The Independent Uganda: You get the Truth we Pay the Price
Dr. Catherine Kyobutungi is the Executive Director of African Population Health Research Center (APHRC), an Africa-led research institution based in Nairobi, Kenya. She spoke to Ian Katusiime about their 20th anniversary, COVID-19 and related issues.
APHRC just received a grant of US$15m from MacKenzie Scott. What does this mean for the work of APHRC?
It is the largest grant we have ever received in the Center’s history and the fact that there are no strings attached to it means we can invest it in things that we have always wanted to do but could not do because of lack of funds. We already have big plans to invest in new areas of work, new staff, staff training and development, new office space, among others. Honestly, the sky’s the limit!
APHRC is marking 20 years as a research institution. What are you taking stock of as you mark this important milestone?
There are many things to be proud of. The Center started as a small fellowship program with a handful of researchers working on a single issue in Kenya. We have grown into a highly successful African Center with a geographic reach in more than 30 countries, a large body of knowledge in the form of thousands of scientific articles and hundreds of African scholars trained and nurtured into successful research careers. We have developed and are running a globally recognised PhD training program called CARTA, and have forged hundreds of partnerships across the world. Of course one may ask – all this for what? We are particularly proud of the policy impact the Center has had in the areas of urbanisation and health, non-communicable diseases, nutrition, Sexual and Reproductive Health and Rights, and Aging in Africa. Our work and experts have shaped debates around these issues and influenced the development of policies and programs at different levels – national, regional and continental.
In an interview I had with you in December 2020, you decried the COVID19 vaccine inequity Africa faces. Fast forward, are you satisfied with the vaccine rollout and what more should be done for a COVID-free future?
No, I am not satisfied. There were many lost opportunities. While in some countries, the supply has been good for the last few months, many countries lost momentum and it is now an uphill battle to get people vaccinated when the world’s attention seems to have shifted. As more and more countries declare the pandemic over, it will get harder for African countries to command attention for the health system issues that are still there. As a researcher, I will say that we need to do more to understand what is going on in the continent, especially how the people who got COVID19 are faring. There is data from many other countries showing devastating effects of the so-called Long COVID whereby people have developed complications in the heart, kidney, brain, liver, pancreas among others. It would be good to see what measures need to be taken to support such people if they exist. It would be misleading to imagine that the world can be COVID-free if millions of people are suffering with the after-effects of the virus.
APHRC has invested a lot in data analysis with a Data, Measurement and Evaluation (DME) Unit. What groundbreaking data have you gathered on Covid-19?
Our funding model doesn’t allow us to collect data on important issues any time we want, so we were a bit slow to start doing COVID19-related research because we did not have funding for it. We now have a couple of exciting initiatives:
- A sero-prevalence survey to determine what percentage of the population have antibodies (indicating prior infection) for SARS-COV2. This survey has shown that in some parts of Kenya up to 40% of the population had antibodies meaning that a much larger population was infected than what has been reported. It also another piece in the puzzle to understand how COVID-19 affected people on the continent.
- Conducting analyses of what is known as excess mortality to determine the true impact of COVID-19 in Africa. This requires comparing mortality trends over time by using already existing data for at least five years before COVID-19 and comparing that with mortality in the last two years and see if there were any changes. Such studies are useful in correcting for gaps in the COVID-19 data for confirmed cases and reported deaths and providing a more accurate estimate of the impact of COVID-19 in a country.
- Understanding the long-term effects of COVID-19: we are setting up a cohort of people who recovered from the disease and we will be following them up for two years to see how they are faring; especially whether they develop chronic diseases such as diabetes, blood pressure, kidney disease, brain malfunction among others.
- using artificial intelligence and machine learning to analyse routine data and understand how COVID19 intersects with gender;
In the next year or so, we will be in a position to provide more evidence about the true picture of COVID-19 in Africa.
Uganda has one of the fastest growing young populations in the world. What does this mean for population dynamics and research?
Uganda’s young population can be looked at through the lens of what is known as the demographic dividend. This is the economic growth potential that can result from shifts in a population’s age structure, mainly when the share of the working-age population is larger than the non-working-age share of the population. This potential can only be realised if at the right time, good policies and programs are put in place to reduce fertility, improve overall health, provide high quality education and create employment opportunities. Countries have narrow windows to initiate and implement these policies. Uganda has made some progress by reducing the total fertility rate (average number of children per woman in the reproductive age of 15-45 years over their lifetime) from about 7 in 2000 to slightly less than 5 in 2020. The country has also done a lot in ensuring that most children get basic education. The question is whether that is enough and so Uganda is in danger of missing this window and may fail to reap the dividend from its youthful population.
Sexual and Reproductive Health and Rights (SRHR) is one of your areas where you are focusing on early adolescents 10-14 years. Why this bracket and what messages are you giving these kids?
Most health policies and programs tend to focus on two age groups – children below the age of five and people in the so-called reproductive age of 15-49 years. There are very few programs for children aged 5-14 years. As an institution, which believes in “no one left behind”, we are doing research in this age group and even older people aged 50+ years. Early adolescence is a very important stage in life when young people experience puberty and are struggling with body, emotional and social changes. It is the stage when lifelong habits related to diet, alcohol, drug use and physical (in)activity are likely to be formed and when sexual experimentation is likely to result in lifelong consequences such as HIV infection or unwanted pregnancy. We are therefore hoping to provide evidence that can shape policies and programs for this very important age group so that they can grow into healthy adults, and fulfil their potential.
There has been an explosion of health research since the pandemic broke out. What are some of the niche areas young researchers can focus on?
The African continent still faces many challenges. It is the region with the worst indicators for many health conditions, very low investment in the health sector, poor access to high quality health services, and high mortality among others. The continent has been dealing with high rates of infectious diseases like HIV/AIDS, Tuberculosis and Malaria and high rates of childhood illness and death. It also has high rates of the so-called neglected tropical diseases like sleeping sickness, bilharzia and elephantiasis. In the last decade, non-communicable diseases, mental health and injuries from accidents and violence are also increasing. All this was before COVID19 appeared on the scene. COVID-19 has shown that African scientists have the capacity to do research and ably advise their governments in designing good public health responses. There are many unresolved problems on the continent and these are likely to be made worse by COVID-19. We need a lot of research on all these problems. African researchers have unlimited options from which to identify niche areas for their research.
There are deep economic inequalities in most African settings. What have you learnt studying slum dwellers and their urban counterparts?
The Center has been doing research in urban informal settlements or slums in Nairobi for almost 20 years. Many times when national statistics are produced, urban centres tend to perform better than rural areas. However, our research has shown that people who live in slum settlements in most instances are as badly off as those in rural areas. Therefore, studies and surveys should make a distinction between formal and informal areas in urban centres and not lump everyone in one category of “urban” because this hides the gross inequalities faced by slum residents. Secondly, we have learnt that social services need to be adapted to the informality in such areas. Slum settlements have very high concentrations of people who are in the informal sector or in casual employment. For such people there is a high opportunity cost for not going to work in order to seek health services, especially if one is not seriously sick. They therefore tend not to seek services like immunisation, family planning and antenatal care if it means missing a day at work. Health services therefore have to be tailored to this reality for example by extending opening hours in public health facilities, or doing community outreach.
Lastly, we have learnt that there are many resources in these areas. Slum residents are not helpless individuals with no agency. They are very resourceful, highly motivated individuals who just need governments to provide an enabling policy and regulatory environment for them to solve their own problems and thrive.
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