Despite numerous efforts by many stakeholders, Uganda still has one of the highest maternal and infant mortality in the world with the maternal and infant mortality rates being 336 deaths per 100,000 births, and 55 per 1,000 live births, respectively as of 2016. Access to quality maternal and neonatal healthcare is being stretched by lack of access to trained health professionals with doctor to patient ratios in Uganda being 25 times higher than the minimum recommended by the WHO. The biggest percentage of Uganda's population live in rural communities where access to specialised care is a major challenge due to long distances to big health facilities. Approaches such as education, advocacy, increasing access to medicine and skilled birth attendance have been used to improve outcomes. However, many mothers in Uganda and other Low and Middle Income countries are dying due to conditions such as postpartum haemorrhage, preeclampsia and malaria, whereas neonatal mortality is mainly due to conditions such as pneumonia, sepsis among others. What is very evident is the clear need for early diagnosis, better access to therapy and improved monitoring. There is therefore an urgent need for innovative, cost effective and sustainable context specific approaches to healthcare delivery, which can reduce maternal and neonatal mortality within a resource limited healthcare system. Appropriate technological innovations present an opportunity to i) deliver economic and efficient improvements in maternal and neonatal outcomes at scale, ii) replace existing technologies which are not designed for the Ugandan healthcare systems and environment, iii) reduce waste and iv) drive local economic growth. Uganda is uniquely placed in SSA in that, driven by academia and supported by the Government, it is expanding local research and technical expertise in biomedical engineering, healthcare diagnostics and technologies and healthcare innovation. We propose to capitalise on a new strategic collaboration between the University of Makerere Biomedical Engineering Unit and College of Health Sciences, and the University of Edinburgh to strengthen capacity for our proposed interdisciplinary Centre of Design, Innovation and Translational Excellence (CITE), initially focused on maternal and neonatal health. Our medium to long-term aspiration is to act as a hub to build innovation and capacity in the region, to act as a blueprint to stimulate innovations beyond maternal and child health and to expand our technological and research expertise to become the leading centre for academic excellence and innovations in biomedical engineering in sub-Saharan Africa. Our initial broad objectives are: (1) To map existing knowledge about the systems and processes for clinical evaluation of locally made Investigational Medical Devices (IMD) amongst key stakeholders in Uganda; (2) To strengthen local research capacity through training on clinical trial design for investigational medical devices and medical writing for the regulation of such devices. Training seminars, sponsorships to attend good relevant courses and exchange bench-marking visits between Makerere and Edinburgh Clinical Trials Units are some of the activities aimed at achieving this objective. The output of this objective is develop a critical mass of Ugandan researchers knowledgeable in IMD trial design, with specific expertise on trials in maternal and neonatal health; and (3) To establish a multi-disciplinary network with the expertise to develop a draft regulatory framework for Investigational Medical Devices, bespoke for Uganda.

In this proposal, Makerere University (hub) intends to work with the University of Witwatersrand, University of Ibadan, Moi University, University of Rwanda and University of Western Cape (spokes) and their partners to enhance the capacity of Gender and Social Work Departments to research changing notions of motherhood and fatherhood, and to use the results to advocate for improved family and child welfare policies and interventions. The preference for Sciences in Africa led to a reduction in research funding for the Humanities and Social Sciences, negatively affecting the interest and capacity to research contemporary social challenges affecting the continent, including identities, motherhood and fatherhood. The notions of Motherhood and Fatherhood are at the core of the debate on gender identities, socialisation, perceptions, status, realities and imaginations. These identities are created, (re)negotiated, contested, affirmed and (re)born at different levels; at family/ household level, community, cultural traditional, national and global levels. Yet motherhood and fatherhood as identities also change and transform. Symbolic representations of motherhood and fatherhood become political especially when informed by ideologies surrounding nationalisms-whether national or tribal, subsequently informing ideals about manhood, womanhood; or masculinity and femininity. Research on motherhood and fatherhood globally points to various forms of fathers and mothers. What do these forms mean or how important are these forms to fathers, mothers and subsequent proof of masculinity and femininity? Different developments, such as colonialism, urbanisation, HIV/AIDS, war and conflict, structural adjustments and technology have reshaped and transformed the material and cultural foundations of parenting, and with it the gendered identities of motherhood and fatherhood. Nonetheless, there is a tendency to treat them as temporary and or deviant from the norm. As a result, there is a dearth of research in family studies. With a few exceptions, research in motherhood and fatherhood in Africa is undertaken as a socio-demographic variable explaining certain economic trends and as a predictor of reproductive health and child wellbeing and outcomes. Limited research has been undertaken to focus on parenting and what the identities of motherhood and fatherhood imply for those who perform them, and how they perform them. Consequently, there is limited evidence for legislators and policy makers in family relations and children's welfare to work with. With the exception of South Africa, we continue to see Family and Children's policies and laws which assume that all mothers are married and will have the support of a spouse or at least extended family. Key questions to be examined will include the following: (1) What are the changes in motherhood and fatherhood in Africa and how does it relate to changes in femininity and masculinity? (2) What are the major drivers of these changes? (3) How best can these changes be conceptualised, studied and researched about? (4) How can researchers engage policy makers for child friendly parenting policies in view of these changes? In this multi-disciplinary proposal, Makerere University and her six collaborators seek to explore ways to enhance the capacity of researchers to research motherhood and fatherhood, and to engage policy makers for better family and child friendly policy making and interventions. This theme is trans-disciplinary, bringing together expertise from Gender Studies, Social Work, African Studies and Ethics to generate new knowledge and build researcher's capacity through research and ethics training, doctoral and post-doctoral research support, conference presentations, workshops and publications to mention a few.

Thanks to medical advances, people living with HIV (PLHIV) can now live long, healthy lives. To remain healthy, PLHIV will need to take drugs against the virus (called antiretrovirals) for the rest of their lives. Antiretrovirals are generally safe but cause serious side effects in some people, particularly with long-term use. Common side effects are discovered in clinical trials; if they are too severe or too common, the drug will fail the trial. It isn't possible to test enough people in a clinical trial to discover less common side effects. These can only be found by monitoring people taking the drug in the real world. Recording which people have side effects and understanding why they happen is essential for making drugs safer. We work in Uganda where 1.5 million people (3.5%) live with HIV. Uganda recently began a programme to rapidly roll-out antiretroviral combinations including dolutegravir (DTG), the new drug recommended by the World Health Organisation (WHO), to PLHIV. Uganda is also rolling-out Isoniazid Preventive Therapy (IPT) to prevent active tuberculosis - the main cause of death in PLHIV. Systems for monitoring drug-related side effects have only recently been developed in Uganda, so we do not understand the risk factors for side effects of the new HIV drugs in Ugandan PLHIV. These include 'clinical' risk factors, such as having other medical conditions, or 'genetic' risk factors, natural variations in a person's DNA that increase the risk of a side effect. Some DNA variations are more common in people of particular ethnicity, so it is essential that we record side effects across all ethnic groups. We aim to: 1) understand which PLHIV are at risk of a side effect to DTG or DTG with IPT and why; and 2) strengthen the systems for reporting drug-related side effects by empowering PLHIV to make their own reports. These are essential steps to enable us to treat each PLHIV with the right antiretrovirals at the right dose in the future. We will recruit 10000 people receiving DTG or DTG plus IPT from eight clinics across Uganda to investigate: 1) how the clinics currently aim to prevent, monitor and treat side effects in these people; 2) which side effects occur and how common they are; 3) whether there are common clinical risk factors across people with side effects; 4) whether there are genetic risk factors for the most concerning of these side effects, high blood sugar. We will also recruit 15,000 people receiving DTG or DTG and IPT to investigate whether mobile applications, 'apps', can improve monitoring of drug-related side effects in Ugandan PLHIV. We will test the Med Safety(R) mobile phone-based app, developed by a European drug safety project. The app has been adapted for Uganda's National Drug Authority (NDA) by the UK's Medicines and Healthcare products Regulatory Agency (MHRA) but isn't yet widely used. The app will enable PLHIV to report side effects directly to NDA. In return, NDA will provide PLHIV with updates on drug safety and take actions to safeguard their health. By the end of the project we will know the main clinical risk factors for side effects in people treated with DTG or DTG with IPT in Uganda and the genetic risk factors for developing high blood sugar. This will form the basis for personalised treatment in the future. In the longer term, our work has the potential to benefit those living throughout sub-Saharan Africa and beyond. The risk factors for drug-related side effects seen in Uganda could give insight into the complex interplay between clinical, genetic and environmental factors in other population groups. Our learning from deploying the Med Safety(R) app across a population that encompasses large, developed cities and isolated rural areas will be invaluable for wider global efforts in drug safety monitoring. Our strong links with National and International agencies including the NDA, MHRA and WHO will help to ensure that our work improves the safety of PLHIV.

Health institutions worldwide, including the World Health Organization (WHO), have recognised that adoption and innovative use of information from electronic medical records will be necessary to provide equitable care to the growing population of the world. Uganda is committed to meeting this goal, however, there are challenges to developing and implementing electronic health record data capture and analysis systems, especially as implementation of these systems have mostly occurred in high-income countries where challenges are different. In this project, we will assess whether or not Uganda is ready to implement an electronic health record data capture system at the point of care that can centrally process information through statistical analysis and provide important information to care providers and public health practitioners to support healthcare delivery. This assessment involves collecting information from key stakeholders about barriers, facilitators, costs and other 'readiness' factors, such as acceptability and training of the healthcare professionals who will enter data into the system. We will map these measures to known models of electronic health record adoption readiness and technology adoption success. We will also assess the opinions of the community on how their health information should be handled and used. Additionally, we will look at the technology components of this system that may already exists and determine the costs to provide all necessary components. Finally, we conduct analyses to determine how long it will take to see benefits in terms of cost savings in healthcare provision. The Ministry of Health in Uganda has recommended a 'stepped' approach to adopting electronic health records, we will therefore focus on areas of greatest concern to the Ministry of Health. While Uganda has a number of important health concerns, such as child and maternal health and cancer, we will focus predominantly on malaria and HIV, and also look at scope for other infections. The reason for this choice is that these infections are still some of the leading health problems in Uganda, and they are treatable. This means that if successful implementation of electronic health record data capture occurred, combined with faster, more efficient and effective treatment due to processing those data and providing key information, such as who to target for testing and treatment, we could reduce costs to the health system and increase human health. The findings of the study will be shared with the scientific community and provided to the Uganda Ministry of Health as a report. The Ministry of Health plans to use this report as a guide to developing their electronic medical record and information analysis platform.

Access to healthcare remains a big challenge in Africa. The situation is particularly appalling for border resident communities as they are often not given priority by policy makers. The existence of different state territorial sovereignty, administrative frameworks with different currencies, support services, legal/regulatory systems, and languages make healthcare access for border resident populations even more complex. Unlike in the central areas; in some sparsely populated border areas, the nearest facility may be in another country. Another significant barrier lies in the economic deprivation to which the border areas are usually exposed. In this era of Universal Health Coverage, how are communities residing along national borders going to be served without any financial burden as well as ensuring their overall wellbeing? This is an overarching question we intend to contribute to. This will be done through a study conducted at five paired-cross border sites in East Africa. Specifically; four interrelated objectives are proposed; Objective 1: This will explore the existing legal-institutional contextual constraints and enablers to access to cross border healthcare services for border resident communities, by way of two main methods; 1) review of administrative and legal documents and 2) Key Informant Interviews with border officials and managers of political administrative units near the border. Objective 2: This objective will explore the health systems constraints and implications for serving border communities. Key informant interviews will be the main methods for this objective. District or county health managers and providers will provide the bulk of this category of respondents. CBOs working to improve health services will also be included in the survey as key informants. Objective 3: This objective will determine how border resident communities navigate legal-institutional and health systems constraints and enablers to health service access. Two main methods will be used a) Survey of those that successfully manage to access services across the border and b) Focus Group Discussions (FGD). For the survey, Appreciative Inquiry (AI) approach will be taken to probe the access pathways for those that have successfully navigated access to three selected services on the other side of the border. We will undertake FGDs to help to mitigate the limitation of surveying only those that successfully navigated the access barriers. The FGD participants will include potential services for cross-border services ie 1) mothers attending child immunization services, and 2) community leaders - including community health workers. Objective 4: This objective aim to identify feasible actions to advance the access and coverage agenda to services for the communities residing along state borders. This will be done through; 1) convening stakeholders to deliberate on the findings from objectives 1, 2 and 3 in order to influence policy and practice and 2) sharing the study findings with the highest regional policy platforms. At these meetings we shall engage sub national, national, and regional policy practitioners to make salient the need to plan for border resident communities. Relatedly, the findings will also be disseminated at local, regional and international conferences in addition to publishing in peer review journals. The survey is anticipated to increase understanding of healthcare access issues and the health systems implications for serving border resident communities. In turn border resident communities will benefit from improved cross border healthcare provision and greater EAC cooperation in health care delivery.