ABOUT THE FELLOW
I am a Field epidemiologist with a Master‟s Degree in Public Health from Makerere University, School of Public Health with a background in nursing and midwifery. During my time as a Public Health Fellow, I was attached to the Department of Reproductive and Child Health at the Ministry of Health.
I have conceptualized, designed and implemented research projects in the area of maternal and child health such as using the BABIES matrix to determine pregnancy birth outcomes in Naguru Regional Referral Hospital (RRH) in Kampala, Uganda.
I have supported health facilities to establish and enhance surveillance systems to monitor and improve maternal and perinatal deaths. I have participated in several trainings that have built my competencies in designing and implementing research protocols, responding to public health emergencies, data analysis and scientific writing.
I have led one malaria outbreak investigation in Oyam District and co-investigated four outbreak investigations including responding to COVID-19 pandemic.
Achievements at the Host Site
- Led the adaptation and writing of the Sexual Reproductive Health (SRH), HIV/AIDS, Gender Based Violence (GBV) integration index report, 2019 for Uganda
- Conducted analysis of data on SRH, HIV/AIDS, and GBV Integration indicators from DHIS2, led the writing of annual SRH/HIV/GBV integration reports and work plans for 2019/20 in the 8 Joint Programme districts under UN Agencies and at National Level
- Team leader for various host site activities including; quarterly adolescent health friendly outreaches, mentorship and support supervision of health providers on Maternal Perinatal Death Surveillance and Response (MPDSR) implementation, SRH, HIV, GBV integrated outreaches
- National trainer and mentor for adolescent health, SRH, HIV, GBV integration, MPDSR, continuity of essential services amidst COVID-19 and led trainings of health workers in these areas.
- Part of the core team that spearheaded development of guidelines for care of pregnant women, breastfeeding women and infants in the context of COVID-19, later incorporated into the national guidelines for continuity of essential services during COVID-19
- Part of the core team that developed these key strategic documents: draft MPDSR costed implementation plan 2020-2025, MPDSR Annual Report 2019/20, draft implementation guidelines for health workers on use of emergency contraceptives, activity implementation framework to accelerate reduction of maternal mortality due to postpartum hemorrhage 2020/21 among others.
- Part of the core team that reviewed and harmonized these key strategic documents: draft training guide on MPDSR and included the BABIES matrix as a topic of consideration, Form 12; notification of death and certification of cause of death form, the adolescent training guide for trainers and trainees, service standards for provision of adolescent friendly services, Information, Education and Communication (IEC) materials for adolescent health and various support supervision checklists such as the voucher programme under adolescent health to mention but a few
- Conducted data quality assessments for MPDSR and SRH, HIV, GBV integration at selected facilities
- Currently a member of the secretariat and scientific committee organizing the scientific conference on SRH-HIV-GBV integration to be held on 4th-5th February 2021
Fellowship program specific achievements
Editor for October-December 2019 issue of the Uganda National Institute of Public Health (UNIPH) bulletin.
- Principal Investigator for the Malaria Outbreak investigation conducted in Oyam District
- Co-investigated the following outbreaks: Rubella outbreak investigation in Nakaseke District.; Leprosy outbreak investigation in Lira District.; COVID-19 investigation in Mbale District.; Screening of travellers and worshipers for Ebola at Namugongo shrine.; Screening of travellers for COVID-19 at Entebbe International airport between March-June 2020.
- Participated in a 2-week workshop on Maternal Infant Matrix (MIM) storyboard Methodology at Emory University, USA
- Deployed as epidemiologist through the regional deployment arrangement of Ministry of health where I supported COVID-19 response, built capacity of district health teams in 7 districts under Bombo Region to respond to the pandemic.
- Facilitated trainings of District trainers of trainees on COVID-19 preparedness and response including orientation, identification, reporting in Eastern region.
- Led a quality improvement project “Establishing BABIES matrix to improve surveillance and focus response measures to reduce perinatal deaths at Mubende Regional Referral Hospital in Uganda”
- Lead investigator for HIV study: Factors associated with uptake of HIV testing among adolescents and young people in Uganda.
- Led an Evaluation on Implementation of Maternal Perinatal Death Surveillance and Response (MPDSR) to Inform Programming in Hoima District, Uganda, 2017-2019
Conference presentations
- Oral presentation on Factors associated with uptake of HIV testing among adolescents and young people in Uganda at East African Virtual Conference on COVID-19 in 2020
- Oral presentation on Using the BABIES matrix to determine Pregnancy Birth outcomes in Naguru RRH at East African Virtual Conference on COVID-19 in 2020
- Oral presentation of Using the BABIES matrix to determine Pregnancy Birth outcomes in Naguru RRH at National Field Epidemiology Virtual Conference, 2020, Kampala, Uganda
- Poster presentation on Anthrax outbreak in Kween District , at 68th EIS conference, Atlanta 2019
- Oral presentation of Malaria outbreak investigation in Oyam District at National Field Epidemiology Conference,
2019, Kampala, Uganda
- Poster presentation of Malaria outbreak investigation in Oyam District at the Joint Annual Scientific Conference (JASH Conference), 2019, Kampala Uganda.
Publications and manuscripts written
- Using the BABIES Matrix to Determine Patterns of Newborn Birth Outcomes in Naguru Regional Referral Hospital, Kampala, Uganda, Nov 2018 – March 2019: article published in the National Institute of Public Health quarterly bulletin
- The CORONA VIRUS DISEASE PANDEMIC: Uganda Holds the First Public Dialogue on Corona Virus Disease (COVID -19): article in the National Institute of Public Health quarterly bulletin.
- UGANDA HOSTS THE FIRST PILOT TRAINING OF EPIDEMIOLOGY IN HUMANITARIAN EMERGENCIES FOR ALUMNI OF FIELD EPIDEMIOLOGY TRAINING PROGRAMS : article in the National Institute of Public Health quarterly bulletin
- Malaria outbreak Investigation in Oyam District : article in the National Institute of Public Health quarterly bulletin
- The Annual Maternal and Perinatal Death Surveillance and Response (MPDSR) Report FY 2018/19 highlighted a reduction in institutional maternal mortality ratio from 108 to 92 per 100,000 deliveries in Uganda: article in the National Institute of Public Health quarterly bulletin
- Policy brief: Guidelines for the management of pregnant women, breastfeeding women, and infants in the context of Covid-19
- Newspaper article in the New Vision “ Born to Soon: Your Role in Preventing Occurrence of Premature Births and Deaths”
- Manuscript on Factors associated with uptake of HIV testing among Adolescents and Young People, Uganda, 2016-2017: Under internal review
- Manuscript on Malaria Outbreak Facilitated by Engagement in Activities near swamps following increased Rainfall and limited Preventive Measures: Oyam District. Uganda, January-June 2019: Under e-clearance
Summary of Epidemiological Study:
Title: Summary of Epidemiological Study: Using the BABIES Matrix to Determine Patterns of Pregnancy Birth Outcomes in Naguru Regional Referral Hospital, Kampala, Uganda, Nov 2018-March 2019
Background: Uganda experiences high perinatal mortality rates (PMR) (38/1,000 births), occuring mostly at or soon after birth. The BABIES matrix (Birthweight and Age at Death Boxes for Intervention and Evaluation System) is a tool introduced in Uganda in 2013 to monitor and improve pregnancy outcomes; birth outcomes are categorized by birthweight, age-at-death, and other customizable variables in boxes indicative of different underlying causes and areas for interventions. We used the BABIES Matrix to determine overall and cause-specific PMR in Naguru Regional Referral Hospital (NRRH) and identify gaps in obstetric service quality.
Methods: We abstracted data from maternity registers at NRRH from November 2018–March 2019. We cross-tabulated age-at-death counts (columns) with birthweight groups (rows) and used total births as denominators. We computed PMR by birthweight group, stage during pregnancy/birth/neonatal period when death occured, maternal age, referral status, and mode of delivery and evaluated using chi-square.
Results: Of 4,122 births, 3,890 (94.4%) were live births, (overall PMR at NRRH: 43/1,000). Neonatal death rate <24 hours was 2/1,000 live births. Among 169 stillborns (rate: 41/1,000 births), 93 (55%) were intrapartum deaths while 76 (45%) were antepartum. Birthweight-specific PMR was highest among <1500g (368/1,000 births), followed by 1500-2499g (199/1,000 births) and >2500g (18/1,000 births). Maternal age was unassociated with PMR. Referred mothers had a higher PMR than walk-ins (87 vs 39/1,000 births, p<0.001), while vaginal births had a higher PMR than cesarean section births (49 vs 28/1,000, p=0.002).
Conclusion and Recomendations: PMR at NRRH was above the national rate. This may relate to the quality of care or late presentation to NRRH. As per the BABIES matrix, the high stillbirth rate indicates opportunities for improvements in care during pregnancy and delivery. We recommended improving intrapartum monitoring, triaging laboring mothers on admission, managing low birth weight babies, and a deeper analysis of reasons for the high PMR.
Key words: Maternal and Perinatal Mortality, Still Births, Birth weight at death, BABIES matrix, Uganda
Key Skills Lessons Learnt
During the fellowship, I learnt and developed the following skill sets:
- Outbreak Investigation
- Scientific writing; Manuscripts, Abstracts, Policy Briefs and Newspaper article
- Editorial skills for scientific articles
- Data analysis skills
- Designing and implementing Quality Improvement Projects
- Evaluating a surveillance system
- Presentation skills
- Writing skills
- Networking skills
- Balancing work and family
Next Steps
I hope to further my career in the field of Epidemiology through service in local and international organisations that will allow me leverage my knowledge, experiences and skills obtained during the Public Health Fellowship Program. Additionally to publish all the work done during the fellowship period in peer review journals.
Pictorial
|