Asthma is the commonest long-term disease in children across the world, but mainly affects those in low-income countries like Uganda. They suffer from severe and frequent asthma symptoms and attacks, and this leads to very frequent emergency clinic visits and hospital admissions. A lot of scare financial resources are spent on these visits, children miss school, and their caregivers miss work, driving families deeper into poverty and contributing to the widening health gap within and between countries. Both the affected children and their caregivers experience psychosocial challenges including stigma, which contributes to the overall poor quality of life of the affected persons and their families. The uncontrolled asthma symptoms also increase the risk of developing other long-term diseases like Chronic Obstructive Pulmonary Disease. Therefore, it is extremely important that children with asthma symptoms are identified early and given appropriate care to minimize the physical, economic and psychosocial problems described above. However, evidence from research in Uganda and similar countries shows that many children with asthma symptoms are not diagnosed and/or treated appropriately even when they frequently interface with health systems. This is partly due to the inadequate knowledge and skills of healthcare providers, and lack of innovative and locally relevant ways to improve identification of children with asthma symptoms. This study aims to understand whether innovations like checking every child and adolescent visiting primary care health facilities for asthma symptoms can lead to an increase in the number of children diagnosed with asthma, and whether education about asthma directed to patients and their caregivers can lead to improvements in the understanding of asthma, use of medicines and subsequent reduction in frequency of symptoms. The study will describe how and whether the training and mentoring of healthcare workers in the health facilities can lead to improvements in identifying and managing children with asthma symptoms. The study will also describe the psychosocial challenges faced by children and adolescents with asthma, and their caregivers. The health facilities in the study site (Jinja district in South Eastern Uganda) will be randomly divided into two groups. In one group, the healthcare workers will be given a standard form to be used to check for asthma symptoms among children and adolescents who will present with symptoms of lung diseases such as cough and difficult breathing. The second group will continue their usual practices of care. Data on the number of children diagnosed with asthma before and during the study will be collected and compared to determine whether the routine checking for asthma symptoms can increase the number of children diagnosed with asthma. A similar approach will be used in another study in which community health workers will be oriented about asthma and participate in educating the patients about asthma and asthma care, and how this can lead to better health for the affected children. In addition, healthcare workers in one health facility will be trained and mentored on diagnosis and management of the children and adolescents with asthma. The process will also involve holding discussions on the best approaches to be used, and documentation of the whole process to derive lessons which can be used in future similar research aimed at finding out if training and mentorship can lead to good control of asthma symptoms. This will be a pilot study. The data on psychosocial challenges will be collected by conducting individual and group explorative interviews. It is anticipated that the findings from the study will inform efforts to integrate asthma care into routine primary care services using evidence-based interventions.

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.

Abstracts are not currently available in GtR for all funded research. This is normally because the abstract was not required at the time of proposal submission, but may be because it included sensitive information such as personal details.

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.