The burden of noncommunicable diseases (NCDs) is borne disproportionately by low- and middle-income countries (LMICs), where about 75% of global NCD deaths occur, almost half of these prematurely (before age 70). In Uganda, NCDs are responsible for four of the leading ten causes of age-standardized deaths, yet data on the burden of NCD risk factors are limited, obscuring the magnitude of the burden and posing a barrier to defining risks, vulnerable groups, and the impact of potential interventions. These limits are a consequence of scarce research capacity to document and analyze the burden and risk factors and to help design responsive interventions. Through a collaborative research program in Uganda, we propose to create a system for data collection and analysis that will define the burden of NCD risk factors, develop sustainable data systems, and train Ugandans in NCD research. We will apply these results to reduce the growing burden of NCDs across the lifespan and propose a larger intervention study at the end of two years. The Mobile Phone Surveys for NCD Risk Factors in Uganda (MoP-NCD) program will be based on close collaboration between Johns Hopkins University Bloomberg School of Public Health (JHU), USA, and Makerere University School of Public Health (MU) and Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS), both in Uganda. We will use US expertise to strengthen the Ugandan institutions, promote a sustainable research enterprise focused on NCDs, and enable further research by proposing an intervention study. After developing a nationally relevant list of data elements key to understanding the epidemiology and burden of NCDs in Uganda, we will create a NCD risk factor survey and develop a mobile phone-based platform suitable for Uganda to run the survey (MoP-NCD) to generate data on NCD risk factors and help to define the epidemiology and outcomes of NCDs in Uganda. We will train IM-HDSS and MU personnel and data collectors to conduct household NCD surveys to collect data on NCD risk factors on all adults at IM-HDSS, run the MoP-NCD survey to collect data on NCD risk factors on all adults at IM-HDSS, then compare MoP-NCD data with household survey data to establish the validity of this novel survey methodology. Joint JHU-MU analysis of all core data will define priorities for future interventions. This project will develop research capacity among Uganda's health professionals to carry out and maintain the use of this tool and analyze the results by offering intensive training at JHU for selected MU colleagues on NCD epidemiology, bioethics, and application of mHealth technologies, as well as short- term training workshops on NCD surveillance and online courses and webinars from JHU on priority topics in measuring NCD risk factors and the health and economic consequences. JHU faculty will help design the training curriculum and mentor MU colleagues; they will contribute to online and on-site teaching in Uganda. We intend this project to culminate in a joint JHU-MU proposal (R01 NIH) to evaluate a set of interventions for NCD risk factors that will promote use of MoP-NCD to evaluate the impact of interventions in Uganda.
The Mobile Phone Surveys for NCD Risk Factors in Uganda (MoP-NCD) program will develop and pilot- test a mobile phone-delivered survey (MoP-NCD) and analysis framework to define the health burden of NCD risk factors across the lifespan in Uganda in a collaborative project involving Johns Hopkins University Bloomberg School of Public Health, Makerere University School of Public Health, and Iganga-Mayuge Health and Demographic Surveillance Site in Uganda. If successfully validated, use of the MoP-NCD survey and framework will generate much needed data on NCD risk factors and define the epidemiology and outcomes of NCDs in Uganda, improving the evidence base for health policy decisions around NCDs. Intensive training during the tool's development, testing and use will develop capacity in surveillance and data analysis skills among a core group of researchers at Makerere University in Uganda, and prepare them to participate in a joint research proposal (R01 NIH) to evaluate a set of interventions for NCD risk factors using MoP-NCD in Uganda, thus furthering a sustainable research enterprise in Uganda focused on NCDs.