Ignatius Wadunde holds a Master of Public Health and a Bachelor’s degree in Bio-Medical Laboratory Technology from Makerere University. Before joining the Fellowship program Ignatius worked for the Infectious Diseases Research Collaboration as a Laboratory scientist, Makerere University School of Public Health as a Research supervisor and conducted various field assignments for Ministry of Health, Uganda ranging from immunisation activities to outbreak investigations and response. During His time as a Field epidemiology fellow at the Uganda Public Health Fellowship program, He has been attached at the Uganda Cancer Institute where He gained skills/ experience in community cancer screening and sensitization, leadership and public health response to including data analysis, interpretation and use. The fellowship program has enabled Ignatius to gain technical expertise in field epidemiology skills that include: outbreak detection, investigations and response, evaluation of public health surveillance systems, project development and implementation, leadership and management, capacity building, scientific writing and communication skills.
Achievements at the Host Site
While at the host site, I was involved in several activities that included
I analysed surveillance data at the Comprehensive Community Cancer Program (CCCP) at the Uganda Cancer Institute
I participated in community cancer awareness programs of the CCCP on cervical and breast cancer.
I trained the data team at the CCCP on cancer data management.
I evaluated of the surveillance system with the data staff at the CCCP at Uganda Cancer Institute
Program specific deliverables
Descriptive analysis of surveillance data
I conducted a descriptive analysis of COVID-19 surveillance data among truck drivers’ in Uganda in 2020. Overall, 139 cases were registered. All cases were males with age ranging from 22 to 68 years (mean age = 37 years). About three quarters (74%, n=103/139) were asymptomatic. Majority(97%, 135/139) of cases were tested at the points of entry. Above average, (66%, 96/139) ) of the cases reported to have entered Uganda from South Sudan through Elegu POE. We recommended continued testing of truck drivers for COVID-19 at the points of entry before entry to Uganda.
Outbreak investigation projects
Led investigation on High-Risk exposures among truck drivers testing positive for COVID-19 at Uganda borders -2020
Led investigation on Epidemiological investigation of confirmed cases of COVID-19 at Mbale regional referral hospital – 2020.
Led the training District Health Teams (DHTs) on developing and interpreting malaria normal channels to detect malaria outbreaks in Uganda – 2020
Led an investigation on barriers and facilitators to care and management among persons with diabetes during COVID-19 pandemic in Uganda, 2020: Patients and health workers perspective.
Led an investigation on Rapid SARS-CoV-2 antigen (SD Biosensor) test in comparison with Real Time (RT-PCR) for diagnosis of COVID-19 in a secondary school, Kampala, Uganda: November – 2020
Led an investigation on factors associated with testing positive for COVID-19 among students, teachers and support staff in a secondary school, Kampala, Uganda: November – 2020
Fellowship program specific achievements
Led an investigation on early cases of SARS-COV-2 infection in a secondary school, Kampala, Uganda: Epidemiology and lessons learnt -November – 2020
Participated in investigation on early cases of SRAS-Cov-2 infection Uganda: epidemiology and lessons learnt from risk based testing approaches -March April 2020
Participated in an investigation of COVID-19 in Aswa Hydro Electricity power plant in Pader district -2020
Participated in the investigation of Measles outbreak in Nakivale Refugee Camp in Isingiro district – 2020
Participated in an investigation of psychosocial impact of COVID-19 among health workers in Uganda – 2020
Participated in the investigation of Jinja-Buikwe COVID-19 cluster – May 2021
Participated in the investigation of COVID-19 deaths in Kampala metropolitan area – 2021
Participated in a baseline evaluation of Malaria Insecticide treated bed net ownership and utilisation in Jinja district following a mass distribution, March-2021
Led an endpoint evaluation of Malaria Insecticide treated bed net ownership and utilisation in Jinja district following a mass distribution, October-2021
Participated in an assessment of preparedness of border districts to respond to Plague in West Nile region, Uganda, August – 2021
Epidemiological study
After investigating the impact of COVID-19 on the care and management of patients with diabetes during the pandemic, I conducted a follow-up epidemiological study to assess for factors associated with adherence to anti-diabetic medication among persons with diabetes during the COVID-19 pandemic, Uganda, 2020. The level of adherence to anti-diabetic medication was sub-optimal, (68%, 157/228) and the commonest reasons for missing doses were drugs running out at one, forgetfulness and transport challenges. Experiencing side effects reduced adherence (AOR=3.0 95% CI:1.6-8). We recommended the need to send reminders to patients, and promote counseling to improve adherence to diabetes treatment.
Quality improvement project
Results from the epidemiological study to assess for factors associated with adherence to anti-diabetic medication among persons with diabetes during the COVID-19 pandemic showed that Lira Regional Referral Hospital registered had the lowest level (59%) of adherence to anti-diabetic medication among persons with diabetes during the COVID-19 pandemic Basing on this finding, I found it necessary to conduct a quality improvement project entitled: “Improving adherence to antidiabetic medicine among persons with diabetes at Lira regional referral hospital, 2021.” Together with the health workers, we assess reasons for the low adherence, generated and implemented practical solutions to increase on the level of adherence for improved patient treatment outcomes. We called the patients to remind them come for medication and conducted adherence counselling and health education on the need for adherence and implications for non-adherence, during medication refills. The level of adherence increased from 59% to 79% by August 2021.
Epidemiological bulletins
Training District Health Teams (DHTs) on developing and interpreting malaria normal channels to detect malaria outbreaks in Uganda.
High-risk exposures among truck drivers testing positive for COVID-19 at Uganda borders: A qualitative study-2020
Rapid SARS-CoV-2 antigen (SD Biosensor) test in comparison with Real Time (RT-PCR) for diagnosis of COVID-19 in a secondary school, Kampala, Uganda: November – 2020
Newspaper article
COVID-19: Which people need to take extra precautions” It was published on the New Vision newspaper.
Policy brief
Participated in the policy brief on introduction of yellow fever vaccine into routine immunisation schedule in Uganda, 2021
HIV study
I conceptualised and implemented an HIV study entitled “Barriers and facilitators to retention in HIV care for persons on community Differentiated Service Delivery (DSD) models in Uganda, 2021”. The facilitators identified included: easy access to medication, less waiting time at facility, good adherence support and reduced transport costs. The barriers identified included: stigma and relocation of clients especially in urban settings. Suggestions by health workers to improve retention in HIV care included: integration with NCD services, sensitisation clients, building community structure and empowering the community pharmacies among others
Conference presentations
Oral virtual presentation at the PEPFAR summit a study entitled: “High-Risk Exposures Among Truck Drivers Testing Positive for COVID-19 at Uganda Borders: A Qualitative Study – 2020”
Oral virtual at 6th Uganda National Field Epidemiology conference: “High-Risk Exposures Among Truck Drivers Testing Positive for COVID-19 at Uganda Borders: A Qualitative Study – 2020.”
Oral semi virtual at 7th Uganda National Field Epidemiology conference: “Outbreak of COVID-19 in a secondary school in Kampala, Uganda – 2020.”
Oral virtual at 8th East African Health and Scientific conference: “Factors associated with adherence to anti-diabetic medication among persons with diabetes in Uganda, 2020.”
Manuscripts
“High-risk exposures among truck drivers testing positive for COVID-19 at Uganda borders: A qualitative study-2020” (CDC clearance)
“Rapid SARS-CoV-2 antigen (SD Biosensor) test in comparison with Real Time (RT-PCR) for diagnosis of COVID-19 in a secondary school, Kampala, Uganda: November – 2020” (At PHFP Secretariat)
“Factors associated with adherence to anti-diabetic medication among persons with diabetes during the COVID-19 pandemic, Uganda, 2020” (at PHFP Secretariat)
“Factors associated with testing positive for COVID-19 among students, teachers and support staff in a secondary school, Kampala, Uganda: November – 2020” (At PHFP Secretariat)
Co-author: “Psychosocial impact of COVID-19 among health workers in Uganda – 2020” (Published in BMC psychology)
Co-author: “Early cases of SRAS-Cov-2 infection Uganda: epidemiology and lessons learnt from risk-based testing approaches -March April 2020” (published in journal of globalisation and health)
Wadunde Ignatius (middle) with the health workers at the COVID-19 isolation and treatment unit at Kabale Regional Referral Hospital.
Summary of Epidemiological Study:
Title: Factors associated with testing positive for COVID-19 among students, teachers and support staff in a secondary school, Kampala, Uganda:November, 2020
Background: Following school closures in Uganda in March 2020 in response to COVID-19, the government re-opened schools to candidate classes on October 15, 2020 with strict COVID-19 guidelines. On October 27, 2020, Secondary School X in Kampala, Uganda reported their first case of COVID-19. By November 17, 2020, 32 confirmed cases were reported in the school. We set out to determine the outbreak extent and factors associated with COVID-19 infection in the school.
Methods: We conducted a cross-sectional study employing quantitative methods of data collection. We used an interviewer-administered questionnaire to collect data on socio-demographics and COVID-19 potential risk factors information from all students, teachers, and support staff at the school. Nasopharyngeal samples were taken from the interviewees and tested using RT-PCR to identify SARS-COV-2 infection. We conducted logistic regression to identify factors associated with infection.
Results: Of the 361 respondents interviewed: 76% (265/361) were students, 10% (36/361) were support staff, and 4% (15/361) were staff. Thirty one percent (110/361) of the respondents tested positive over the 3-day study period; students had the highest attack rate (32.5%; 101/311)., 90% (328/361) of respondents were asymptomatic at sample collection. The attack rate was 45% (81/180) among those who reported participating in gatherings at school and 45% (74/166) among those who reported spending time in shared areas. Among those who reported attending gatherings, 88% (229/260) mentioned that they attended the Catholic chapel at the school. 78% (188/241) of those who reported exposure to shared areas said it occurred in the dining hall. Being a support staff (AOR: 3.1, 95%CI: 1.2-8.5) and being in Senior Four class (AOR: 1.8, 95%CI: 1.1-3.1) were associated with testing positive for COVID-19.
Conclusion:There was widespread of COVID-19 infection at Secondary School X in Kampala during November 2020. Being a support staff or a student of Senior Four class were associated with testing positive for COVID-19. In order to mitigate the spread of the COVID-19 infection, we set up an isolation and treatment center at the school to treat mild and moderate COVID-19 cases.We recommended intensifying daily screening, testing and isolation of symptomatic cases and their contacts, discouraging gatherings, and introducing shifts at the dining halls.
Students of school X filling questionnaires before they tested for COVID-19
Key lessons learnt during the fellowship
Outbreak detection, investigation, response, and control