Emily Atuheire Barigye

Emily Atuheire Barigye 

 BEHS (Mak), MPH (Mak), Field Epidemiology Fellow (PHFP) +256772120949eatuheire@musph.ac.ug

Host Site

Reproductive Health Division, Ministry of Health

Host Mentors

Dr. Nakiganda Blandina, Dr. Livingstone Makanga

Academic Mentor

Dr. Elizabeth Ekirapa, MakSPH

ABOUT THE FELLOW

Ms. Emily Atuheire is a graduate holder of Master of Public Health and Bachelor of Environmental Health Science from Makerere University, Kampala, Uganda. She’s an upcoming public health epidemiologist with a passion for maternal and child health. Emily is a proactive and dynamic leader with a pragmatic approach to undertaking assigned projects. Prior to joining the Public Health Fellowship Program in 2016, she had over 10 years’ experience in environmental health practice and 3years in reproductive maternal and child health epidemiology.As a fellow, Emily has been hosted at the Ministry of Health’s Reproductive Health Division (RH), within the Community Health Department. The Division is responsible for policy development and gives oversight to reproductive, adolescent, maternal and child health policy and programing

  Achievements at the host site

While at the RH division, Emily used her leadership and writing skills to contribute to the division’s mandate of developing policies and guidelines; she coordinated the writing of the national guidelines for maternal and perinatal death surveillance and response (MPDSR) including development of training materials for health workers. She has subsequently supported training of regional and district teams on implementation of the revised MPDSR guidelines which is ongoing. She used her excellent epidemiological skills, to successfully implement a quality improvement project for identifying and managing hypertensive disorders of pregnancy in Bududa hospital, contributing to improved outcomes for pregnant mothers and newborns. As part of her contribution to quality improvement initiatives for maternal child health, Emily recently coordinated a national training of trainers for ‘BABIES MATRIX’, a powerful quality improvement tool that uses locally generated data to inform decisions and actions for improved quality of care for maternal and child health.

Program-specific achievements (key deliverables)

Emily has had several other achievements during her fellowship period in the following areas:

Emergency response

• Lead investigator, Yellow fever disease outbreak, April 2016
• Participated in investigation of suspected aflatoxicosis in Bukomansimbi District and mercury poisoning outbreak in Amudat District
• Lead investigator, rapid assessment of disease surveillance system in refugee settlements in Arua (Rhino Camp) and Adjumani (Mungula, Ayilo, Pagirinya and Boroli) Refugee Settlements.
• Lead investigator, rapid assessment of HIV services delivery in Adjumani hospital, Mungula HC IV, Ayilo HC II & III, Pagirinya HC III and Bira HC III.
• Member of the National Rapid Response Team Public health surveillance
• Documented the trends of caesarean section births in Ugandan Health Facilities through report writing
• Participated in data analysis and writing of the national Annual Health Sector Performance Report of the Ministry of Health,2016

Leadership and management

• National trainer for Integrated Disease Surveillance and Response and Maternal Perinatal Death Surveillance and Response
• Mentored a team of Frontline Health Workers on disease and event surveillance in refugee settings for timely and effective response in Arua

Scientific communication

• 4 Presentations at national and international conferences including the Ghana Field Epidemiology and Laboratory training program conference Sept 2017:
  • Evaluation of water sanitation and hygiene infrastructure in health care facilities in Kamwenge district, March 2017
  • Rapid evaluation of disease surveillance in Rhino camp refugee settlement in Arua district, Sept 2016
    Trends of cesarean section in Uganda, Nov 2016
• Published 2 articles in the Uganda National Institute of Public Health bulletin.
  • on Strengthening Disease Surveillance in Rhino Camp Refugee Settlement – Arua District, Sept 2016
  • Uganda adapts the WHO medical eligibility wheel for improved quality Family Planning care, June 2016
• 2 manuscripts currently under review
  • Spatial and Temporal Trends of Cesarean Section Deliveries in Uganda: 2012-2016
  • HIV transmission and related behavioral risk factors associated with early sexual debut among women in fishing communities in Lake Kyoga basin, Uganda, 2013- 2014

 Summary of the Quality Improvement Project:

 TITLE:  Improving Identification and Management of Hypertensive Disorders in Pregnancy, Labour and Puerperium in Bududa Hospital, Oct 2017
Introduction:      Hypertensive disorders of pregnancy (HDPs) are important contributors to maternal and perinatal mortality accounting for 14% of maternal deaths worldwide and 18-20% in Africa [1]. In Uganda, HDPs are an important cause of maternal morbidity, second only to bleeding, with an estimated case fatality rate of 5.1% [2, 3]. Poor diagnosis of the condition due to gaps in assessment and management worsen the problem. A review of Maternal Deaths(MDs) in Mbale Regional Referral Hospital from July 2015 to June 2016 showed an institutional Maternal Mortality Ratio (MMR) of 674/100,000 live births, twice the national MMR of 310/100,000 live births. HDPs were the leading cause of death, accounting for 27% of deaths, followed by bleeding at 21%. Three quarters of MDs were referrals, and 96% of referred conditions should have been managed by the referring facilities. Of the 14 referring Districts, Bududa District contributed the most (15%) referrals leading to MD, despite the presence of a General Hospital. A follow-up survey, found that 78% of the maternity ward staff were unable to correctly administer magnesium sulphate for the management of HDPs per national policy. We set out to improve the identification and management of HDPs through a continuous quality improvement (CQI) approach

Objectives: 

1) To identify knowledge gaps that are causing delayed identification and mismanagement of HDP’s in Bududa hospital.

2) To train selected hospital staff on CQI and identification /management of HDPs using ministry of health guidelines/protocols;

3) To monitor and evaluate changes in identification and management of hypertensive disorders during antenatal, labour, delivery and the pueperium.

Methods:   We reviewed, abstracted and summarized data to identify gaps in delayed identification and mismanagement of HDP’s in Bududa hospital. Found that 33% of women attending ANC had their BP measurements taken, 15% had their BP measurement recorded at first visit and no urine testing for protein during pregnancy. Health workers in ANC and maternity had knowledge gaps in administering treatment for HDPs. We conducted a problem outcome analysis using the fishbone method and prioritized the possible interventions to the identified problems basing on their impact value for the patient outcome – is the proposed change under control of the team?Is it easy to do? and what resources are required to implement it? We used the Plan Do Study and Act (PDSA) approach to set objectives, indicators, targets, activities, assign tasks and executed the plan. We observed the effect of implementation which is increased BP monitoring in pregnancy, labour and pueperium using data. We shared progress in weekly and monthly QI meetings.

Results: From May to September 2017, BP monitoring increased from 33% to 94% in pregnancy and BP measurement at first ANC visit increased from 15% to 84%. Monitoring in labour increased from 27% to 32% and 40% to 88% in the first 2hours post-delivery

Conclusion and Recommendations: Capacity building for health providers improved BP monitoring in pregnancy, labour and post-delivery. Use of data through reviews, display and analysis helped to track progress.We recommend adoption of the QI methodology used to improve service delivery in other sectors in Bududa Hospital. The model and lessons learntcould be used to implement and spread the strategy to improve maternal health services in Bududa District and beyond.