Host Site: National Animal Disease Diagnostics and Epidemiology Centre, Entebbe Uganda
Host Mentor: Dr. Deo Ndumu Birungi and
Dr. Serugga
ABOUT THE FELLOW
I hold a Bachelor of Veterinary Medicine and Master of Veterinary Preventive Medicine of Makerere University, Kampala. During my two years of the fellowship, I have gained skills in scientific writing, leadership, communication, reporting of public health events, and analysis of public health surveillance data using computer software including Excel, Epi-info, & STATA. In addition, I gained competencies in the first steps of transforming data into policy by preparing policy briefs. I prepared several articles for the Uganda National Institute of Public Health (UNIPH) quarterly epidemiological bulletin, technical reports, newspaper articles, and manuscripts. I have gained experience in conducting trainings, conducting epidemiological investigations, and quality improvement projects. I have also gained skills in extracting, cleaning, and analyzing secondary data. Before joining the fellowship, I worked as a Veterinary Inspector at Entebbe International Airport for the Ministry of Agriculture Animal Industry and Fisheries in the Department of Animal Health. My role was to ensure that all live animals and animal products were free from diseases before they are allowed into or out of the country. Because of my interest in Epidemiology, I was given special assignment to manage data at the National Animal Diseases Diagnostics and Epidemiology Centre (NADDEC). It is from there that I was identified to participate in an International Training Programme (ITP) in animal health, food safety and antimicrobial resistance in the animal food value chain: “Healthy livestock – Safe food” which took place in Uppsala and Jönköping, Sweden in May to November, 2019. The training was organized by the Swedish National Food Agency (SLV), the Swedish National Veterinary Institute (SVA), the Swedish Board of Agriculture (SJV) and the Swedish University of Agricultural Sciences (SLU) on behalf of the Swedish International Development Agency (Sida). Through this training, I acquired knowledge on disease surveillance, crisis management of zoonotic diseases, control of foodborne zoonoses, and prevention of antimicrobial resistance in the animal food chain. I also completed a graduate fellowship in infectious Disease Management supported by USAID and Minnesota University – implemented by Makerere University School of Public Health and College of Veterinary Medicine, Animal Resources and Biosecurity. During the fellowship, I was attached to the Division of Veterinary Public Health, Ministry of Health where I participated in a number of activities. These included Yellow Fever outbreak investigations in Rukungiri, training of VHTs in Community-Based Disease Surveillance (CBDS) in Adjumani and Masaka Districts, and training of District Health Teams in Integrated Disease Surveillance and Response (IDSR) in Gomba District. I also led a team of Health educators to mobilize communities for Yellow Fever Mass Vaccination in Kalangala District.
Achievements at the Host Site
Drafted guidelines and SOPs to protect Veterinary practitioners and farmers from COVID-19 while working with animals during the pandemic.
Received and reviewed articles for the establishment of the One Health Epidemiological The articles were then compiled and the first issue of the One Health Epidemiological bulletin was published.
Drafted SOPs for FMD surveillance during quarantine period. These were used to guide livestock farmers, veterinary professionals and livestock traders to prevent further spread of
to other parts of the country which had not been affected.
Analysed the NADDEC surveillance data for the year 2019 and the trends of district report submission from 2015-2020. From this analysis, I developed a QI project to improve the monthly report submission from Masaka district to NADDEC.
Fellowship program specific achievements
Lead Investigator on the following outbreak investigations:
COVID-19 Cluster in Achwa Hydroelectricty Power Plant in Pader District, Northern Uganda-October 2020
Suspected Brucellosis outbreak in Dufile and Lefori sub counties, Moyo district, March 2021
Co-Investigator on the following outbreak investigations:
Measles outbreak in Nakivaale Refugee settlement in Isingiro district, February 2020.
Investigation of the first community COVID-19 case in Uganda, Masindi district, May 2020
Suspected Rift Valley Fever outbreak in Dufile and Lefori sub counties, Moyo district, March 2021
Suspected Anthrax Outbreak Associated with Handling and Consuming Cow Meat – Kapchorwa District, April 2021
Measles outbreak in Semuto sub county, Nakaseke district, September 2021
Wrote a policy brief entitled “Enforcing Compulsory Mass Dog Vaccination to Reduce Human Deaths from Dog Rabies in Uganda”. This was presented to the National One Health Platform and is under discussion by the various relevant stakeholders.
Conducted a 6-month project to improve monthly submission of surveillance reports from Masaka district to NADDEC. By the end of the project, there was an increase in report submission from 40% in May 2021 to 80% by November 2021. There was also an improvement in the timeliness of the report submission.
Conducted an epidemiological study to assess the knowledge, attitudes and practices of zoonotic diseases among livestock farmers in Kiboga district, September 2021.
Analyzed surveillance data on Trends and Distribution of animal bites and deaths due to suspected human rabies in Uganda, 2016-2020.
Other activities involved in:
Led the Anthrax Community Assessment study in Kapchorwa and Kween, November-December 2021
Training of District Health teams of Kole, Apac, Dokolo, Alebtong, Oyam and Lira on early detection of malaria outbreaks through development of malaria normal channels
Reviewing of articles for the publication of the UNIPH quarterly bulletin
Participated in a project entitled “Using the human centered design (HCD) approach to increase uptake of COVID-19 preventive measures and develop community led surveillance among dwellers of informal settlements in Kampala Metropolitan”
Conference Presentations
Association between Perceived risk of infection with COVID-19 and protective behaviour among adults in Uganda, May 2020 at the 6th National Field Epidemiology Conference, 4th November
Investigation of a COVID-19 Cluster in Achwa Hydroelectric Power Plant, Pader District, Uganda- October 2020 at the 7th National Field Epidemiology Conference, 29th October 2021.
Investigation of a COVID-19 Cluster in Achwa Hydroelectric Power Plant, Pader District, Uganda- October 2020 at the 8th East African Health & Scientific Conference from 17th-19th November 2021.
Publications and manuscripts written
Manuscripts:
Set up and management of quarantine centres during the early phase of the COVID-19 epidemic, Uganda: A case of COVID-19 in Masindi District, May 2020
Association between Perceived risk of infection with COVID-19 and protective behavior among adults in Uganda, May 2020
Investigation of a COVID-19 Cluster in Achwa Hydroelectric Power Plant, Pader District, Uganda- October 2020
Newspaper articles:
Submitted a newspaper article entitled ‘Pay attention to COVID-19 patients without symptoms which was published by Nation Media on 27 May
Bulletin articles
The National Institute of Public Health quarterly bulletin:
Set up and management of quarantine centres during the early phase of the COVID-19 epidemic, Uganda: A case of COVID-19 in Masindi District, May 2020
Association between Perceived risk of infection with COVID-19 and protective behaviour among adults in Uganda, May 2020
The One Health Epidemiological Quarterly bulletin:
Trends and Distribution of animal bites and deaths due to suspected human rabies in Uganda, 2016-
Summary of Epidemiological Study:
Title: Investigation of a COVID-19 Cluster in Achwa Hydroelectric Power Plant, Pader District,Uganda- October 2020
Background: Achwa Hydroelectric Power Plant (AHPP) in Pader District, Uganda introduced multiple measures starting in April 2020 to reduce risk of COVID-19 introduction and spread. These included testing of visitors/returnees to AHPP for COVID-19 on arrival, enforcement of regular hand washing, face mask use and, maintaining ≥2 metres distance from others. Despite these measures, on October 3, 2020, a COVID-19 cluster was reported at AHPP. We investigated to identify factors facilitating spread and recommend control measures.
Methods: A confirmed case was a positive RT-PCR for SARS-CoV-2 in a person who lived, worked at, or visited AHPP from August-October 2020. We reviewed routine COVID-19 test results from the medical records of AHPP to find cases and develop the line list. We performed environmental assessments and conducted a retrospective cohort study among AHPP employees.
Results: Among 525 employees in six residential camps at AHPP, we identified 105 case-persons (overall attack rate (AR)=20%); mean age was 32 years (range, 18-60 years). The index case-person delivered supplies to AHPP from Kampala on August 10, 2020, interacted directly with two employees, and left immediately; his positive result returned on August 17. The second case-person was an employee who travelled to Gulu City from August 5-8; his sample was collected on August 15 and tested positive on August 25. Alnour camp was both the most congested, with all workers sharing a single dining area, and the most affected (AR=61%) camp. Risk was higher among persons sleeping >2 per room (~20×20 feet in size) than those who slept ≤2 per room (adjusted relative risk=1.2, 95%CI=1.1-1.5).
Conclusion: Crowded employee living conditions facilitated the spread of COVID-19 at AHPP. Long test turnaround time also likely enabled spread of COVID-19 at AHPP. We recommended decongesting sleeping areas at the station and continued surveillance for early detection and management of infections.
Key lessons learnt during the fellowship
Improved communication skills; Train district veterinary officers openly and with confidence
Presentation skills; presented my investigations at both local and international conferences
Expanded professional network (Got to know several persons instrumental in my profession)
Ability to multitask
Public speaking (with a lot of opportunity to present in different fora and to different researchers)
Next Steps
With the skills Phoebe has acquired throughout the period of the fellowship, she hopes to further her career in the field of Epidemiology through service in an organization that will leverage on her knowledge, experiences, skills, and networks.
Phoebe plans continue with writing abstracts, manuscripts and publishing all the work done during the fellowship period as well as the work she will do post the fellowship period.
Pictorial
Josephine Namayanja, fellow cohort 2020 interviewing a parent to one of the case-patients during the Measles outbreak in Nakivaale refugee settlement, Isingiro District in February 2020.
Josephine, Fellow 2020, reviewing medical records of Dufile HCIII during a suspected Brucellosis outbreak in March 2021.
In October 2020, we set out to investigate a COVID-19 cluster at Achwa Hydroelectricity Power Plant. Josephine, Fellow cohort 2020 interviewing one of the managers of the Power Plant on the preventive measures in place to control the spread of the disease at the plant premises.
Interview with a community member of Kapsinda sub county in Kapchorwa district on consumption of meat from a dead cow during the Anthrax outbreak in May 2021.
Josephine, fellow cohort 2020, training Oyam district health team on development of Malaria normal channels in March 2020.