Kyamulibwa station, a resilient public health research hub 

Nestled in a rural setting over 20km from Lukaya town council, is a serene self-contained 35-year-old health field station focusing on research and services on population dynamics and public health situation and trends.

Welcome to Kyamulibwa B village, Kyamulibwa sub-county, Kalungu district!

This unique facility, known as the ‘Kyamulibwa General Population Cohort’ or ‘Kyamulibwa Health Field Station’, is an internationally recognized center of excellence for research in infectious and non-communicable diseases in East Africa.

It handles disciplines of clinical medicine, epidemiology, basic science, public health, social science with strong community development and behaviour bias, statistics, laboratory support and capacity building.

Though not much in the limelight, the Kyamulibwa general population cohort (GPC)/ health field station boasts several accolades since its establishment in 1989 during the HIV/Aids peak years in Uganda. It has collected and stored valuable longitudinal population and clinical data since then to-date.

Starting with a study area of 15 villages, the number was raised to 25 in 1999; the station now has 26 villages. The bulk of its voluminous data, including collected samples, is stored at Entebbe, the headquarters of the mother research unit, the MRC/UVRI and LSHTM Uganda Research Unit.

Dr Joseph Mugisha, a clinical immunologist and the head of the research facility, introduced Kyamulibwa as “a centre of excellence that conducts large-scale and long-term epidemiological and intervention studies, clinical trials, virological and immunological research and behavioural studies.”

He said the station boasts of having generated a substantial volume of research samples and data that have not only been used to inform policy and practice but will also be useful for future research projects. “Our data is available for use, prospectively or retrospectively,” he said.

POPULATION DAY MEDIA CAFE

As part of the World Population day celebrations, the station organized a media café to enable interaction among its staff, members of the Community Advisory Board (CAB), clients and the media on July 11, 2024.

Dr Mugisha, told the media café that the greatest part of their work is field work, which bears several detailed and carefully executed components including house-to-house demographic surveillance census and survey activities.

The census also collects data on births and deaths, including verbal autopsy, and immigration and emigration. The station has collected and stored data on 25,000 people in 26 villages that constitute its study area across a period of over 30 years.

It also has links to other valuable demographic, epidemiological and genomic data from individual external projects, Ugandan or non-Ugandan, conducted using the station’s facilities. Mugisha said results from their work get published in peer-reviewed journals. In addition, their stored data and samples of so many years are available for anyone doing future research and needing to make historical data comparisons.

“We have supported numerous MSc and PhD students in different way over the years,” he added.

“As such, the station has become a highly productive and respected research unit, influencing local and international policy and scientific thinking,” Mugisha affirmed, adding, “We are fulfilling our threefold mission of conducting research to add knowledge and improve the control of infectious and non-communicable diseases; contributing to the translation of research findings into policy and practice; and building capacity to do research.”

The facility is a joint project of the Medical Research Council of United Kingdom (MRC), Uganda Virus Research Institute (UVRI) and the London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit. It also has collaboration with Makerere University, Rakai Health Sciences Programme and other international scientific and health institutions.

COMMUNITY ENGAGEMENT AND MOBILIZATION

Mugisha emphasized their participatory community engagement model which has led to long-term existence and success. Besides collaborating with authorities that include the district health officer, the GPC established a robust Community Advisory Board which eases engagement with the community through house-to-house and hub-meeting sensitisation and mobilisation. Many of the field staff are recruited from the community and, therefore, more knowledgeable and trusted by the participants.

Beatrice Kimono, the GPC survey coordinator, led the media through a tour of Kiwunga village, aka Village 3, one of the 26 field research hubs. She explained how the GPC conducts its field work in a meticulous and professional manner.

A village is considered as a research unit, with its own on-site leadership and mobilisation structure. Each village has its hub, which is established at a central and convenient location in the village, making it easier for participation by residents and more cost-effective to achieve research targets.

In collaboration with the village administrative structures such as the local council and the village health teams (VHTs), and the project community structures, the study carries mapping of households, general and specific mobilisation for regular censuses, surveys and treatment sessions.

The hub collects and keeps medical and census records of everyone in the village aged 15 and above. Potential participants are given invitation cards. After verification, they are given hub cards that entitle them to make visits to hub activities including meetings and medical tests.

Every participant is given a confidential identifier number, and is entitled to free services at the GPC Study Clinic.

“Our team has community mobilisers. These hold mobilisation meetings with 16 categories of people in the village, say teachers, religious leaders. Then we hold meetings with local council leaders, and lastly we hold meetings with participants, including one-on-one consultations. We know each and every household in the villages. Even when somebody migrates to another place, dies, or a new person enters the village, we capture and store the information,” Kimono said.

The study carries out regular house-to-house censuses and surveys throughout the villages in the study area, an exercise that lasts three weeks in every village, depending on the turnout and the numbers of participants. In addition, every village has an events reporter who keeps the study team informed of any new events or emergencies.

Because of the participatory methods of the study, Kimono said the project has registered 75 per cent receptive rate which is quite high. A

FEW INTERESTING FINDINGS

Three staff of the station: Moses Kwizera, a medical laboratory science officer and head of the main laboratory at the station; Dr Bernard Mpairwe, a public health specialist; and Dr Ivan Kasamba, a statistician, presented briefs on some of the station’s recent research findings.

Kasamba reported that the recent five years have registered decreased incidence (new infections) of HIV, while the prevalence remains stable. This was largely attributed to the regular testing, usage of ART and changed social behaviour. However, more efforts are needed to raise awareness especially for populations between ages 15 and 30.

For people on ART, the main cause of death is non-communicable diseases. Other findings include: migration is common, starting at 15 years of age, and higher among females than males; migrants have higher HIV prevalence than residents; female migrants have higher HIV burden than male migrants; and provision of public health services needs to consider population dynamics.

Mpairwe said contrary to their initial expectations of two per cent, they have established that diabetes burden/ prevalence is quite high, at six percent.

Secondly, what majority of people consider as the cause of diabetes – such as body weight, sugar, lack of exercises or old age – are not necessarily the cause. The causes are many and not yet well established, but they all zero on the pancreas failing to perform properly.

Hence diabetes has been found in children below five years. Mpairwe also reported that Kaposi’s sarcoma (skin cancer) is very common in the population, across all age brackets. The means of transmission are not yet known, which makes control quite difficult.

Lastly, for any disease, regular screening and early treatment make a great deal in the control and management; they reduce the treatment costs and mortality rates. Hence the staff urged everyone to have regular screening of various conditions, start treatment early and adhere to professional medical prescriptions.

Also, the longitudinal studies at the GPC have enabled close collaboration with authorities and communities, ensured accurate measurements, deeper engagement and more relevant research questions.