Immaculate Akusekera

Immaculate Akusekera

Bachelor of Veterinary Medicine, MSc CEB Muk)
Email: iakusekera@musph.ac.
Telephone: 0788109081/0700345335

Host Site: National Animal Disease Diagnostics
and Epidemiology Centre, Entebbe Uganda

Host Mentor: Dr. Deo Ndumu Birungi

ABOUT THE FELLOW

Dr. Immaculate Akusekera holds a bachelors degree of Veterinary medicine and a Master of Science in Clinical Epidemiology and Biostatistics from Makerere University. During the two years fellowship training, she has gained skills in investigation of public health emergencies, non-scientific communication, scientific communication, or dissemination. She developed her leadership skills, skills in reporting of public health events and analysis of public health surveillance data. She also trained and prepared policy briefs during her stay on the fellowship. She interfaced and used analysis software like epi-info & STATA for analysis of the data that was generated during the implementation of the various projects, she therefore improved the analysis skills gained during her masters education. She additionally disseminated her findings by sharing several articles for publication in the Ministry of Health quarterly epidemiological bulletin, technical reports, and manuscripts. She has implemented several projects including a quality improvement project, one HIV project, COVID 19 projects and Anti microbial Resistance projects during which she developed a skill of coordination, organizing meetings, leading implementing teams successfully. She has developed a career in one health issues and AMR and she has implemented projects and write ups around this subject matter. Before she joined the program, Immaculate worked as the District Veterinary Officer in Kibaale District.

The investigations led during her stay on the program included: measles outbreak in Nakivaale refugee settlement, COVID 19 cluster among Health Care workers, Malaria mortality in Kakumiro, an assessment of bed net coverage and usage in Kibaale, time to graduation and factors associated among orphans and vulnerable children supported by Baylor in the Rwenzori region, KAP towards AMR among farmers, KAP towards COVID 19 during the early phases of the pandemic and response to the first community case (case with no known travel history in Masindi) Additionally, she supported the surveillance of COVID 19 deaths and cases in Fortportal, Mubende regional referral hospitals. She is currently supporting the mentorship of field epidemiologist trainees from Entebbe regional referral hospitals and is an editor for the National One Health bulletin.

  Achievements at the Host Site

National Animal Disease Diagnostics and Epidemiology Centre (NADDEC- Entebbe)

• Analyzed and described the trends and distribution of the monthly surveillance reports from the District Veterinary offices to the National animal disease and diagnostics center in Uganda;2016-2020.Following the analysis, she designed a project to improve reporting from selected districts that had recorded zero reporting during the analysis period.
• Participated in the review of the reporting tools used by the district staff.
• She supported and participated in the evaluation of One health institutions in Uganda. This was led by the ILRI/BMZ One Health Research, Education, Outreach and Awareness Centre (OHRECA) whose outcome was to help OHRECA know where to focus efforts in partnering with the government and other one health stakeholders
• in Uganda.
• She supported the compilation of the Nationalone health bulletin which they successfully
• published on 10 September and are still supporting the editing.
• Drafted guidelines that would be followed while around animals during the COVID 19 pandemic. These were urgently needed since a lot was unknown regarding the role of animals in the transmission of the deadly virus.
• Drafted SOPS to be followed while vaccinating animals against FMD and other diseases during the COVID 19 epidemic since the vaccination was also a potential source of spread of the virus among the animal handlers and the veterinarians

Fellowship program specific achievements

• Participated for two days in a workshop during which the Field Epidemiology training programme for the intermediate trainees was launched by the Hon Ambassador of the US. Following this launch, she was allocated a group of trainees to mentor from the Entebbe Regional Referral Hospital. She supports the team to conduct their epidemiological investigations and compile their reports
• She trained frontline field epidemiology trainees from the 19-24 September in Mbarara.
• Participated in the scientific writing training where she enriched her skills of writing Public Health Bulletins (PHB)
• She participated and applied skills in writing policy briefs using existing data following a highly mentored data to policy training organised by the S CDC, following the training they developed and disseminated a policy brief “Adopting compulsory vaccination of dogs in Uganda” to eliminate rabies deaths in Uganda.
• Supported the National COVID-19 response team with compiling a detailed literature review write up and report to help inform decisions while responding to the rising number of Health care worker infections in Uganda.
• She was an editor for the July-September 2020 UNIPH Epidemiological Bulletin
• Conducted a malaria surveillance training with emphasis on malaria Normal channel drawing and use for detection of outbreaks in Eastern Uganda.
• She investigated COVID 19 cases in Fort portal and Mubende isolation centres and also built capacity for the district teams to epidemiologically investigate future COVID 19 cases
• She supported compilation of qualitative data for all COVID 19 deaths in Uganda During her stay on the program, She led the following investigations:
• Improving monthly reporting of Veterinary surveillance data from Kibaale District to the ministry (NADDEC), Uganda May 2021
• Lead an investigation of a COVID-19 hospital-initiated cluster in Abim Hospital in October 2020.
• KAP on COVID-19 during the early phases of the epidemic in Uganda, April 2020
• Trend and spatial distribution maternal deaths in Uganda over the last 5 years
• Knowledge Attitudes and practices towards Anti-Microbial resistance and Use among selected farmers in Nakaseke and Wakiso Districts, September 2021
• Measles outbreak in Nakivaale refugee settlement in Isingiro District, Febraury 2020
• Predictors and Time to Graduation from Orphans and Vulnerable Children (Ovc) Programmes in Fort-Portal Region, Uganda: June 2021
• Co-Investigator on the following outbreak investigations:
• Investigated malaria Insecticide treated bed net ownership and utilisation in Kibaale District following a mass distribution.
• Investigation for the Malaria mortalities and morbidities in Kakumiro District; Jan 2020 to May 2021.
• I was actively involved in response to the first COVID 19 Community case in Masindi District May 2020. Our team was particularly supporting the district with follow up of contacts, data management, quarantine set up, surveillance, reporting and leadership for response.
• Co investigated COVID-19 Knowledge, Attitudes and Practices among Refugees in Nakivaale refugee camp Conference Presentations at the Field Epidemiology conferences held in Kampala 2020 and 2021
• Measles outbreak in Nakivale refugee settlement: Isingiro district, Uganda, February 2020• COVID-19 cluster within health facilities in Abim District, Uganda: October 2020
  

  Publications and manuscripts written

  Manuscripts: Missed opportunities for isolation of measles case-patients propagated a measles outbreak in Nakivaale refugee settlement Uganda: February 2020 Delayed COVID-19 suspicion and long result turnaround time led to a HCW cluster in, Abim District, Uganda: October 2020Epi-bulletin articles in the National Institute of Public Health quarterly bulletin:

  Submitted an article entitled “COVID-19 cluster within health facilities in Abim District, October 2020” for publication in the NIPH epidemiological bulletins.

  • Published a Newspaper article in new vision on 24 Nov 2020 on “The public has the biggest role to play in slowing down the rising trend of anti-microbial resistance

   

Summary of Epidemiological Study: 

 Title: Measles outbreak propagated by not isolating measles case-persons: Nakivaale refugee

Background:On 20 February 2020, four months after a single-dose mass measles immunization campaign targeting children 9 months-17 years in Uganda, a measles outbreak was reported in Nakivale refugee settlement in Isingiro district, southwestern Uganda. We investigated the outbreak to determine its scope, identify risk factors for transmission, and recommend evidence-based control measures.

Methods: We defined a case as an acute illness characterized by a generalized maculopapular rash lasting ≥3 days and fever, plus one or more of: conjunctivitis, cough, and/or runny nose in a Nakivale refugee settlement resident. A confirmed case was a suspected case with measles-specific IgM (+). We reviewed medical records and conducted active community case-finding. In a case-control investigation involving probable case-persons and age- and neighbor- matched controls, we evaluated possible exposure factors for association with illness. We calculated one-dose vaccination coverage by calculating the percentage of controls with a one-dose self-reported vaccination history.

Results: We identified 79 case-persons (attack rate [AR]=6.3/10,000), including five confirmed cases; 21 (32%) had arrived at the camp after the vaccination campaign had completed. Forty-four (56%) case-persons reported no measles vaccine history, of whom 24 (55%) were camp residents during the vaccination campaign. Children <5 years (AR=27/10,000) were the most affected age group, while children aged 5-18 years and those >18 years had similar attack rates (2/10,000). Rushasha sub-county residents (AR=45/10,000) were the most affected by the outbreak. The epidemic curve revealed a propagated outbreak with a 29-month-old index case, a longstanding camp resident who was reportedly vaccinated in the recent campaign, having onset on 7 December 2019 (6 weeks after the campaign). Among all exposures evaluated, only sharing a household with a case-person was associated with infection (43% of case-persons vs. 24% of controls, OR=2.9; 95% CI=1.2–4.7). Self-reported vaccination history against measles was not protective (OR=0.5; 95% CI=0.2-1.6). The single-dose vaccination coverage was estimated at 46%.

Conclusion: Only household exposure to a case was associated with illness in this measles outbreak. Vaccination status was not associated with case status; the reasons are unclear but may relate to limitations of self-reporting or vaccine challenges. Vaccination coverage was below the required herd immunity levels of 95%. We recommended supplemental measles vaccination of all susceptible camp residents, vaccination of all new camp arrivals, community health education on signs and symptoms, and early detection and isolation of measles cases.

Key lessons learnt during the fellowship

• Improved communication skills; Train and mentor health teams.
• Presentation skills; clearly presented my investigations in conferences
• Improved scientific writing skills (proposal/ protocol writing, report and manuscript writing skills have greatly improved)
• Project Management (Gained experience in conducting projects to completion)
• Improved data analysis skills especially advanced analysis
• Expanded professional Network (Got to know a number of persons instrumental in my profession)
• Improved analytical skills (Deeper understanding of elements)
• Public speaking

Next Steps

plan to continue supporting the Districts and the country with my enriched skills of epidemiology and also continue supporting the One Health initiative in Uganda.

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