Joyce Nguna Tusaba
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ABOUT THE FELLOWJoyce graduated with a Master of Science in International Infectious Diseases Management from Makerere University, Uganda. She’s a competent public health epidemiologist with a passion for infectious Diseases. She also participated in building individual and program capacity to effectively execute a high impact quality improvement project that resulted in the increased surveillance of Tetanus in Mayuge District. Joyce was also a member of the National Task Force Surveillance and Vaccination subcommittees for Ebola Virus Disease preparedness. This experience placed her in a position towards achieving her career developmental goal and acquiring competencies to develop, execute and monitor cutting-edge life saving strategies. UNEPI gave me numerous opportunities to work on diverse areas where health policy and science intersect. Projects undertook during the Advanced Field Epidemiology Training;Project
Leadership and management
Scientific communication
Summary of Epidemiological Study: Title: Malaria Outbreak Facilitated by Increased Human Activities around Swamps: Kisoro District, Uganda, December 2017-March 2018 Introduction: Malaria is a life-threatening febrile illness caused by Plasmodium parasites that are transmitted to people through bites of infected Anopheles mosquitoes.The global focus on malaria is now shifting away from smaller-scale control towards efforts to eliminate and later eradicate malaria. The Ugandan Ministry of Health (UMOH), with several implementing partners, have supported various strategies for malaria control, including enforcing adherence to national case management guidelines for simple and severe malaria at health facilities and communities, distribution of long-lasting insecticide-treated nets, indoor residual spraying, and prevention of malaria in pregnancy. This has led to a decline in national malaria prevalence from 45% in 2010 to 19% in 2016. However, most areas of Uganda are still highly endemic, and not approaching elimination of malaria. On 19 December 2018, a malaria outbreak was reported in two of the sub-counties of Kisoro District, Kanaba and Murora sub-counties. The outbreak was detected through routine analysis of malaria surveillance data reported in the District Health Information System 2 (DHIS2) for December 2017 (weeks 49-52, 2017) and January 2018 (weeks 1-2, 2018) [16]. This analysis showed a sudden increase in malaria cases (>200 cases/month from DHIS2 during this time period) compared to the previously low reported cases from DHIS2. Malaria cases diagnosed by malaria rapid diagnostic test or microscopy in the district in this time period exceeded the action thresholds established by the Malaria Control Program. We investigated this outbreak to determine its magnitude and scope, identify factors associated with transmission in this usually low-endemic area, and recommend evidence-based control and prevention measures. Methods: We defined a confirmed case as a positive malaria rapid diagnostic test or microscopy from December 2017–March 2018in a person in Kisoro District, where the outbreak was reported. We reviewed medical records in all health facilities in the affected Kanaba and Murora sub-counties to find cases. We calculated attack rates (AR) by age, sex, and village using the projected 2016 population.In a case-control study, we compared potential exposures between case-persons, selected randomly from the line-list, and village- and age-matched asymptomatic controls. We conducted an entomological and environmental assessment of the affected sub-counties. Results: We found 3,130 malaria cases (compared with 879 cases during the same period the previous year). Persons in the age groups 10-19 (AR: 14/1,000) and 20-29 (AR: 12/1,000) years were the most affected. In the case-control study, 89% (129/145) of case-persons and 73% (106/145) of controls reported that they usually went to bedafter 9:00pm(ORM-H=2.9; 95%CI: 1.6-5.7); 22% (32/145) of case-persons and 15% (21/145) of controls reported not sleeping under a mosquito net (ORM-H=3.9; 95% CI: 1.2-13). Villages closest to the Sereri and Mpundu swamps were more affected than those further away. Investigation revealed that in July 2017, the Sereri and Mpundu swamps began being used for agricultural and brick-making activities, which might have increased mosquito density as well as human exposure to mosquitos. Further research revealed that a heavy rainfall had occurred in the area in early January 2018. Anopheles gambiae sensu lato was identified in breeding places around Sereri and Mpundu swamps. In total, 64% (23/36) of female adult Anopheles captured in case-persons’ households by pyrethrum spray catches were fed, suggesting low mosquito net usage the previous night. Conclusion: This malaria outbreak occurred in an area that had already reached pre-elimination levels of malaria. It was likely propagated by favorable breeding conditions, including recent heavy rainfall, and exacerbated by new human activities around two swamps. In the context of progress towards elimination, low-endemic areas should be particularly aware of activities that can lead to resurgences in malaria, such as night-time exposures, lack of mosquito net usage, and human activities focused around breeding sites. We recommended increased awareness about mosquito net usage, and use of larvicides in the residential area and swamps to break the breeding cycle. Additionally, persons working in the swamps or other high-risk areas should use protective clothing. Field in pictorial |
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