ABOUT THE FELLOW
I am a Field epidemiologist with a Master of Public Health Nutrition from Makerere University, School of Public Health. During my time as a Public Health Fellow, I have been attached at the Integrated Epidemiology, Surveillance and Public Health Emergencies (IES & PHE) Department, Ministry of Health. My role at IES & PHE involved district surveillance strengthening activities, event-based disease surveillance, verification, and analysis of surveillance data on epidemic prone diseases according to the 2005 International Health Regulations (IHR). I wrote reports in the national weekly epidemiologic, and National Institute for Public Health (UNIPH) bulletins and gave presentations on surveillance at the Surveillance Subcommittee of the National Task Force.
As a fellow with IES & PHE, I led investigations on yellow fever and malaria outbreaks and actively participated in five more outbreak investigations. This involvement in response to disease outbreaks coupled with engagements in simulation exercises, action reviews, surveillance and preparedness strengthening sharpened my knowledge on Uganda‟s IHR and health security obligations. I have undertaken four short courses in surveillance and public health emergency operation center management.
I have advanced my understanding of Uganda‟s health information systems and its role in guiding public health interventions and improving health security. Routine surveillance data analysis in my role has polished my skills in using electronic data collection tools like ODK, Kobocollect and GoData, and statistical and spatial packages like STATA, SPSS, EPI Info and QGIS.
Achievements at the Host Site
- Contributed articles and edited the national weekly epidemiological bulletin which serves to inform national and international health stakeholders on priority epidemic prone diseases/conditions.
- Conducted verification of national weekly surveillance data for the priority epidemic prone diseases/conditions
- Participated in surveillance data strengthening activities with a focus on weekly surveillance data (HMIS 033b). Through trainings, verifications and data quality checks, we improved use, consistency, completeness, timeliness of reporting across registers, HMIS forms and District Health Information System (DHIS2) at facility and district levels.
- Played active role in IHR monitoring and evaluation activities including: notification of public health events, simulation exercises, action reviews, Integrated Disease Surveillance and Response guidelines adaptation and implementation.
- As the secretary of the Surveillance Subcommittee of the public health emergencies‟ National Task Force, I contributed to documentation of preparedness and response interventions to public health emergencies. This role enabled me to participate in discussions and planning for emerging public health events. During the COVID-19 outbreak, I was a member of the national Incident Management Team for coordinating the response.
- I engaged in activities of the National Action Plan for Health Security (NAPHS).
These included: development of standard operating procedures for points of entry, situation analysis of food safety and, strengthening COVID-19 district surveillance.
- I received training in integrated disease surveillance and response (IDSR), event-based surveillance, Epidemic Intelligence for Open Sources (EIOS) and public health emergency operation center management.
Fellowship program specific achievements
- Actively participated investigations of: food poisoning in Napak and Amudat Districts, Yellow fever outbreaks in Bullisa, Maracha and Moyo Districts; Ebola Virus Disease outbreak in Kasese District; Malaria outbreak in Kole District; Leprosy in Lira District and case investigations of COVID-19
- Conducted a descriptive analysis of dysentery surveillance data (2014 – 2018) extracted from DHIS2
- Published the following articles in the UNIPH bulletin: Investigation of Yellow fever outbreak in Masaka District; Investigation of Malaria outbreak in Kole District; Highlights of the COVID-19 outbreak in Uganda, March to June 2020
- Published a Policy brief in the UNIPH bulletin titled, “Yellow fever vaccine should be added to the routine immunization program in Uganda”.
- Conducted an HIV project comparing maternal and perinatal outcomes among HIV positive and HIV negative women in Saving Mothers Giving Life (SMGL) programs in Uganda using program surveillance data from 2015 to 2016
- Published four newspaper and media articles: Knowing when NOT to use Personal Protective Equipment during this Corona Virus Disease outbreak; Making smart dietary decisions during this Coronavirus Disease (COVID-19) outbreak; Diabetes, the role of society in improving care; When food becomes a poison.
- Implemented a quality improvement project on improving adherence to IDSR standard sase definition for Typhoid fever in Kitebi Health Center III in Kampala District
- Presented the following abstracts at national conferences: Yellow fever outbreak in Masaka District; Comparison of maternal and perinatal outcomes among HIV positive and HIV negative women in SMGL programs in Uganda, 2015-2016; Malaria outbreak facilitated by cessation of indoor residual spraying, Kole District, 2019
- Presented the following abstracts at international conferences: The role of contact tracing during an EVD outbreak, Kasese District, Uganda, 2019; Contact tracing during COVID-19 outbreak in Uganda, 2020
- Wrote and submitted a manuscript titled, “Epidemiology of dysentery in Uganda, 2014-2018” to a peer reviewed journal. The following manuscripts are under review: Malaria outbreak facilitated by cessation of indoor residual spraying, Kole District, 2019; Comparison of maternal and perinatal outcomes among HIV positive and HIV negative women in SMGL programs in Uganda, 2015-2016
Summary of Epidemiological Study:
Title: Summary of Epidemiological study: COVID-19 in East Africa and Democratic Republic of Congo: A Comparison of the Outbreaks, and Interventions in the First Four Months.
Background: In the East African Community (EAC) and Democratic Republic of Congo (DRC), the index case of COVID-19 was reported by DRC on 10 March 2020. These countries share borders which posed challenges in limiting COVID-19 spread across Points of Entry (PoEs) during trade and social travel. World Health Organization (WHO) recommends strategic preparedness and response for COVID-19. This calls for prompt analysis of available data to help characterize transmission and role of interventions. We described the COVID-19 outbreaks, preparedness status and interventions in EAC and DRC from March to June 2020 to inform response.
Methods: The study was conducted among DRC and EAC member states: Uganda, Kenya, Tanzania, Rwanda, Burundi and South Sudan. We analyzed routinely-collected COVID-19 data from WHO- and Ministries of Health- databases, documents, and social and published media from March to June 2020. Variables included: total case and death counts, attack rates, tests per capita, preparedness and response status, and interventions. Preparedness and response status were described using WHO‟s categorization based on International Health Regulations State Parties Annual Reporting tool and additional country specific information. Countries‟ response status was categorized based on their position in response to COVID-19. Using country specific population data, we computed attack rates (AR), case fatality rates (CFR) and tests per capita. We tabulated preparedness and response status. We drew maps of cases and deaths. We ploted trends of confirmed cases and interventions by country.
Results: Between March – June 2020, 17,908 cases were reported in the region. DRC (6,938) and Kenya (6,366) reported more cases than South Sudan (2,007), Rwanda (1,025), Uganda (893), Tanzania (509) and Burundi (170). South Sudan had the highest AR (17.8/100,000) and Burundi, the lowest (1.4/100,000). The region reported 374 deaths; DRC had 166 (CFR = 2.4) and Kenya (148, CFR = 2.3). All countries implemented public health interventions to limit the spread. These included: limiting in-country and abroad travel, banning mass gatherings, schools and most workplaces, promoting hand hygiene and mask use, screening at PoEs, mass testing and nation-wide lockdowns. In preparedness, 5/7(71%) countries scored ≤60% while 2/7(29%) scored ≤40%. Kenya, DRC and Tanzania were in response category 5 and had already demonstrated community transmission of COVID-19. Tanzania did not have adequate information on COVID-19.
Conclusion and Recomendations: Between March – June 2020, DRC, Kenya and Tanzania reported more cases and deaths than South Sudan, Rwanda, Uganda and Burundi. Kenya, DRC and Tanzania had large outbreaks and community transmission. All countries implemented multiple public health interventions to limit the spread. Despite most of the countries in the region scoring ≤60% in preparedness, there was a slow increase in cases and deaths over the first four months of the pandemic which was likely supported by the prompt and strict public health interventions. EAC and DRC governments should strengthen interventions and adjust public health and social measures in response to increasing COVID-19 infections. Ministries of Health should ensure that accurate and complete information on COVID-19 is easily accessible on national and social media platforms to improve public awareness and guide interventions in the region.
Key Skills Lessons Learnt
During the fellowship, I learnt and developed the following skills:
- Outbreak Investigation
- Scientific writing: Manuscripts, Abstracts, Policy Briefs and Newspaper articles
- Editorial skills for scientific articles
- Surveillance data analysis and presentation
- Designing and implementing Quality Improvement Projects
- Evaluation of surveillance systems
- Writing and presentation
- Networking with key players in the field of health security
Next Steps
I hope to apply the skills gained during the Public Health Fellowship Program to serve in relevant public health organizations. I‟m interested in applying my field epidemiology expertise and experience in surveillance and epidemic disease control in activities that contribute to Uganda‟s health security objectives.
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