Fred Nsubuga
|
|
ABOUT THE FELLOWDavid is a Parasitologist with first degree training in Biomedical Laboratory Technology, Master of Zoology/Parasitology and a diploma in Medical Entomology and Parasitology. In 2001, he started working as a Laboratory technician at the Vector Borne Diseases Control Division, Ministry of Health and later as a Parasitologist until 2014. He was one of the national field supervisors of Indoor Residual Spraying and entomological surveillance (bionomics and insecticide susceptibility) until 2014. From 2007-2014 he led molecular surveillance of onchocerciasis elimination using Ov16 & O-150 techniques, and monitoring Entomological inoculation rate (EIR) of Malaria parasites in communities using Pf. CS ELISA. In 2013 he was selected a health Lifeline hero in river blindness elimination action in Uganda; http://www.aljazeera.com/programmes/ lifelines/2013/10/david-oguttu-elimination-beingachieved-2013102311526664978.html. David was also a Central supervisor/Trainer, Neglected Tropical Diseases (NTD) Control Program, Ministry of Health. In 2010 he led rapid mapping of schistosomiasis, STH and Lymphatic filariasis in South Sudan. As a Field Epidemiology Fellow 2015-2016, he was hosted by the National Malaria Control Program-Tororo Site. He led and participated in several outbreak investigations. Achievements at the host site
Program-specific achievements (key deliverables)
Summary of Planned study:
Introduction: Malaria a huge public health problem despite implementation of universal coverage of Long Lasting Insecticide treated Nets (LLINs), Indoor Residual spraying (IRS), and prompt case management at health facilities. The proportion of asymptomatic people hosting malaria parasites as reservoirs in the community is not known in Uganda. Furthermore, daily individual exposure time before sleeping under a net is not well documented. It is also unclear whether introducing active community malaria testing and treatment can contribute to reduction in malaria parasite prevalence in settings with active IRS. We aimed to determine the prevalence of symptomatic and asymptomatic malaria in the community after four rounds of IRS, estimate daily person exposure time to mosquito bites before sleeping under LLIN and assess the effect of active testing and treatment on community malaria parasite prevalence. Secondary objective was to describe relationship between malaria incidence and indoor biting Anopheles. Methods: We conducted a cluster randomized trial involving twenty villages in Osukuru and Magola sub-counties of Tororo District. At baseline we screened 50 under fives and 50 adults per village for malaria using Rapid Diagnostic Tests (RDT) and prepared blood slides to quantify parasitaemia using microscopy. We classified malaria positive individuals as symptomatic or asymptomatic. The villages were randomly assigned to intervention or control arms in equal proportion. We collected data on LLIN use and exposure period before using a net. In the intervention villages we introduced active malaria testing and treatment to cover all people in households. After six months we shall compare malaria prevalence in the intervention and control clusters. We described the relation between malaria incidence and indoor Anopheles density using routine surveillance data and entomological monitoring data. Results: The prevalence of asymptomatic malaria after four rounds of IRS was 14%; higher among children <5 years (21%) than adults (7.0%). A large number of people (90%) stay outdoors up to 21:00 hours exposed to malaria vectors before sleeping under bed nets. After four rounds of IRS indoor biting malaria vectors were successfully controlled, but malaria incidence stayed in the population at a moderate endemic level. Conclusion: Community malaria prevalence in Tororo reduced to a moderate endemic level after four rounds of IRS. Moderate malaria parasite prevalence after successful control of indoor Anopheles, presents a silent risk of malaria resurgence after halting IRS. Active malaria testing and treatment at community level should be done to reduce the disease prevalence to low endemicity and prevent resurgence after IRS is halted. Key skills/competences acquired.
Lessons learnti. Public health activities require strong multidisciplinary team work ii. Efficient public health laboratories are important in epidemiologic investigations iii. Inland cross-border points of Uganda lack capacity required to implement IHR iv. Translation of public health research findings into policy is inadequate in Uganda Next career steps
|
|