Alex Ndyabakira

Alex NdyabakirA, MPH

Fellow Cohort 2020
Public Health and Environment
Email: andyabakira@kcca.go.ug

Host Site: Kampala Capital City Authority

Host Mentor: Dr Okello A Daniel, Director

ABOUT THE FELLOW

Alex Ndyabakira is a medical doctor with postgraduate diploma in project planning and management from Uganda Management Institute and Master of Public Health degree from Makerere University. Before joining the field epidemiology training program, he worked as a project coordinator at Infectious Diseases Research Collaboration where he designed and coordinated implementation of several community trials. He has published about use of incentives to promote health behaviours, HIV care and malaria. During the fellowship, Alex was hosted at the Kampala Capital City Authority where he led the city COVID-19 response, air quality management and mentored staff in scientific writing through initiation of the KCCA public health bulletin. Several achievements were attained at the host site for the COVID-19 response and air quality management:

  Achievements at the Host Site

COVID-19 Response

• Training surveillance teams, COVID-19 contact tracing, set up of emergency operations center and investigation of COVID-19 cases. Participated in the development of COVID-19 community surveillance system for transport hubs, arcades and workplaces, operationalized the Kampala metropolitan emergency operations centre for COVID-19. I represented KCCA on national COVID-19 Incident Management Team.
• Did rapid assessment of compliance to preventive measures to inform lockdown relaxation strategies, investigation of workplace COVID-19 clusters in Kampala city hospitals, factories, arcades and formal workplaces, as well as use of Human-centered design approach to develop a community-led COVID-19 strategy for slums in Kampala city.

Air QUALITY Management

• Coordinated and led air quality management for the city
• Participated in drafting of the Uganda air quality regulations, Uganda state of the environment report 2021 which focuses on environment in cities and the EAC air quality standards
• Led the formation of Uganda air quality working group and organized the 2021 air quality awareness week and which included several air quality awareness activities. Also raised and created more awareness about air quality through publishing air quality data on open map, developed a web-based public access link and published articles in the press, UNIPH/ KCCA Bulletin
• With funding from UN Environment and support from Environmental Compliance Institute, I led the development of clean air action plan for KCCA
• Undertook world bank funded training in air quality management, following a competitive selection process
• Appointed expert facilitator for air quality and Health at the University of Winston, Nelson Institute for Environmental Studies
• Appointed on permanent basis as supervisor medical services at KCCA which is a middle management position in KCCA structure.

Fellowship program specific achievements

• Analysis of longitudinal data from the Kampala city air quality monitoring network to assess its association with prevalence of cardiorespiratory We found that locations prone to high pollution also present high prevalence of cardiorespiratory diseases. We are using this data to design interventions to promote health in areas affected by high pollution.
• Led the public health response to a COVID-19 outbreak at Masaka Sssaza quarantine prisons which had affected 102 prisoners. We controlled the outbreak and recommended public health interventions to mitigate the risk of future outbreaks
• Participated in COVID-19 risk mapping along Uganda-Rwanda and Uganda Tanzania borders to establish the travel patterns to control importation of COVID-19 early in the outbreak.
• Led investigation of many clusters of COVID-19 outbreaks in hospitals, arcades, factories and formal offices in Kampala city and recommended/implemented control measures. This was necessary given that these clusters happened at the start of the epidemic
• Presented 2 abstracts at both national and international conferences.
• Published an article about the public’s responsibility in cleaning the air we breathe in New Vision, 3 articles in the UNIPH bulletin and 4 articles in the KCCA bulletin. I have co-authored on other 4 articles in the UNIPH/KCCA bulletins
• I have authored two manuscripts that are still being cleared by the PHFP secretariat. I have also co-authored six manuscripts that are at different stages of clearance.
• Conducted a continuous quality improvement project that led to improvement of OPD malaria data quality at Kabwohe HC IV, Sheema district by 80%
• Assessed the HIV/NCD care cascades for hospitals, health center IVs and health center IIIs which showed that care cascades were better at hospitals that at health centers. It also showed that there was no integrated NCD/HIV care at facilities lower than hospitals
• I was a mentor and trainer for the frontline FETP where I supported teams at Naguru referral hospital to implement quality improvement projects at the hospital. I am also member of the city health team and national Maternal and child health working group and division medical officer

Summary of Epidemiological Study: 

 Title: COVID-19 outbreak at a quarantine prison, Central Uganda, September 2020

Background: During September-October 2020, an outbreak of COVID-19 occurred at Masaka Ssaza, a COVID-19 quarantine prison (holding center for newly-sentenced persons before transit to their host prison) in Central Uganda. We investigated to identify factors associated with introduction and spread of infection in Masaka Ssaza prison.

Methods: We defined a case as PCR-confirmed SARS-CoV-2 infection in a prisoner/staff at Masaka Ssaza prison during September-October 2020. A control was defined as a prisoner or staff at Masaka Ssaza with a negative test during the same timeframe. We reviewed prison medical records to identify case-patients and interviewed prison staff to understand possible avenues of introduction of infection and opportunities for spread. We conducted a case-control study interviewing prisoners and staff to determine factors associated with spread of the infection. Logistic regression was used to assess factors associated with infection.

Results: The index case was Inmate A, a 33-year-old male who entered the prison on September 16, 2020. On September 23, Inmate A learned that a colleague with whom he had close contact before imprisonment had died of COVID-19. He immediately reported this to prison authorities, prompting mass RT-PCR testing of all 254 prisoners at the prison on September 30, revealing three cases, including Inmate A. Additional follow-up testing of 251 prisoners confirmed 98 cases on October 15. On October 29, testing of 153 prisoners confirmed one case. The overall attack rate was 40/100. Ward-specific prisoner density ranged from 0.3-2.1 prisoners/m2 and prisoners were observed to congest at ward entrances and at mealtimes. Face mask ownership among case-patients was 35%. Using a face mask all the time was protective (aOR= 0.03: 95% CI 0.01-0.09). Residing in Ward 6 was associated with increased odds of infection (aOR=7.4; 95% CI 1.6-3.4).

Conclusion: COVID-19 was likely introduced into Masaka Ssaza prison by an infected incoming prisoner. The outbreak may have been amplified by congestion in wards and at mealtimes and low use of preventive measures. Importantly, consistent use of face masks was protective. Unrestricted access to handwashing facilities, facemask use, and strict adherence to ‘do not enter another ward’ rules could mitigate risk of future outbreaks.

Next Steps

I have developed passion for urban health programing and in my new role as the supervisor medical services for the KCCA, I will continue implementing all the projects that are still ongoing despite the fellowship training termination. I will continue taking lead on air quality management as well as NCDs in the city, ensuring publication of the quarterly bulletin as well as mentoring the KCCA staff in scientific writing. As a visiting lecturer for air quality planning and Health at University of Wisconsin, USA, I will continue to foster collaborations with all partners in this sector.

Key words: COVID-19, Quarantine prison, Uganda

Pictorial