The research on Uganda’s response to COVID-19 adopted a mixed-methods approach. Researchers at the Makerere University School of Public Health completed a set of research projects on the country’s testing and surveillance strategies, maintenance of essential health services (EHS), health system readiness, unintended consequences of public health and social measures (PHSMs, also known as nonpharmaceutical interventions), and uptake and intention for COVID-19 vaccination.
For most themes, the study team undertook a literature review, secondary data analysis on relevant indicators, and key informant (KI) interviews. For the cross-sectional study on COVID-19 vaccination and strategies to improve uptake of interventions for COVID-19 prevention and control (details below), data were collected through mobile phone calls.
Literature review
The first phase of research involved a review of country guidelines, response plans, and response reports. For each project, this was followed by a review of gray and public literature including project reports, journal publications, ministerial statements, news articles, and blogs on the select theme in Uganda’s response to COVID-19.
Information was collected on key events including new policies and strategies on testing and surveillance, surveillance updates including new strains or variants, and PHSMs imposed. For the maintenance of EHS, published work was reviewed on how health services had been maintained during previous health crises, and guidance from global, regional, and national institutions (e.g., the World Health Organization [WHO], Africa Centres for Disease Control and Prevention , Uganda Ministry of Health) were considered.
Researchers searched PubMed, Embase, Google Scholar, and relevant organization websites. The literature review was synthesized and organized around key themes, and any gaps identified informed the improvement of the key informant interview guide.
Data analysis
Surveillance data were accessed from the Ugandan health management information system (HMIS) and other government and nongovernmental organization databases. For each project, data were gathered on relevant indicators (e.g., tracking occurrence of service utilization, DTP3 immunization, maternal deaths, tests per case, gender-based violence, teenage pregnancies).
For the maintenance of EHS, routine health facility data were analyzed for the two years preceding the COVID-19 pandemic to explore differences in health facility performance. To understand the unintended consequences of interventions, data were analyzed descriptively, considering the periods before, during, and after PHSMs were in effect.
Additionally, to assess the efficacy of PHSMs, researchers constructed a mathematical model called UgaMod and used it to forecast the effect of the different interventions on the number of cases and deaths. Publicly available data were used from WHO and the Ministry of Health on daily confirmed cases of COVID-19.
Key informant interviews
Stakeholders were selected for KI interviews to provide a deeper perspective for each project theme. Information from the literature review and secondary data informed the development of KI interview guides. Interviews were audio-recorded and transcribed. Transcripts were thematically analyzed, and emerging themes were mapped to the relevant conceptual framework. Research teams were able to include additional questions in the KI interview guides where more specific information was required. For each project theme (testing and surveillance, the maintenance of EHS, health system readiness, unintended consequences of PHSMs) 20 to 30 interviews were conducted. For the survey on uptake and intention for COVID-19 vaccination, over 1000 respondents were interviewed.
For each project, key interviewees were selected: policymakers from several ministries and the national committee on the maintenance of health services, directors in charge of health and clinical services and the regional and district level, health facility staff such as nurses and midwives, community health workers, representatives from civil society, local leaders, and law enforcement personnel.
To better comprehend the consequences of school closures in Uganda, KI interviews were conducted with representatives from the Ministry of Education and Sports, the Ministry of Gender, Labor and Social Development, school owners, parents, and students at different levels. After transcription and analysis, the KI interview findings were triangulated with the literature review and secondary data analysis to address research questions and objectives.
Finally, through a partnership with Massachusetts Institute of Technology Governance Lab, researchers conducted a cross-sectional study among adults across the four regions of Uganda to assess the uptake and intention for COVID-19 vaccination and associated factors among adults in Uganda. The study aimed to identify strategies to improve uptake of these interventions for COVID-19 prevention and control. Data were collected in November 2021 through mobile phone calls to 1,173 adults using a semistructured questionnaire programmed in SurveyCTO and uploaded on mobile devices. The tool was translated into nine major local languages in Uganda: Luganda, Lusoga, Lugisu, Ateso, Luo, Lugbara, Runyoro-Rutooro, Runkankole-Rukiga, and Ngakarimojong. Survey respondents were selected using quota sampling, with quotas (age, gender, and region) informed by the distribution of reported COVID-19 cases across the country as of February 2021. After data were examined and cleaned, a modified Poisson regression analysis was employed to determine factors associated with vaccination intention and vaccination status.
Ethical approval
Ethical approval to conduct the research was obtained from the Makerere University School of Public Health Higher Degrees Research and Ethics Committee. The Uganda National Council for Science and Technology (UNCST) registered the studies.