Edirisa Juniour Nsubuga

Edirisa Juniour Nsubuga

BSc. HND (KYU), MPHN (MUK),DCMCH
(Fort Portal-SOCO), Enhancing,Academic Qualifications in Teaching and Research in Public Health (HIGHUniversitätHeidelberg), Planetary, Boundaries and Public Health (HIGHUniversitätHeidelberg), Advanced Field Epidemiology (UPHFP),
Email:nsubugaeddiej@musph.ac.ug, nsubugaeddiej@gmail.com, nsubugaeddiej@daad-alumni.de
Telephone: +256704131375/+256774655666

Host Site: Ministry of Health, Uganda National Expanded Program on Immunization

Host Mentor: Dr. Fred Nsubuga, Dr. Immaculate Ampaire

ABOUT THE FELLOW

Edirisa Juniour Nsubuga is a certified Advanced Field Epidemiology Fellowship graduate. He holds a master’s degree in Public Health Nutrition (MPHN) from Makerere University (School of Public Health), a bachelor’s of science (Hons) degree in Human Nutrition and Dietetics (BSc. HND) from Kyambogo University, a Diploma in Clinical Medicine and Community Health (DCMCH) from Fort Portal School of Clinical Officers, a Postgraduate Certificate in Enhancing Academic Qualifications in Teaching and Research in Public Health and a Postgraduate Certificate in Planetary Boundaries and Public Health from the Heidelberg Institute of Global Health (HIGH), Universität Heidelberg.

As an epidemiologist, he has interest in disease outbreak investigations and response, vaccine preventable diseases, global health security, maternal and child heath, and nutritional epidemiology.

During his time as a fellow, he was attached to the Uganda National Expanded Program on Immunization (UNEPI) at the Ministry of Health. Through the advanced field epidemiology training, he has networked and attained skills and competencies in interpersonal and effective communication in leadership, strategic thinking in leadership, management and leadership, mentoring, coaching and support and supervision in leadership, outbreak investigation and response including data analysis, interpretation and use.

  Achievements at the Host Site

• Attended and actively participated in the weekly Immunization National Coordination Committee meetings
• Compiled weekly vaccine preventable disease (VPD) case and death data reported in the DHIS2; identified abnormal figures and issues that needed further investigation on VPD reporting; and called the district EPI and surveillance focal persons to rectify the abnormal data and confirm the reported numbers.
• Attended the COVID-19 vaccine national/central supervisor’s training from 2 to 3 September 2021 and subsequently conducted weekly COVID-19 vaccination supportive supervision activities in Kassanda District on three occasions.
• Attended the training of Trainers’ of Trainers (TOT) on the new Immunization in Practice (IIP) guidelines from the 14th–19th August 2022 and subsequently conducted a one-week training of all facility in charges and EPI focal persons in Mitoma District in September 2022 on the new vaccines that were introduced in the national routine immunization schedule
• Participated in the development and launch of the Second COVID-19 vaccine deployment plan organized by UNEPI and CHAI from 24–27 August 2021
• Attended the National Trainer of Trainers (TOT) on the role out of the Smart Paper Technology (SPT) for Immunization Services in Uganda
• Supervised the Type 2 Novel Oral Poliovirus Vaccine (nOPV2) Adverse Events of Special Interest (AESI) Sentinel Site Surveillance Monitoring in Moroto Regional Referral Hospital
• Supervised the Safety Evaluation of the Type 2 Novel Oral Poliovirus Vaccine (nOPV2) during a Supplemental Immunization Activity (SIA) in Abim, Kaabong, Kotido, Moroto, and Napak districts
• Participated in the investigation of yellow fever cases in Wakiso, Masaka and Kasese districts in March 2022
• Lead the investigation of a measles outbreak in August 2021 among children aged 6–9 years in Semuto Subcounty, Nakaseke District
• Participated in the one-day engagement with city authorities on urban immunization and national immunization strategy on 28 July 2022.
• Participated in the one-day COVID-19 round 3 national feedback meeting on 27 July 2022.
• Attended training on organized defaulter tracking of routine immunization

Fellowship program specific achievements

Outbreaks and other public health emergency response investigations led:

• Evaluating the effect of community dialogue meetings on self-efficacy, willingness to receive and attitudes towards the COVID-19 vaccine among district leaders in Rwenzori and Bunyoro regions of Uganda
• Measles Outbreak in Semuto Subcounty, Nakaseke District, Uganda, June-August 2021
• Trends in watery diarrhea among children under 5 years before and after introduction of rotavirus vaccine in Uganda, 2016–2021: analysis of surveillance data
• Tuberculosis Preventive Treatment (TPT) care cascade among People Living With HIV/AIDS and factors associated with TPT completion in Uganda: Analysis of Surveillance Data, 2019–2020
• Trends and Spatial Distribution of All Cause Pneumonia Among Children Under-Five Years in Uganda, 2016– 2021: Analysis of Surveillance Data
• Factors associated with Acute Watery Diarrhea among children under 5 years of age in Obongi District, Uganda: a case‒control study
• Improvement of Infection Prevention and Control Practices Using a Quality Improvement Approach in Lwampanga and Nakayonza Health Centers, Nakasongola District, Uganda

Outbreaks and other public health emergency response investigations participated in:

• Ebola Virus Disease Outbreak Investigation and response in Mubende, Kassanda and Kampala in September–December 2022
• Investigation of Hospitalized and Non-Hospitalized COVID-19 Cases in Mulago and Entebbe Hospitals
• Assessment of ownership and utilization of insecticide-treated mosquito nets and associated barriers immediately after a mass ITN distribution campaign in 14 districts in Uganda
• Evaluation of readiness of health facilities to deal with the 3rd wave of COVID-19 in 7 regions in Uganda, June 2021
• Assessment of Adverse Events Following Covid-19 Immunization in Uganda
• Risk Factors for Malaria Deaths in the 8 Selected Districts in Uganda
• Malaria outbreak in Nabitende subcounty, Iganga district, March 2021
• Plague Risk and Readiness Assessment in six border districts of West Nile Region, Uganda, August 2021
• Evaluation of the Implementation of Xpert MTB/RIF Ultra Assay Testing in Uganda, 2019–2021
• Assessment of the Impact of Point-of-Care Technology on Early Infant Diagnosis Testing and Linkage to Antiretroviral Therapy among HIV-positive Infants in Uganda, 2018– 2021
• Training on developing malaria normal channels and malaria Data Quality Assurance dissemination in 6 districts of West Nile (Nebbi, Zombo, Arua, Maracha, Moyo, and Adjumani districts)
• End-line Integrated Community Case Management survey, Moyo District
• Investigation of yellow fever cases in Wakiso, Masaka and Kasese Districts, Uganda
• Knowledge, attitude and practices regarding anthrax among affected communities in Kazo District, southwestern Uganda

1. Community dialogue meetings among district leaders in Rwenzori and Bunyoro regions

Baylor College of Medicine, Uganda, conducted dialogue meetings among district leaders from the Rwenzori and Bunyoro regions on self-efficacy, willingness to receive and attitudes towards the COVID-19 vaccines in May 2021. I led the study that assessed the self-efficacy, attitudes and willingness to receive the COVID-19 vaccines by the district leaders pre and post the meetings.

Written communication

1. a) Manuscripts: First authored 4 (listed here) and co-author on six others

• Measles outbreak in Semuto Subcounty, Nakaseke District, Uganda, June–August 2021. Published in the International Journal of Infectious Diseases Regions (IJID Regions)
• Community Dialogue Meetings among District Leaders Improved Their Willingness to Receive COVID-19 Vaccines in Western Uganda, May 2021. Under peer review in BMC Public Health
• Loss to Follow-up Among People Living with HIV on Tuberculosis Preventive Treatment at Four Regional Referral Hospitals, Uganda, 2019–2021.
• Factors Associated with Acute Watery Diarrhea among Children Aged 0–59 Months in Obongi District, Uganda, April 2022: A Case–Control Study.

1. b) Epidemiological bulletin articles: Edited and published articles in the Uganda National Institute of Public Health epidemiological bulletin

• Investigation of a Measles Outbreak, Semuto Subcounty, Nakaseke District, Uganda, June– August 2021
• District Leader Community Dialogue Meetings Improved Willingness to Receive COVID-19 Vaccines in Western Uganda, May 2021: A Pre-Post Study
• Loss to Follow-up Among People Living with HIV on Tuberculosis Preventive Treatment at Four Regional Referral Hospitals, Uganda, 2019–2021.
• Factors Associated with Acute Watery Diarrhea among Children Aged 0–59 Months in Obongi District, Uganda, April 2022: A Case–Control Study.

• Newspaper Articles Published:

• • “Celebrating the World Immunisation Week at the time of COVID-19” in the New Vision on 24 April 2021

Conference presentations

• Oral presentations
  • 8th East African Health and Scientific Conference (EAHSC) in November 2021
  • 7th and 8th National Field Epidemiology Conference (NFEC)
  • 16th Joint Annual Scientific Health Conference (JASH) 2022,
  • 20th DR. Mathew Lukwiya Memorial Lecture
  • 1st National Antimicrobial Resistance Symposium
  • 28th UNACOH Conference
  • 3rd MINOSH International Poster presentation at the 3rd International Conference on Emerging Infectious Diseases 2022 (ICIED) in Atlanta, Georgia

Mentorships and trainings

conducted:

1. Participated in the training of Cohort 16 and 18 frontline FETP fellows
2. Mentored 10 frontline fellows (3 in cohort 16, 2 in cohort 17, and 5 in cohort 18) for a duration of 12 weeks
3. Trained District Health Team Members in 6 Districts of West Nile (Zombo, Nebbi, Arua, Maracha, Adjumani, and Moyo) on a malaria case study, drawing of the malaria Normal Channel and its use in determining malaria outbreaks

12. Trainings undertaken: I completed a one-month course on writing for public health bulletins training, from 1st–28th February 2022, conducted by Bloomberg philanthropies, data for health initiative, and the CDC foundation

Summary of Epidemiological Study: 

 Title: Measles Outbreak in Semuto Subcounty, Nakaseke District, Uganda, June–August 2021

Background: Semuto Subcounty reported rubella/ measles outbreaks in 2020 and 2021. We investigated the measles outbreak in 2021 to determine the scope, assess factors associated with transmission, estimate vaccine coverage and effectiveness, and recommend evidence-based control measures.

Methods: We defined a probable case as acute onset of fever and generalized maculopapular skin rash with ≥1 of cough, cold, or red eyes in a resident of Semuto Subcounty, Nakaseke District, from June 1–August 31, 2021. A confirmed case was a probable case with a blood sample positive for measles-specific IgM. We reviewed medical records and used snowballing to identify cases. We conducted a 1:4 village-matched case‒control study to identify associated factors. A control was a randomly sampled person aged 6 months-9 years without signs/ symptoms of measles from June 1– August 31, 2021, residing in the same village as the case. We used Epi Info to obtain adjusted Mantel‒Haenszel odds ratios (ORMH) and confidence intervals (CIs) and calculated vaccine coverage and effectiveness.

Results: We identified 30 case persons (3 confirmed); 16 (53%) were male, and none died. The overall subcounty attack rate (AR) was 3.2/1000. Children aged 5-9 years were the most affected (AR=5.0/1,000). Twenty-two (79%) case-persons and 116 (97%) control-persons had ever received measles vaccine (ORMH=0.13, 95% CI: 0.03- 0.52). Interaction with symptomatic persons at water collection points (ORMH=4.4, 95% CI: 1.6-12) and playing at community playgrounds (ORMH=4.2, 95% CI: 1.7-11) during the exposure period increased the odds of infection. Vaccination coverage was 97% (95% CI: 92-99%), and vaccine effectiveness was 87% (95% CI: 48-97%).

Conclusion: Socializing and congregating at water collection points and community playgrounds facilitated measles transmission in this outbreak. Measles vaccination was protective. We recommended mass community vaccination (or re-vaccination) for children in Semuto Subcounty to capture unvaccinated children and act as a second dose in those who received only one dose. We urged parents/guardians to recognize, isolate, and keep children with measles-like symptoms at home.

Key lessons learnt during the fellowship

During the fellowship, I learned and developed the following skills:

• Leadership and management
• Outbreak detection, investigation, response and control
• Grants proposal and budget writing
• Accountability and financial management
• Data analysis using Excel, Epi info, STATA, and QGIS
• Editorial skills for epidemiological bulletins and journal articles
• Scientific writing of SITREPs, concepts, protocols, reports, abstracts, posters, PowerPoint slides, manuscripts, policy briefs, bulletins and newspaper articles
• Designing and use of electronic data collection tools such as KoBoCollect and ODK
• Designing and implementing quality improvement projects
• Written, oral, visualization, electronic, and interpersonal communication
• Evaluation of public health surveillance systems
• Mentorship, coaching, facilitation, teaching, and training
• Multitasking with a high level of efficiency
• Networking

Next Steps

• To continue advancing my knowledge and skills in epidemiology, outbreak investigations, public health leadership and management
• To apply the skills and competencies gained from the fellowship program through government/implementing partners operating nationally/ internationally on global health security and public/global health emergencies
• To complete writing up and continue sharing the findings of all studies and projects conducted during the fellowship program through presentations, bulletins and manuscript publications
• Participation in any public health emergency response and mentorship of fellows at all levels once called upon by the fellowship program

Pictorial