects of parenting and spousal relationships. In Bweya, four groups have been identified and sessions are currently underway. A large scale pilot with a before-and-after outcome evaluation is planned in Luwero district. The programme promises to improve some skills and social norms around parenting and spousal relationships.

This study examines equitable and inequitable gender attitudes and their consequences on behavioral outcomes – including intimate partner violence (IPV), and SRH knowledge, attitudes and practices – among young people in Uganda. A quantitative household survey to investigate gender attitudes and its potential relationships with several key behavioral outcomes such as violence, unsafe sex, and access to care in a representative sample of 930 young Ugandan males and females aged 10 to 24 years old was conducted. In addition, among a subsample of 40 survey participants, ages 15 to 24, a qualitative study was conducted in order to gain a greater understanding of the factors that influence their nascent gender attitudes. The study will provide critical information to policymakers and programmers in designing relevant interventions, aiming to increase equitable gender attitudes and healthy SRH behaviors and practices in Uganda.

The Link Up consortium is a global HIV and sexual reproductive health (HIV/SRH) integration project carried out in five countries: Bangladesh, Burundi, Ethiopia, Myanmar, and Uganda led by the International HIV/AIDS Alliance (IHAA). Studies conducted under Link Up aim to identify and evaluate effective program strategies, and fill specific knowledge gaps about critical HIV and sexual and reproductive health (SRH) issues affecting key populations. In Uganda the collaborators are Population Council, Community Health Alliance Uganda (CHAU), Marie Stopes-Uganda (MSU), and Child Health and Development Centre (CHDC).  The focus of the research has been on young people.

Funded by Grand Challenges Canada the research started in September 2012. This is a 3 year intervention research project being implemented in the Districts of Gulu, Nwoya and Amuru. It aims to; Increasing access to care and utilization of mental health services for people with common mental illnesses (depression, PTSD, suicide behavior and anxiety disorders);Reduce stigma among people with mental illnesses and their families and assess the effectiveness of Wayo-Nero model in enhancing access to and utilization of mental health services. A Baseline survey was conducted between January and June 2013). Psychiatric Nurses have been recruited and trained and 360 Wayos and Neros (Mental Health Community Counsellors) have also been selected by the community and have been trained. The main problems being presented by the community include depression, alcoholism, epilepsy, shortage of the necessary medicines, and failure to respond to referral due to fear of stigma and long distances to the health facilities.

The Population Council in collaboration with Child Health and Development (CHDC) Makerere University will conduct research in Uganda to support uptake of key HIV services and prevention behaviors by male sexual partners of adolescent girls and young women (AGYW, i.e. women ages 15-24). This research is part of a portfolio of implementation science (IS) studies for the DREAMS Initiative, a program to significantly reduce new HIV infections among AGYW in high-incidence areas of 10 countries in sub-Saharan Africa.  

Similar to many other African countries, AGYW are particularly vulnerable to HIV in Uganda, which has an adult HIV prevalence of 7.6%, and a prevalence among young women ages 15-24 of 3.7% versus 2.3% among young men.[1] It is important to understand both AGYW and their male partners’ perspectives on dynamics and risk perceptions within their relationships, as well as to find effective ways of linking men to underutilized HIV prevention and clinical services, including HIV counseling and testing (HCT) and early antiretroviral therapy (ART). Currently, little is known in Uganda about the characteristics and perspectives of male partners of AGYW, dynamics within their sexual relationships, and what they want from HIV services, information that could improve service uptake and impact. In addition, the DREAMS Initiative in Uganda includes various programmatic strategies to reach and retain male partners of AGYW in these services, presenting an opportunity to explore those strategies in depth.

The overarching goal of this study is to support uptake of key HIV services and HIV prevention behaviors by male sexual partners of adolescent girls and young women (AGYW) in Uganda. The specific objectives of this study are: (1) to improve understanding of the sexual dynamics between AGYW and their male sexual partners and what male partners want from HIV services, in diverse locations in the country; and (2) to explore DREAMS strategies to link male partners of AGYW to key clinical HIV services (HCT, ART). The research will be carried out in an urban and rural location within three districts where the DREAMS Initiative is taking place: Mukono (Central1 region), Sembabule (Central2 region) and Gulu (Mid Northern region). 

To meet Objective 1, up to 30 in-depth interviews (IDIs) per district (approximate total of 90 IDIs) with male partners of AGYW will be conducted to understand sexual relationship dynamics, perceptions of HIV risk, knowledge of HIV prevention and transmission, and insights into potential strategies to decrease their HIV risk including HIV testing and treatment services. In addition 6 focus group  discussions (FGDs) (2 per district) will be conducted with key informants, including community opinion leaders, DREAMS implementing partner staff and HIV service staff, to provide an overview of the context and types of relationships between male partners and AGYW.  Data will be collected in first quarter of 2017. 

To meet Objective 2, a secondary analysis will be conducted of monitoring data from DREAMS programmatic activities and will yield information about the reach of DREAMS HIV prevention and gender norms programming and men’s uptake of HIV testing, care and treatment across the intervention period. To explore individual reasons for uptake and non-uptake in more depth, qualitative IDIs will be carried out with up to 30 men (10 per district) drawn from the sample of participants in the first IDIs (forming a qualitative cohort) and who report participating in DREAMS programming and subsequently linking or not linking to HIV services. This data collection will take place during Q4 2017, towards the end of the currently planned DREAMS intervention period. Finally, 6 FGDs (2 per district) will be conducted with key informants including DREAMS outreach and HIV service staff to further explore perceived successes and challenges of strategies to link men to services. 
 

The purpose of the study is to find out whether vaccination against some types of the germs that causes cancer of the mouth of the womb (cervical cancer) and/or a contagious wart of the private parts decreases the chance of catching the germ that causes AIDS. Both germs are very common in Uganda. Young women easily catch these germs soon after they start having sexual intercourse. We are interested in learning about the level of the germ that causes AIDS (HIV) among adolescents and young  girls (15-24) who received HPV vaccination in 2012/13 and 2013/14 and compare them with those who did not receive the vaccination in Oyam district.  

Institutional care for vulnerable children may be inevitable in certain circumstances and can result in some positive benefits. However, institutional care is increasingly being scrutinized in many countries, and recommended as a last resort. Children growing in institutional care are prone to negative consequences for their development, including poor health, greater probability of antisocial behavior, and reduced intellectual, social and behavioral abilities. The family provides a better environment for children to grow well as it provides a natural, safe and nurturing environment that promotes normal growth and development as well as better health and wellbeing. The government of Uganda recommends de-institutionalization of child care through reintegration of children as well as systems and family strengthening interventions to reduce the risk of children losing family care.  

A consortium of four organizations: SOS Children’s Villages, ANPPCAN, Alternative Care Initiatives and Makerere University Child Health and Development Centre have designed a three year (June 2016-December 2018) formative evaluation of an intervention ‘The Alternative Care Consortium on Systems Strengthening’ (ACCoSS). The project aims at addressing the causal factors that have perpetuated institutionalization of children. The main objective is to promote appropriate family based care for children through an integrated systems strengthening approach in Buikwe, Mukono, Wakiso and Kayunga districts. 

This is a mixed methods longitudinal study employing both quantitative and qualitative approaches. Baseline quantitative data will be collected from a total of 300 child-parent dyads among children to be reintegrated and a series of repeat qualitative interviews will be conducted at three intervals during the course of the project to collect data regarding acceptability and experiences and impact of the ACCoSS project on children, families, and systems at national, district and community levels. 

RESEARCH PROPOSAL SUMMARY
RESEARCH QUESTIONS TO BE ADDRESSED BY THIS PROPOSAL 
This formative research addresses the following major questions: 
1.    How the ACCoSS project is received (acceptability) and perceived in terms of relevance by the target groups? What is people’s reaction to the project?
2.    What is the most appropriate mode of implementing the ACCoSS interventions? How comparable are the different approaches of the implementing partners?
3.    What is the process and experience of conducting child assessment for readiness? What is the most appropriate way and process to identify and trace the families to reintegrate children? How participatory should the process of reintegration of children be – mobilization, involvement of the relevant institutions? 
4.    What is the most productive way to conduct community dialogues and engagement with local existing structures 
5.    What is the process and experience of reintegrating children to their families or alternative caregivers, and how is it perceived by the children, the families, and institutions targeted? How do relations and interactions between the different actors develop and/ or be affected by this process? What adjustments are necessary for them in order for this process to be effective? What gender patterns are emerging in relation to reintegration?
6.    How do the various ACCoSS interventions that children and households receive (such as provision of temporal family support, referral for health care, supporting children to receive legal services, education support for reintegrated children) affect the households and children in terms of livelihood and vulnerability, family relationships, parenting skills, and child well-being?  
7.    How effective is mobilization of vulnerable families in strengthening their networks, capacities and resilience to take advantage of existing opportunities for VSLA?  

RATIONALE
Background and reason for conducting the study
Institutional care for vulnerable children may be inevitable in certain circumstances and can result in some positive benefits. However, institutional care is increasingly being scrutinized in many countries, and recommended as a last resort. Children growing in institutional care are prone to negative consequences for their development, including poor health, greater probability of antisocial behavior, and reduced intellectual, social and behavioral abilities. The family provides a better environment for children to grow well as it provides a natural, safe and nurturing environment that promotes normal growth and development as well as better health and wellbeing. The government of Uganda recommends de-institutionalization of child care through reintegration of children as well as systems and family strengthening interventions to reduce the risk of children losing family care.  

A consortium of four organisations: SOS Children’s Villages, ANPPCAN, Alternative Care Initiatives and Makerere University Child Health and Development Centre have designed a three year (June 2016-December 2018) formative evaluation of an intervention ‘The Alternative Care Consortium on Systems Strengthening’ (ACCoSS). The project, funded by Terre des Hommes (TdH) aims at addressing the causal factors that have perpetuated institutionalization of children. The main objective is to promote appropriate family based care for children through an integrated systems strengthening approach in Buikwe, Mukono, Wakiso and Kayunga districts. 
Objectives of the study
The ACCoSS project aims to generate an evidence base on alternative care systems strengthening and reintegration interventions undertaken during the project. The objective of the formative research is to 
study the process of implementation of the ACCoSS project, examine the lessons learned, and evaluate the impact of the intervention. 

We plan to collect empirical evidence before, during and after the design and delivery of the ACCoSS project, to clarify the appropriateness of the ACCoSS intervention in the lives of the children being reintegrated and their families, its design and implementation process and the impact of project.

Methods
This is a mixed methods longitudinal study employing both quantitative and qualitative approaches. Baseline quantitative data will be collected from a total of 300 child-parent dyads among children to be reintegrated and a series of repeat qualitative interviews will be conducted at three intervals during the course of the project to collect data regarding acceptability and experiences and impact of the ACCoSS project on children, families, and systems at national, district and community levels.  
Stage 1: Baseline 
Baseline data will be collected from all (census) the 150 children target for reintegration and their families (150) to obtain basic quantitative information about their demographic and socioeconomic status. Secondary documentary review shall be undertaken to provide wider contextual insights on the determinants of child vulnerability to losing parental care and separation from their families
Stage 2 Longitudinal qualitative studies 
These will be with (a) children being reintegrated, (b) their families. At least 3 repeat interviews with all children targeted for reintegration and their families will be conducted before (collected alongside quantitative data), during and after project implementation. In particular qualitative data will be collected from the children and families, three times during the course of the project as follows:
Phase 1: This will be conducted approximately in November-December 2016. interviews with the child/family, community structures and CCI during and or shortly after being selected for the ACCoSS project. 

Phase 2 :  It will be conducted approximately in May-June 2017. This repeat interview will take place six months after the child/family has been enrolled into the ACCoSS interventions/ being resettled. 

Phase 3  : Will be approximately May-June 2018. This final interviews at the end of the project, as part of final evaluation to assess how reintegrating has worked, assess the successes (and failures), outcomes of the intervention, based on the embedded theory of change. 

Study sites and sample selection  
Data will be collected from four ACCoSS project districts namely: Wakiso, Mukono, Buikwe and Kayunga.

Procedures:
On the day and time of the interview, participants will be given two copies of the attached Informed Consent Form, one for them to keep and one (signed) for the research team to keep for records. The Consent Form (attached) states the objectives of the study and includes information concerning confidentiality, maintaining security of all documents, and being respectful towards the participant’s experiences and emotions throughout the interview. Participants will be asked to read the form thoroughly or it will be read to them if they are not able to read, and sign it only if they are willing to participate. If they sign, the researcher will once again verbally summarize the consent policies and will remind them that they are not required to answer every question, they can take a break if needed, and that they have the power to terminate the interview at any time, without penalty and without affecting our relationship. Since the children and families involved are already vulnerable in many different ways, a critical issue will be to ensure that the research does not further harm them. We will be sensitive to this in terms of the questions being asked, and if a child shows signs of distress the interview will be discontinued/halted, and he/she will be linked up with the social workers in the project or if they prefer they can be referred to their usual service provider if any, and facilitated with transport if necessary.

Benefits: There is no direct benefit received from your participation in this research, but your views and ideas will enable the PI gain a clear understanding of issues surrounding reintegration and alternative care so that alternative care programming and implementation may be improved.   The PI will use your views/ responses, along with information from others to determine how well ACCoSS project interventions can be implemented, improved and monitored to meet the desired objective, for the benefit of all children in similar circumstances, in Uganda.  The indirect benefits may include an opportunity for you to increase your knowledge about issues surrounding reintegration, alternative care, as well as having your questions answered.   

Risks
The consortium members are aware of the potential risk of children’s interests being abused during the implementation of the ACCoSS project, if due diligence is not taken at all stages of the project. Within the framework of their own institutional child protection policies, each member of the consortium therefore commits to priorities the best interest of the children and their families by following standard operating protocols. 

We do not anticipate serious risks to children resulting from our interviews. Potential risks may include psychological distress arising from answering certain questions and reflecting on their plight or recalling some previous negative life experiences. CHDC will ensure that the research is reviewed by relevant IRB, and that assent is obtained from children and consent from their family/caregivers at different stages of the study process. We will adopt child centered approaches to data collection in which children’s perspectives will be generated with extreme care and will as much possible try to minimize causing further distress to the children being.

COMPENSATION
The children or families will not be provided any financial incentives since they will be interviewed either in the child care institution or at home. It is assumed that the parents/care givers and children involvement in the study will have benefited/ expected to benefit from the wider support provided by our partners implementing the ACCoSS project, and therefore will need not other incentive from the research component of the project. 
 
Reimbursement:  
While the research will not provide reimbursement, it is understandable the in the event that a respondent incurs costs such as transport in order to participate in the research, in another alternative venue other than his/her place of residence, then the PI will reimburse the respondent with what he/she has spent on transport, which should not exceed UGX 10,000 (USD 3).