ABOUT THE FELLOW
Allen Eva Okullo has a Masters degree in Public Health from the International Health Sciences University, Kampala and a Bachelors Degree in Zoology/Pschology from Makerere University Kampala.
During the fellowship period, she was placed under the National Malaria Control Program which was her first choice of preference, given her profound interest in malaria. Thus, not surprisingly, she has had a great deal of achievements. She regards her experience as having been very fulfilling and worthwhile. Prior to joining the UPHFP, she worked as a Technical Officer with a consultancy firm called Montrose.
Her roles in this position involved managerial and technical support to health projects for the Ministry of Health and a wide range of multilateral and unilateral organizations. One of her fondest memories is that when she told her former boss at Montrose that she saw herself as an epidemiologist five years from the time. True to what she said, January 24th 2017 marks its fulfillment!
Achievements at the host site
- She was the lead editor of the Uganda Malaria Quarterly Bulletin in November 2015, and has since produced four issues; Introduced innovations in the Uganda Malaria Quarterly Bulletin such as the production of maps to showcase malaria burden in all districts in terms of incidence and Test Positivity Rate (TPR); graphs showing trends in TPR in the 10 epidemic districts; and upcoming events in malaria;
- The only person who mapped and presented to the National Task Force (NTF) the burden of malaria in terms of incidence and TPR down to sub county level by week in all 10 affected districts, during the heat of the epidemic in 2015, this helped NMCP to target resources;
- Along with NMCP staff, quantified ACT needs for the 10 epidemic districts and shared the results with task force members under the mentorship of Dr. Ambrose Talisuna, a Ugandan malaria expert as a guide in supporting the National Malaria Control Program to control the malaria epidemic
- Actively participated in the control of the malaria epidemic as a rapid response team member sent out to strengthen response at the district level, as well as being a member of the incident management team responsible for coordinating all response activities;
- Assessed and provided support supervision for management of Malaria In Pregnancy in two districts of Mbarara & Ibanda with a team from President’s Malaria Initiative (PMI)/USAID;
- Worked with Anna Minta, an Epidemic Intelligence Surveillance (EIS) Officer on a study titled ‘Assessment of risk factors for malaria outbreak, Uganda 2016’; Along with Anna; cleaned key malaria HMIS data for Uganda for period July 2015- Feb 2016 under the mentorship of a world renown malaria expert, Dr. Albert Kilian;
- She provided data on malaria indicators for Uganda to Prof. Bob Snow ( World renown malaria guru) at the KEMRI Welcome Trust Research Programme for development of the Uganda malaria profile, she has also been mentored by him on a few malaria studies;
- Produced a huge dataset of malaria incidence data for all the sub counties in Uganda, 2015, a key requirement by Against Malaria Foundation (AMF) which facilitated the provision of 10.4 million LLINs for the upcoming mass net campaign in Uganda 2016/17;
- Conducted an analysis with PMI/USAID showing the trend in malaria incidence in northern Uganda during a period when a key intervention was implemented in Sept/Oct 2015 along with other multiple analyses;
- Provided malaria data and performed analysis for Jennifer Ross, a Forgarty Global Health Research Fellow, working on a Project titled ‘Estimating the impact of cotrimoxazole prophylaxis on malaria burden in Kenya and Uganda’;
- Provided health facility data for a project titled ‘Improving the quality of health facility data to
- monitor trends in malaria burden; Effectiveness of the Improvement Collaborative Approach’ led by Nelli Wester camp, an EIS Officer;
- Became a co-author on a publication entitled, ‘The challenge of using both long lasting insecticide bed nets and intermittent preventive therapy among pregnant women in Uganda’ and a co-author on another upcoming publication entitled, ‘Factors associated with malaria parasitaemia among children under 5
- years in Uganda: A secondary data analysis of the 2014 Malaria Indicator Survey dataset’, with the lead author, Humphrey Wanzira;
- Supported the iCCM national coordinator in developing training materials for iCCM, participated in meetings with partners to guide planning and rolling out of iCCM, contributed ideas to the research agenda, in particular, a need for evaluation of the plan for roll out; An active team player in the development of the first ever Uganda Malaria portal;
- Coordinated district micro planning activities in Uganda prior to distribution activities for the 2017 Long Lasting Insecticidal Net mass campaign for period Sept 2016- Dec 2016;
- She is coordinating the development of a malaria epidemic prediction model using climate data on behalf of the National Malaria Control Program in conjunction with WHO, CHAI Uganda and a senior software developer from Eco Health Alliance in New York, USA
Program-specific achievements (key deliverables)
- Performed a descriptive analysis of malaria incidence among under 5yr olds in relation to malaria control interventions;
- Submitted a manuscript titled, ‘Malaria incidence among children less than five years during and after cessation of Indoor Residual Spraying in Northern Uganda: a descriptive study’
- Wrote a protocal for her planned study entitled, ‘Factors associated with malaria illness in three districts of Northern Uganda, 2015’, This rotocal was cleared by the IBR at Makerere University School of Public Health and approved by the Uganda National Council for Science and Technology.
- Led the investigation of a suspected guinea worm outbreak in Isingiro district.
- Participated in the investigation of a number of disease outbreaks such as typhoid, cholera, and suspected viral hepatitis
- Performed a comparative cost analysis on prevention and control of a cholera outbreak
- Made three oral presentations at national conferences, and the first and second national field epidemiology conference
- Obtained a second runner up prize for a project on malaria whose idea she pitched at the IMED2016 (International Meeting on Emerging Diseases and Surveillance 2016) pre-conference MIT Hackathon event in Vienna, Austria
- Made an oral and poster presentation at the IMED2016 conference in Vienna, Austria. The oral presentation was on a project developed while at the pre-conference Hackathon activity on creation of an epidemic prediction model for Uganda using climate data
- Published two articles on malaria in the New Vision Newspaper in 2015
- Has been an editor for four issues of the Ministry of Health quarterly epidemiological bulletin
- Trained the 2015 cohort over a 2 day period on map making using QGIS for epidemic investigations and health programming; in addition has made a number of maps for FETP fellows in both 2015 and 2016 cohort as well as for UPHFP secretariat members
Summary of Planned study:
Title: Factors associated with malaria illness in three districts of Northern Uganda, 2015
Introduction: Malaria continues to be a huge public health threat worldwide with an estimated 3.3 billion people at the risk of being infected. An epidemic of malaria was confirmed in 11 districts of the Northern part of Uganda in June 2015. Ten of the eleven districts had Indoor Residual Spraying for a minimum of five years but had not had spraying for six months in five of the districts and twelve months in five of the remaining districts prior to the epidemic. This study was conducted to identify factors associated with malaria illness in two epidemic and a non epidemic district of Northern Uganda in 2015 in order to make recommendations to alleviate future malaria epidemics.
Methods: The study was a comparative cross sectional study which used both quantitative and qualitative methods of data collection. This involved the study of three districts, Arua and Gulu which had a malaria epidemic in 2015 and Moyo, a neighboring district which didn’t have an epidemic. Household interviews were conducted in the three districts to determine possible host behavioral and knowledge factors for malaria illness. Key Informant Interviews were conducted at the national and district level to assess systems and environmental factors that could be associated with malaria illness in the three districts.
Logistic regression analysis was performed to identify factors which were associated with the risk of suffering from malaria in both the epidemic and the non epidemic district. Bivariate analysis was used to identify factors that were independently associated with the risk of an individual having malaria in either the epidemic district or the non epidemic district. Multivariate logistic regression analysis was used to identify factors that remain significantly associated with the risk of acquiring malaria in the epidemic and the non epidemic district. Qualitative data from KII’s was transcribed, key categories identified and organized into themes which were related to the objectives of the study.
Results:The 2015 data quality audit conducted in Kabarole District found that the majority of our respondents were nursing assistants 32% (16/50) and enrolled nurses 26% (13/50). All the health centers’ reports were timely between January and June and from November to December. The timeliness and reporting rates remained above 60% between August and October. The mean health center verification factor was 87±27.
Sixty five percent (32/49) of the health centers had consistent data, 27% (13/49) over reported and 4% (2/49) underreported. The factors that affect immunization data quality under the data dimension include; arithmetic errors 20% (10/49) and inability to have a single view of immunization data 53% (26/49). The other items used for tallying immunization data included exercise books and plain papers.
Quality index (QI) scores varied at all levels of health service delivery. Mean QI for the 49 health centers that conduct immunization was 61% ±26. The factors that affected the data collection process were: Recording component; omission of tally sheet data into HMIS reports 29% (14/49), irregular update of vaccine and injection material control book (VIMCB) 22% (11/49), storing/ reporting; poor storage practices like lack of designated storage place, lack of files for keeping records, tally sheets not arranged in order, limited of access to records because incharge has moved with the key 6% (3/49), missing tally sheets 27% (13/49), monitoring and evaluation; inability to classify target population according to immunization strategy 100%, catchment area maps not displayed 61% (30/49), graphs showing coverage and drop out rates not displayed 41% (20/49), involvement of the community during planning rare done 4% (2/49). There was a weak positive correlation between the health center verifaction factor and quality index though this was not statistically significant (r=0.014; p=0.92).
Conclusion: There is inadequate knowledge on transmission and prevention of malaria in the epidemic area studied. Programmatically, the epidemic has been attributed to withdrawal of IRS in Gulu and to both an influx of refugees and inflation of aggregated figures in DHIS2 for Arua. There is need to strengthen BCC on malaria in all the communities especially the epidemic districts of northern Uganda. There is need to enforce and implement an adequate withdrawal strategy during and after implementation of IRS. Emphasis should be put on accuracy of data presented in DHIS2 to adequately reflect actual figures.
Lessons Learned, skills/competencies acquired and next steps:
- Over the course of the fellowship Allen acquired a number key skills and competencies. These were skills in: outbreak investigations; map making using QGIS; data entry and analysis using EPI INFO 3.7 and STATA; quality presentation and making of power point slides; team work; writing skills for abstracts, bulletin and newspaper articles; writing of manuscripts; project planning and management; and networking skills. After the fellowship program, Allen will be moving on to manage the first ever malaria portal under development by the National Malaria Control Program, WHO, and CHAI
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