Ben MasiiraMBChB (Mak), MScEpi (LSHTM), +256782897922, +256704594004 ben.masiira@musph.ac.ug Host Mentors
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ABOUT THE FELLOWBen Masiira holds a Bachelor of Medicine and Bachelor of Surgery from Makerere University and Master’s Degree in Epidemiology from London School of Hygiene and Tropical Medicine. He had 7 years of experience in clinical research before joining the Public Health Fellowship Program in 2015. He was attached to Epidemiology and Surveillance Division of Ministry of Health which has a mandate of spearheading preparedness and response to Public Health Emergencies and spearheading disease epidemiology and surveillance. During his 2 year placement, Ben gained knowledge and hands on experience in disease outbreak preparedness and response and planning and implementation of disease surveillance strategies. He worked with and built networks with key health partners involved in prevention and control of priority diseases and conditions. Although Ben had been in management positions before joining the fellowship program, he had never had a formal training in leadership and management. “This fellowship has empowered me with skills that have made a much better public health leader. Without effective public health leadership at all levels, Uganda remains at higher risk of recurrent disease outbreaks and other Public Health Events”. Achievements at the host site
Program-specific achievements (key deliverables)Descriptive analysis of public health surveillance data
Disease outbreak investigation reports
Articles in newspapers
Abstracts for conference presentation Wrote five abstracts three of which were accepted for presentation:
Manuscript
Summary of Planned study: TITLE: Trends of priority infectious diseases in Uganda – Analysis of weekly Epidemiological Surveillance Data, 2011-2015 Introduction: Infectious diseases are estimated to kill up to 13 million worldwide each year, majority of whom are the developing world. In Uganda, 54% of the disease burden is attributed to infectious diseases. In 1998, WHO/AFRO introduced Integrated Disease Surveillance and Response (IDSR) as an intervention to reduce the impact of infectious diseases, through early detection and response to disease outbreaks. After almost 15 years of IDSR implementation in Uganda, there is limited documentation on how the disease trends have changed in the country. Objectives: To describe trends and To describe trends and geographical distribution of priority infectious diseases in the country from 2011-2015 Methods: District weekly epidemiological data on 8 major priority infectious diseases was analyzed. Line graphs were used to describe trends of different diseases and maps to describe the geographical distribution of cases. Ordinal regression analysis was used to test if observed difference across years were significant at P<0.05. Results: Typhoid: A total of 344,133 suspected typhoid cases were reported in the country between 2011 and 2015. The incidence of typhoid fever (per 100,000 population) significantly increased from 164 to 518 in Central region (p=0.001), 105 to 145 in Eastern region (p=0.03), 168 to 245 in Northern region (p=0.02) and 129 to 199 in Western region (p=0.04).However, only the Central region (Kampala City) had a confirmed outbreak in 2015. Nighteen out of 112 districts (17%) exceeded the surveillance alert threshold of ≥20 suspected typhoid fever cases 50% of which were districts in the Central region. Malaria: Up to 43,160,075 cases of malaria were reported from health facilities in Uganda. The annual malaria incidence (per 1,000 population) was 341 in Northern, 330 in Eastern, 256 in Central and 239 in Western region. From 2011 to 2015, there was a significant decrease in the incidence of malaria from 341 to 160 (p<0.001) in Central and 398 to 252 in Eastern (p<0.001). Although the incidence decreased from283 to 180 in Western region, this was not statistically significant (p=0.06). In the Northern region, malaria incidence decreased from 373 in 2011 to 304 in 2014 and then sharply increased to 377 in 2015. Analysis of malaria normal channels showed that a total of 33 out of 112 districts experienced malaria outbreaks of which 52% were in the Northern region, 27% from Western, 15% from Eastern and 6% from Central region. Dysentery: A total of 239,076 Dysentery cases were reported from districts across the country. The annual average incidence (per 100,000 population) was 259 in Northern, 204 in Central, 170 in Western and 153 in Eastern region. There was a significant decrease in the incidence from 374 in 2011 to 259 in 2015 (p=0.02) in the Northern region and a non significant decrease from 163 to 153 in Eastern region (p=0.99). Although not statistically significant, the incidence increased from 144 to 204 (p=0.45) in Central and 162 to 170 in Western region (p=0.62). The districts with the highest incidence included: Otuke (848), Kapchorwa (800), Zombo (751), Mubende (733), Alebtong (584), Kalangala (553), Nwoya (516), Bukwo (516), Hoima (510), Bukomansimbi (492), Abim (464) and Nakasongora (453). Measles: The total number of laboratory investigated suspected cases was 10,195 in Uganda out of which 1,651 (14%) were confirmed measles cases. Of the confirmed measles cases, 52% were from Western, 28% from Central, 11% from Eastern and 9% from Northern region. Overall, a total of 89 districts (79.4%) had at least one confirmed case in during the study. In 2015, the number of districts with ≥1 confirmed measles cases was 16 (14.3%) in Central of which 9 had ≥3 cases, 16 (14.3%) in Western of which 10 had ≥3 cases, 7 (6.3%) in Northern of which one had ≥3 cases and 7 (6.3%) in Eastern region of which one had ≥3 cases. Acute Flaccid Paralysis (AFP): From 2011 to 2015, 2,641 stool samples from suspected patients with AFP were sent from districts to the national reference laboratory at Uganda Virus Research Institute. Out of these samples, 803 (30.4%) were submitted from Eastern, 723 (27.4%) from Central, 626 (23.7%) from Western and 489 (18.5%) from Northern region. The most important indicator of the sensitivity of the polio surveillance system was above the recommended WHOAFRO Non-Polio AFP target rate of ≥2.0 per 100,000 population below 15 years in 68.8% of districts. No case of wild polio virus was isolated from any these samples. Three cases of Vaccine Derived Polio virus (VPD) were isolated from districts of Kamuli, Kween and Kisoro in 2014. Cholera: A total of 8,723 cholera case patients and 191 deaths were reported in Uganda. Of the cholera cases, 52% were from Western, 30% from Northern, 13% from Eastern and 5% from Central region. Overall, 25 districts experienced cholera outbreaks in Uganda with the highest number of cholera cases observed in the districts of Nebbi (2,075), Hoima (1,426), Buliisa (1,129) and Kasese (814). Most of the districts that experienced cholera outbreaks are located along the Democratic Republic of CongoUganda border with a few districts in the Central region (Kampala and Wakiso) and along the Kenya-Kenya border. Animal bite injuries: These are used as a proxy of human rabies infection in Uganda. The total number of animal bite injuries treated at health facilities was 82,072 of which 28.6% were reported from Northern, 27.5% from Central, 24.0% from Western and 19.9% from Eastern region. The average annual incidence of animal bite injuries (per 100,000 population) was 58 in Northern, 50 in Central, 49 in Western and 41 in the Eastern region. Although not statistically significant, there was an increase in the incidence of animal bite injuries in all regions. Meningococcal meningitis: Out of 1,850 suspected meningococcal meningitis casepatients, 31% were reported from Northern, 27% from Eastern, 25% from Central and 17% from Western region. The average annual incidence (per 1,000 population) was 1.6 in Northern, 1.2 in Central, 0.7 in Western and 0.5 in Eastern region. Confirmed outbreaks occurred in Kiryandongo and Amuru districts in 2012. Conclusion and recommendations: Uganda remains at a significant risk of outbreaks from typhoid, malaria, dysentery, cholera, measles, meningococcal meningitis and rabies infection. However, the country has made significant progress in the fight against poliomyelitis evidenced by lack of any confirmed wild polio viruses during the 5 years of the study. More funding should be committed in the area of infectious disease prevention to lower the current disease burden and consolidate on achievements gained. Lessons Learned, Competences acquired and next steps
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