Dr. Angelina Kakooza Mwesige
Associate Professor and Child Neurologist, Makerere University College of Health Sciences, Uganda
Postdoctoral Researcher University of Cambridge, United Kingdom
PhD Makerere University, Uganda and Karolinska Institute, Sweden
When Dr. Angelina Kakooza Mwesige was choosing what to study at university, neurology and neuroscience were not topics she even considered. She initially wanted to be a veterinarian because of her love for animals, but with guidance from her parents, she eventually decided to study medicine as an undergraduate focus. Even this early in her career, Angelina recognized her particularly strong drive to care for the most helpless populations. When her brother—who suffered from autism, cerebral palsy, and epilepsy—passed away, her plans shifted again. Ultimately, this intense personal motivation led Angelina to pursue research on the conditions that had affected her brother. Today she is an Associate Professor and child neurologist at Makerere University College of Health Sciences in Kampala, Uganda. She works as a clinician, lecturer, and researcher studying neurodevelopmental disorders.
Angelina’s brother was minimally verbal, relying primarily on gestures or single words to communicate, but the lack of communication did not stop them from developing a deep bond. When he died from Sudden Unexplained Death in Epilepsy (SUDEP), Angelina was crushed. While her siblings were able to mourn and move on, Angelina became depressed and could not find a way to get past his death. During her undergraduate and master’s training in medicine, however, Angelina finally found her way through the grief: pediatric neurology. In helping young patients who suffered in some of the ways her brother had, she felt as if she could continue to honor him. Shortly after finding this new path, she formed a serendipitous connection with a scientific researcher who was retiring from her position at the Environmental Health Investigations Branch in California and wanted to do more global work, particularly in Africa. Together, they applied for and received funding for a study aimed at understanding the prevalence of neurodevelopmental disorders in Angelina’s home country of Uganda. Going into the community to collect data for this project was incredibly impactful for her. She realized that she loved research and wanted to work more with patients in their communities rather than exclusively in a hospital setting.
Having just finished her master’s in medicine, Angelina was already thinking that she wanted to pursue research. Then, as part of the Linnaeus-Palme teacher exchange program, she spent eight weeks in at the Astrid Lindgren’s Children Hospital, Karolinska, in Solna, Sweden teaching medical students and attending clinical ward rounds and lecture series. In addition to enriching her medical practice, this experience enabled her to develop new research networks and further cemented her resolve to do a PhD. She began her PhD jointly at Makerere University in Uganda and Karolinska Institute in Sweden, studying cerebral palsy in human populations in rural Uganda in collaboration with the neuropediatric research unit at Karolinska Institute. Soon, however, she was approached by a team planning a multi-site study of epilepsy across several sub-Saharan countries: Kenya, Ghana, Tanzania, South Africa, and Uganda. They wanted Angelina to be the lead researcher at the Uganda site. She was committed to continuing her work on cerebral palsy, but Angelina could not pass up the chance to be a part of this large collaborative effort to understand the disorder that had taken her brother. Ultimately, she managed to balance both projects. The multi-site epilepsy project was especially important for propelling Angelina’s career forward; it led to many publications comparing aspects of epilepsy (e.g. prevalence, clinical features, risk factors, proximate causes, mortality) across five African countries. These publications gave her a level of visibility in the field that was helpful for securing funding for future projects.
As a postdoc, together with research scientists at Uganda Virus Research Institute in Entebbe, Uganda and at University of Cambridge in the UK, Angelina pursued another public health question that had long been on her mind. In 1947, the Zika virus was isolated from a monkey in the Zika Forest in Uganda. Angelina thought it was fascinating that so much time passed before the virus caused severe global concern (with particular severity in South America) in 2015. Were the Ugandan populations that lived around the Zika Forest somehow resistant to the severe birth defects that became associated with the virus? To answer this question, Angelina ran a study on the prevalence of Zika virus and other mosquito-borne viruses in the Ugandan population. She collected blood and urine samples from pregnant women residing around the Zika Forest to test for the presence of Zika or other viruses or infections. She was particularly interested in whether episodes of fever in pregnant women might affect the brain of the child later in development. While Angelina has moved past her postdoc, this project is still ongoing. Hopefully the data will help to shed light on whether there is evidence of Zika virus infection in Ugandan populations and whether various communities have developed resistance to it across the years.
Now, as an Associate Professor and child neurologist at Makerere University College of Health Sciences, Angelina does field research and treats children with neurodevelopmental disorders, maintaining a focus on epilepsy, cerebral palsy, and autism. She mentors undergraduate, master’s, and PhD students in addition to collaborating with scientists across Africa, Europe, and the U.S. Overall, her research is having two important impacts. First, her work has generated a wealth of data on the prevalence of certain disorders in Uganda and other African countries. Importantly, this includes not only assessments of those in well-funded hospitals but also community-based field research in low-resource areas that are too often overlooked in epidemiological work. Second, a large portion of Angelina’s research is based on testing low-cost interventions that improve quality of life of those living with various disorders (for instance, improving functioning and activity of children with cerebral palsy). She and her research team recently completed a multi-dimensional, parent-led intervention program for children with cerebral palsy which shows tremendous promise.Such studies are especially rewarding, not only to see the children doing well physically, but also to see the smiles return and some of the stress melt away from the parents’ faces.
As Angelina’s research has brought her into more contact with patients and their families directly in their communities rather than in the hospital, it has become clear to her that raising awareness and trying to erase the stigma that surrounds neurodevelopmental disorders can sometimes be as important as reducing symptoms. For instance, if a family does not know what epilepsy is, they might fear that seizures are a manifestation of a demon and take their child to a traditional healer rather than a hospital. This delay in treatment can mean worse outcomes for the child. Thus, Angelina does a lot of work to spread knowledge about neurodevelopmental conditions. One recent project involves a community-based trial to co-create solutions that empower people to make informed decisions about epilepsy, reduce stigma, and promote community health among adolescents living with epilepsy in Uganda. Specifically, Angelina’s research team is working with a group of adolescents with epilepsy to come up with new ideas for teaching their communities about their condition (e.g. a drama skit, song, or pamphlet). Angelina will then evaluate the impact of this patient-community engagement program in reducing the stigma of epilepsy among adolescents and their caregivers—a change in mindset driven by a deeper understanding of the disease.
Because of how her university is organized, there is no clear-cut demarcation of research vs clinic vs teaching time, and striking the right balance among her many roles is one of the main challenges that Angelina faces in her career. Another hurdle has been funding—for much of her work, she has needed to find international collaborators with access to funding mechanisms (such as the Swedish Research Council, Wellcome Trust, and NIH grants) that she cannot apply for alone. While such European or American collaborations are common in African countries, collaborative projects between two or more African countries are less common. As she looks to the future, Angelina would like to see—and perhaps lead—more of this type of collaboration. Whatever work she does in the future, it is clear that Angelina will continue to be a positive force for children suffering from neurodevelopmental disorders, honoring her brother in all that she does.
Find out more about Angelina and her lab’s research here.
Listen to Margarida’s full interview with Angelina on March 14th, 2024 below!
