Dr. Migisha Richard

MBChB (MUST), MPH (MUST), M.Sc. (MUST)Field Epidemiology Fellow (UPHFP)
Email:migisha@musph.ac.ug
Telephone:0774394502

Host Site: Neglected Tropical Diseases (NTD)

Host Mentor: David Oguttu and Dr. Mubangizi Alfred

ABOUT THE FELLOW

Dr. Migisha is an epidemiologist and holds a Bachelor’s degree in medicine and Surgery, a Master’s degree in Public Health, and a Master’s degree in Science in Physiology. Before joining the Uganda Public Health Fellowship Program (UPHFP), I worked as a medical officer in Kisoro District Local Government, and Ntungamo District Local Government, mainly as a clinician for seven years. I am an alumnus of One Health Institute (OHI) of Makerere University, and I have experience in working with infectious disease outbreaks, and non-communicable diseases. I have published more than 20 scientific papers in the field of disease outbreak investigations, zoonotic diseases, and non-communicable diseases including hypertension, diabetes, and cardiovascular diseases. As a member of the National Rapid Response Team, I have been involved in the national response to the COVID-19 pandemic, including leading three COVID-19 outbreak investigations in different parts of the country.

  Achievements at the Host Site

• Investigation of early cases of SARS-CoV-2 infection in Uganda, March -April 2020
• Investigation of COVID-19 clusters in southwestern Uganda, August 2020.
• Investigation of a COVID-19 outbreak at Moroto Prison, Northern Uganda, September 2020I participated in four other outbreak investigations:
• Measles outbreak investigation in Nakivale Refugee Settlement, Isingiro District, February 2020
• Investigation of COVID-19 among long-distance truck drivers, May–June 2020
• Food poisoning Outbreak in Obongi District, August 2021
• COVID-19 outbreak among contacts of patients in home-based care, Western Uganda, November 2020I published two COVID-19-related bulletin articles in the UNIPH Epidemiological Bulletin, in the January-March quarter bulletin.During the early phase of the COVID-19 pandemic in Uganda, I wrote a newspaper article entitled “COVID-19 and tobacco smoking: fighting a double pandemic”. This was published in the New Vision.My HIV project assessed the prevalence and risk factors of high blood pressure among adolescents and young adults (13-25 years) infected with HIV in Rwenzori Region, Western Uganda.I conducted a quality improvement project. “Improving rational use of medicines at Itojo Hospital, Ntungamo District, Southwestern Uganda”I participated in drafting a policy brief, entitled “Turning anthrax from a private good to a public good disease”I made six oral presentations at scientific conferences; four of these oral presentations were at local conferences —three of the abstracts were presented at the National Field Epidemiology Conferences, and one abstract was presented at the June 11, 2021 PEPFAR summit. I made two oral presentations at an international conference (East African FETPs Conference on COVID-19 Response) that was held on November 18, 2020.I have authored and co-authored a number of manuscripts over the year period. I have written five manuscripts as the lead author, tow of which have already been published in peer reviewed journals.
• Migisha, et al., 2020. Early cases of SARS-CoV-2 infection in Uganda: epidemiology and lessons learned from risk-based testing approaches–March-April 2020. Globalization and Health, 16(1), pp.1-9. – published in BMC
• Investigation of a COVID-19 outbreak, at a regional prison, Northern Uganda, September 2020 – under peer review
• Psychological impact of COVID-19 among health workers in referral hospitals during early phase of COVID-19 pandemic, Uganda – under peer review in BMC Psychology
• Compliance to handwashing among Ugandan citizens during early phase of COVID-19 pandemic: a nationwide survey – under peer review
• High blood pressure and associated factors among HIV-infected young persons (13-25 years), Rwenzori Region, Western Uganda – under clearance at PHFP secretariat I am a coinvestigator on six other manuscripts, five of which are COVID-19 related:
• Individual and household risk factors for COVID-19 outbreak in home-based care settings in Western Uganda, November-December 2020 – Under CDC clearance
• Estimating the Cost of Treating a COVID-19 patient in government health facilities in Uganda, March to June, 2020 – under CDC clearance
• Investigation of a measles outbreak in a refugee settlement, Isingiro District, February 2020 – under CDC clearance
• COVID-19 outbreak at a quarantine prison, Central Uganda, September 2020 – under CDC clearance
• High-risk COVID-19 among truck drivers testing positive for COVID-19 at Uganda borders, May-June 2020 – under CDC clearance
• Use of a toll-free call center for COVID-19 response and continuity of essential services during the lockdown, Greater Kampala, Uganda, 2020 – under peer review.

Summary of Epidemiological Study: 

 Title: Psychological Impact of COVID-19 on Healthcare Workers in Referral Hospitals During the Early Phase of the Pandemic, Uganda

Background: Safeguarding the psychological well-being of healthcare workers (HCWs) is crucial to ensuring sustainability and quality of healthcare services. During the COVID-19 pandemic, HCWs working in COVID-19 treatment units may be subject to excessive mental stress. We assessed the risk perception and immediate psychological state of HCWs early in the pandemic in referral hospitals involved in the management of COVID-19 patients in Uganda.

Methods: We distributed paper-based, self-administered questionnaires to HCWs in five referral hospitals from April 20–May 22, 2020. The questionnaire included questions on socio-demographics, occupational behaviors, potential perceived risks, and psychological distress. We assessed risk perception towards COVID-19 using 27 concern statements with a four-point Likert scale. We defined psychological distress as a total score >12 from the 12-item Goldberg’s General Health Questionnaire (GHQ-12). We used modified Poisson regression to identify factors associated with psychological distress

Results: Among 335 HCWs who received questionnaires, 328 (98%) responded. Respondents’ mean age was 36 (range 18-59) years; 172 (52%) were male. The median duration of professional experience was eight (range 1-35) years; 208 (63%) worked more than 40 hours per week; 116 (35%) were nurses, 52 (14%) doctors, 30 (9%) clinical officers, and 86 (26%) support staff. One hundred and forty-four (44%) had a GHQ-12 score >12. The most common concerns reported included fear of infection at the workplace (81%) and if a colleague contracted COVID-19 (89%), stigma from colleagues (79%), lack of workplace support (63%), and inadequate availability of personal protective equipment (PPE) (56%). In multivariable analysis, moderate (adjusted prevalence ratio, [aPR]=2.2, 95% confidence interval [CI]: 1.2–4.0) and high (aPR=3.8, 95% CI: 2.0–7.0) risk perception towards COVID-19 (compared with low-risk perception) were associated with psychological distress.

Conclusion:

Forty-four percent of HCWs surveyed in hospitals treating COVID-19 patients during the early COVID-19 epidemic in Uganda reported psychological distress related to fear of infection, stigma, and inadequate PPE. Higher perceived personal risk towards COVID-19 was associated with increased psychological distress. To optimize patient care during the pandemic and future outbreaks, workplace management may consider identifying and addressing HCW concerns, ensuring sufficient PPE and training, and reducing infection-associated stigma.

Key lessons learnt during the fellowship

• Conducting outbreak investigations and response
• Scientific writing skills: manuscript writing, policy briefs, newspaper articles
• Grant writing skills
• Presentation skills
• Leadership skills
• Data analysis
• Designing and implementing quality improvement projects

Next Steps

hope to share the skills and competences gained during the fellowship with the aim of improving public health practice in Uganda.I hope to further my career in field epidemiology.

Pictorial