Dr. Freda Loy Aceng

Dr. Freda Loy Aceng

MSC (International Infectious Diseases Management)(Mak), BVM(Mak), Field Epidemiology Fellow (UPHFP)
Email: faceng@musph.ac.ug; acengfreda@gmail.com

Contact: +256774679087, +256750316750

Host Site: National Tuberculosis and Leprosy Program-MOH

Host Mentors: Dr. Frank Mugabem and Dr. Ekuka Godfrey

ABOUT THE FELLOW

Dr. Freda Loy Aceng is a Veterinary Doctor strongly interested in Infectious Diseases Management. She has a Bachelor’s degree in Veterinary Medicine from Makerere University, Uganda and a Master’s degree in from Makerere University and North Dakota State University. She has been a Uganda Field Epidemiology fellow, cohort 2017. She has investigated multiple disease outbreaks most notably ‘Cutaneous anthrax outbreak investigation in Arua district Uganda district’ and ‘Rift Valley Fever outbreaks in Kiboga and Mityana districts.’ In addition she was attached to the Uganda National Tuberculosis and Leprosy Program where some of her activities included; writing of the quarterly bulletin which showcases the program’s activities and TB research.

Achievements at the Host Site

I have enjoyed my time at the National Tuberculosis and Leprosy Program (NTLP) where I was attached for the two years of my fellowship. It has been an interesting experience where I have learnt a lot especially about programming. The greatest satisfaction for me comes from the fact that I achieved all the activities in my Terms of Reference (ToR).

• I pioneered the NTLP quarterly bulletin where we have published 6 issues to date. The NTLP Quarterly Bulletin aims to display the functional achievements of the program by presenting the past, present and future activities.
• I was a part of the Structured Operational Research and Training IniTiative (SORT IT) which is an intensive training program that seeks to build a critical mass of operationresearchers within public health institutions especially programs of the Ministries of Health. The focus was Tuberculosis (TB) Operational Research where my topic was, ‘Tuberculosis case notifications among health care workers at public health facilities in Uganda from 2015 to 2017.’The findings of the study will influence policy and practice and improve program outcomes especially enhancement of the program goal to find missing TB cases.
• My quality improvement project was titled, ‘Improving Tuberculosis reporting in Lira district using continuous quality improvement science.’
• My epi-study which was another fellowship deliverable was titled, ‘Extra pulmonary Tuberculosis cluster Investigation in Napak District, June 2018.’ My descriptive study, ‘Spatial Distribution and Temporal Trends of Leprosy in Uganda, 2012-2016: a Retrospective Analysis of Public Health Surveillance Data’ informed leprosy programming and I submitted the manuscript to a scientific journal.
• I successfully coordinated the District TB and Leprosy Supervisors training in Buluba where we had the highest number of trainees ever. The training is critical in capacity building for TB and Leprosy prevention and control in the country.
• I also led the coordination of several leprosy activities at the program.

Program-specific achievements

The Field Epidemiology training is what I describe as ‘bringing epidemiology to life!’ It has been an exciting and challenging journey where I got a number of achievements. I was able to achieve all the key deliverables.

• My descriptive analysis on Leprosy was successfully completed and a manuscript developed.
• I led the investigation of two outbreaks; cutaneous anthrax outbreak in Arua district and Rift Valley Fever outbreak in Kiboga and Mityana districts. In addition I participated in a number of other investigations such as cholera in Nebbi District, measles in Kampala District and fatal methanol poisoning outbreak in Wakiso District.
• I published articles and a policy brief in the epidemiological bulletin. My newspaper article, ‘The Fallacy of No-Man’s Land at border points in Disease Transmission and Control’ was published in the New Vision. I have submitted my manuscript for the study, ‘Spatial Distribution and Temporal Trends of Leprosy in Uganda, 2012-2016: a Retrospective Analysis of Public Health Surveillance Data’ to the BMC infectious diseases journal.
• My HIV study was ‘Analysis of the data from the Prevention of Mother to Child Transmission (PMTCT) program to identify demographic, health and social characteristics of HIV+ mothers who were lost to follow up.’
• I had abstracts presented at various conferences both locally and internationally which included the International Conference on Emerging Infectious Diseases (ICEID) 2018, 7thAfrican Field Epidemiology Network scientific conference, 3rd and 4th Uganda National Field Epidemiology Conference and the 4th Global Health Security Agenda High Level Ministerial Conference. I was also honored to present during the FETP International Night 2018 at the 67thAnnual Epidemic Intelligence Service Conference in Atlanta, Georgia.

Summary of Epidemiological Study: 

 Title:  Outbreak of Cutaneous Anthrax Associated with Handling Carcasses of Animals that Died Suddenly – Arua District, Uganda, January 2015-August 2017

Freda Loy Aceng1*, Phoebe Hilda Alitubeera1, Daniel Kadobera1, Musa Sekamatte2, D. Okethwangu1, Lilian Bulage1, A. R. Ario1, B.P. Zhu1
1Uganda Public Health Fellowship Program, Kampala, Uganda 2Zoonotic Disease Coordination Office (ZDCO), Kampala, Uganda

Introduction:  During May–June 2017, three persons with suspected cutaneous anthrax were reported from Arua District to the Uganda Ministry of Health; one died. All had recently handled carcasses from animals that died suddenly. A skin lesion from a deceased person and a blood sample from a recently–deceased bull in same area tested positive for Bacillus anthracis. Informal community reports suggested cases since 2015. We investigated the outbreak to establish the scope, exposures for transmission, and recommend evidence-based control measures.

Methods:  We defined a probable case as acute onset of a papulo–vesicular skin lesion subsequently forming an eschar in an Arua District resident during January 2015–August 2017. A confirmed case was a probable case Polymerase chain reaction (PCR)–positive for B. anthracis. We identified cases by medical record review and active community search. In a case–control study, we compared exposures between case-patients and frequency–matched asymptomatic village controls.

Results: We identified 68 case-persons of which 67 were probable, one confirmed, and two died [case fatality rate (CFR=2/68=2.9), from two neighboring sub–counties: Rigbo (AR=20.1/10,000) and Rhino Camp (AR=2.1/10,000). Males (AR=17/100,000) were more affected compared to females (0.52/100,000). Age-group 30-39 (AR=26/100,000) was most affected. Cases occurred throughout the three–year period, peaking during dry seasons. In the case-control study, 84% (57/68) of case-persons compared to 53% (72/136) of control-persons skinned animals that died suddenly (ORM-H=5.0, 95%CI: 2.3–11), 96% (65/68) of case-persons compared to 56% (76/136) of control-persons butchered meat of those animals (ORM-H=22, 95%CI: 5.5–89) while 90% (61/68) of case-persons compared to 54% (74/136) of control-persons carried the meat (ORM-H=6.9, 95%CI: 3.0–16). All cases occurred following sudden animal deaths.

Conclusion: The cutaneous anthrax outbreak was associated with handling carcasses of animals that died suddenly in Arua District. Investigations to establish the magnitude and exposures for anthrax transmission in animals have been done and revealed that skinning/butchering animals in the grasslands and animal deaths along riverbanks were risk factors. The district set up a One Health structure to facilitate epidemic preparedness and response. We recommended only consuming meat from slaughtered healthy animals, safe disposal of animals that died suddenly, and animal vaccination.

Lessons Learned and skills acquired

During the fellowship, I have learned a lot of lessons and acquired various skills. I learned that field epidemiology requires patience, perseverance and dedication based on the unpredictable field challenges that I encountered. However despite all of them I managed to achieve my objectives and that was always the driving force. I acquired several skills including leadership, analytical, communication and computer skills. I am now confident and equipped to work as an epidemiologist in a reputable organization.