With the aim of producing One Health graduates with transformative knowledge that can contribute to preventing, detecting and responding to infectious disease outbreaks, OHCEA implemented initiatives that are building a competent One Health workforce, targeting the pre-service level. In addition to incorporating One Health concepts in the didactic curricula, other pre-service capacity building initiatives involved all colleges and included: the Makerere University Students’ One Health Innovation Club (MAKSOHIC); the development of a One Health Institute (OHI) (One Health theoretical principles, field placements, and fellowships); small grants, research and innovations; and collaborative teaching as described in detail below.
Makerere University Students One Health Innovation Club (MAKSOHIC)
Using a platform in which students from different disciplines convened for innovative intellectual debate and engagement around identified One Health challenges, participants developed skills and competences in One Health leadership, collaboration and teamwork, community engagement, research, innovation and scientific communication. Open to scholars at all Makerere University colleges, over 560 students from academic disciplines, such as veterinary medicine, environmental health, engineering, social sciences, agriculture and nursing have been involved (40% from College of Veterinary Medicine, Animal Resources and Bio-Security (CoVAB), 25% from College of Health Sciences (CHS), 10% from College of Humanities and Social Sciences (CHUSS), 10% from College of Engineering Design, Art and Technology (CEDAT), and the rest from other colleges).
The club led by seven elected student members, has a constitution which was developed for and by the club members. It is mentored by University faculty patrons and builds students’ skills during hands-on community engagement activities, such as outbreak investigation and rapid response, risk communication and public sensitization on priority zoonotic diseases (e.g., rabies, Ebola, Rift Valley Fever, plague) which are part of the Global Health Security Agenda (GHSA) (21). Students’ participation in national response to disease outbreaks in Ugandan communities are summarized in Table 1.
Table 1: Summary of outbreaks in Uganda in which Students One Health Innovation Club members have been involved
Outbreak
|
Period
|
Region (District)
|
Activities
|
Rift Valley Fever
|
February 2016
|
Western (Kabale)
|
Identification of missed cases including contact tracing; Outbreak characterization; Case data collection and analysis; Risk factor assessment through interviewing suspected cases; Line listing of suspected cases; Report writing; Post outbreak evaluation on Interventions of Rift Valley Fever
|
Yellow Fever
|
April 2016
|
Central (Masaka)
|
Identification of missed cases including contact tracing; Outbreak characterization; Case data collection and analysis; Risk factor assessment through interviewing suspected cases; Line listing of suspected yellow fever cases; Report writing
|
Highly Pathogenic Avian Influenza (HPAI)
|
February 2017
|
Central (Shores of Lake Victoria: Masaka, Mukono, Nakasongola, Wakiso, Kalagala)
|
Social mobilization and sensitization; Stakeholder coordination meetings; Risk and impact assessment of HPAI; Sample collection; Infection control training; Report writing
|
Anthrax High Alert
|
July 2017
|
Northern (Arua)
|
Epidemiological study to assess factors associated with anthrax outbreak, including community knowledge, attitudes and practices regarding the outbreak; Identification of active human cases and animal deaths due to anthrax; Report writing
|
Crimean Congo hemorrhagic fever (CCHF)
|
September 2017
|
Central (Kiboga and Nakaseke)
|
Risk assessment of CCHF in livestock; Post evaluation of case management in the hospitals that handled the CCHF cases; Report writing
|
Marburg
|
October-November 2017
|
Eastern (Kween and Kapchorwa)
|
Designing active case search tool and systematic case finding including entry and management of the active case search logs and contacts listed; Daily situational reports; Cross-border surveillance; Community sensitization using film vans; Receiving/responding to alerts of suspected cases; Record review (passive surveillance) in health centers; Assessment of water sanitation & hygiene, infection control and prevention (IPC) standards in health facilities; Engagement of traditional healers as a key social and belief structure of the affected communities; Orientation in basic IPC drills for field surveillance teams
|
Other interventions in communities included mass vaccination of dogs and cats against rabies (Figure 1), rabies prevention awareness for school going children in Kampala city, deworming of domestic animals, and sensitization on zoonotic diseases among meat handlers in abattoirs. Students’ engagement in these activities was important for building their capacity in leadership, collaborative approaches, awareness campaigns and community engagement, including mobilization and sensitization. During such community engagements, students joined other partners whose contribution to their training activities has been critical. Key partners included the National One Health Platform [a collaboration between the Ministry of Health, Ministry of Agriculture Animal Industry and Fisheries, Uganda Wildlife Authority and Ministry of Water and Environment and other agencies/entities including Food and Agriculture Organization of the United Nations and research institutes, such as the Uganda Virus Research Institute.
One Health Institute
The development of a One Health Institute improved multidisciplinary training on management of infectious diseases for undergraduate and graduate students. In the Institute, facilitators from different specialties and disciplines engaged students through didactic instruction on theoretical principles of One Health, followed by experiential learning through field placements and fellowships.
a) One Health theoretical principles
One Health theoretical principles were explored through modules designed to provide the multidisciplinary participants with transformative knowledge, fostering abilities to prevent and mitigate risks at the animal-human-ecosystems interface. The modules were offered to both undergraduates and postgraduates, and participants were competitively selected from different colleges and disciplines within the University, including public health, social sciences, agriculture, veterinary medicine, zoology, biomedical lab technology and economics. The seven modules offered were: (i) Leadership in Infectious Disease Management; (ii) Gender and Risk Management; (iii) Health Policy Analysis; (iv) Bio-risk Management; (v) Disease outbreak Investigation and Emergency Response; (vi) Antimicrobial Resistance and (vii) Community Engagement. Participants were also challenged to innovatively think about problems in terms of entrepreneurship, a socio-innovation concept that they later applied when addressing community challenges during field placements. The multidisciplinary delivery model involved group discussions, role playing, case studies and simulations.
b) Undergraduate field attachments
Field attachments aimed to equip students with hands-on experiences, while giving them an opportunity to apply taught course concepts. In the attachments, groups of students from different disciplines were assigned to one of the eleven One Health field demonstration sites in Uganda for a period of 2-4 weeks. Students conducted problem prioritization and stakeholder identification and engagement, and developed daily action plans through student-led discussions. They were required to carry out projects aimed at addressing a community problem using limited resources, during which all students worked together to suggest appropriate interventions grounded from their disciplines, as well as implementation of a multidisciplinary solution. Highlights of projects from these placements include: using locally available resources to develop repellents to expel bats from infested households and institutions; water treatment systems for use at the household level; and novel hand washing facilities. In another example, a food market in Hima Township of Kasese District had a problem of accumulated charcoal dust residue. In response, a team of students led a community session on how to recycle this waste (charcoal dust) into briquettes, which also served as an additional solution to rising energy demands in the community. Following the attachments, the teams successfully wrote reports and disseminated findings to the district officials, local communities and other key stakeholders to ensure sustainability and ownership of interventions.
c) Graduate fellowships
The One Health Institute also offered multidisciplinary fellowships for graduate students using a mentorship-training model. Following discipline-specific training in their respective programmes and the One Health theoretical principles, graduate students were placed at selected partner organizations and assigned two mentors (academic and field) to support and guide them to acquire One Health competencies. These competencies included problem-solving, multisectoral communication, community engagement, proposal writing, scientific writing and publication. Some of the practical tasks the fellows completed offered important learning opportunities in: submission of financial requisitions, budgeting, acquisition of supplies, collection of samples, submission to laboratories, teambuilding, moderating of discussions, and scientific and financial reporting.
As a primary training activity, fellows conducted a situation analysis at the organization of placement to identify a problem that could be solved using the One Health approach and their newly-acquired competencies, and proposed an intervention to aid the community. Specific technical competencies acquired included Monitoring and Evaluation of OHCEA Field Attachment 2017 and Amref-Health Africa; data analysis at the Uganda National Laboratory Systems involving disease investigation; risk analysis and mapping disease hotspots and zoonoses with the Food and Agriculture Organization; Human Centered-Design-Thinking with the Resilient African Network; drafting training manuals on antimicrobial resistance and assessment of bio-risk management with the Infectious Diseases Institute. In addition to their experiential training and participation in field activities, each One Health fellow was asked to offer routine services of the organization in which they had been placed under close supervision and guidance of the organizational field supervisor. Some of these placements then led to long-term work opportunities for participants by linking them or absorbing them into organizations involved in their fellowships. A summary of the graduate fellow completion statistics is shown below (Table 2).
Table 2: Summary of graduate fellows
OHI Graduate Fellowship
|
Intake Year
|
No. awarded
|
Completed (%)
|
Male
|
Female
|
2017
|
8
|
8 (100%)
|
4 (50%)
|
4 (50%)
|
2018
|
10
|
10 (100%)
|
5 (50%)
|
5 (50%)
|
2019
|
6
|
4 (67%)
|
4 (67%)
|
2 (33%)
|
Total
|
24
|
92 (78.4%)
|
13 (54%)
|
11 (46%)
|
Small grants, research, and innovations
The OHW project offered grants for undergraduate and graduate students to conduct research and develop innovations that addressed One Health challenges. Innovations were invited from multidisciplinary teams of students who submitted a concept utilizing their collective expertise. Students received support from faculty mentors to develop and execute innovations, which were evaluated collaboratively with study communities to assess feasibility. One example of such an innovation is the improved tippy tap with water reservoir developed by a team of environmental health and engineering students. A tippy tap itself is a simple device for hand washing with running water and is very effective in homesteads. The student innovation involved making the tippy tap more efficient and appropriate for high density population areas, such as schools, which necessitated making it more durable with a bigger reservoir for a more sustainable supply of water (Figure 2). Another group of students developed The Farmers’ App (Figure 3) which is an offline platform that describes clinical signs, symptoms, cause and spread for animal diseases, which has been helpful for farmers in identifying affected animals and seeking veterinary advice. This App was developed collaboratively by students of software engineering, veterinary medicine and environmental health sciences. These and other innovations, including Bulamu Mobile, an application that delivers the location of health services (developed by a team led by students of Biomedical Lab Technology), and the Urban Organic Agriculture (developed by a team led by a Bachelor of Science in Wildlife Health and Management), were frequently presented at conferences and exhibitions for wider distribution. Research awards also supported dissertation work for many students, examples of which are provided in Table 3.
Table 3: Examples of student dissertations supported by One Health research awards.
No.
|
College, Program
|
Title of Dissertation
|
1
|
CHS, School of Public Health (SPH) – Master’s in Public Health (MPH)
|
Factors associated with diarrhea in children under-five after the occurrence of flash-floods and adaptation strategies developed by households in Bwaise, Kampala
|
2
|
CHS, SPH – MPH
|
Evaluation of community-based groups’ capacity to implement disaster risk reduction interventions in the Mt. Elgon Region
|
3
|
CHS, Department of Pharmacy—
MSc. in Pharmacology
|
The potential role of rodents in the transmission of leptospira spp. to humans around Queen Elizabeth National Park
|
4
|
COVAB, School of Veterinary Medicine and Animal Resources (SVAR) – Master of Science in Livestock Development Planning and Management (MLD)
|
Investigation of the antimicrobial resistance crossover along the domestic-wildlife interface in scoring calves of cattle and zebras in pastoral communities around Lake Mburo National Park
|
5
|
COVAB, SVAR— MLD
|
Predictive patterns of fascioliasis outbreaks in cattle grazing around the wetlands of Soroti in eastern Uganda
|
6
|
College of Business and Managerial Sciences School of Economics (COBAMS) – Master’s in Arts in Economic Policy and Planning
|
Health implications on children of poor food safety measures amongst slum dwellers in Kampala
|
7
|
College of Agriculture and Environment Sciences (CAES) – M.Sc. Animal Science
|
Safety of insects and insect meal as protein source for poultry and fish feed
|
8
|
CHS –M.Sc. Immunology and Clinical Microbiology
|
Prevalence of Mycobacterium bovis and Mycobacterium tuberculosis in samples collected at Kisenyi, Kampala
|
Collaborative teaching and cross-college integration of One Health in curricula
To further enhance efforts of multidisciplinary collaboration within the University, structures were created to enable faculty to facilitate courses in their areas of expertise in other colleges. For example, students of Bachelors of Environmental Health Sciences at the School of Public Health at CHS are taught food inspection, including animal anatomy and zoonotic diseases by lecturers from COVAB. The OHCEA Secretariat also worked hand-in-hand with university departments especially in CHS and COVAB to ensure that curricula for newly developed programmes (such as International Infectious Disease Management degree and MPH/MBA, a graduate programme focusing on both Public Health and Business and Management) incorporate concepts and principles of One Health. The MPH/MBA is a dual degree programme that aims to bridge the gap between public health and business, through strengthening and expanding leadership to advance a culture of health in business. The graduates will be equipped with business skills to establish sustainable, well-managed institutions to address health threats across the public and private sectors. Through improved curricula, graduates and professionals from such programmes are most likely to adopt One Health approaches in their future work in Uganda and other countries.