Host Site: Department of Integrated Epidemiology, Surveillance and Public
Health Emergencies (IES&PHE), Ministry of Health
Host Mentor: Dr. Freda Loy Aceng, Dr. Stella Lunkuse
ABOUT THE FELLOW
Hildah Tendo Nansikombi is a field epidemiologist with a Master of science in Clinical Epidemiology and Biostatistics, and a background in Medical Laboratory Science. Before the fellowship, she worked with the Uganda Ministry of Health as an Epidemiologist during the COVID-19 response. During her time as a fellow, she was attached to the Department of Integrated Epidemiology, Surveillance and Public Health Emergencies (IES&PHE), Ministry of Health.At IES & PHE she developed skills in surveillance and response coordination.
She was an editor, and drafted reports in the National Weekly Epidemiological, and National Institute of Public Health (UNIPH) bulletins.She led projects on a Rift Valley Fever Outbreak, COVID-19 vaccine uptake among people with non-communicable diseases and improving weekly surveillance reporting on epidemic prone diseases in Jinja District. She also actively participated in eleven other investigations of public health importance. These engagements coupled with surveillance and preparedness strengthening sharpened her knowledge on International Health Regulations (IHR), and Integrated Disease Surveillance and Response (IDSR) implementation in Uganda. She has advanced her understanding of Uganda’s health information systems and their role in guiding public health interventions. Routine surveillance data analysis polished her skills in using data collection tools like ODK, KoboCollect and statistical packages like STATA, EpiInfo and QGIS.
Achievements at the Host Site
Led the drafting of the national weekly epidemiological bulletin which serves to inform all stakeholders at district, national, and global levels.
Participated in the automation of the national weekly epidemiological bulletin.
Participated and facilitated IHR monitoring and evaluation activities.
Participated in the monitoring of the NAPHS 2021/2022 and development of the NAPHS 2022/2023.
Participated in editing, roll out and evaluation of the third edition of the national technical guidelines of the Integrated Disease Surveillance and Response (IDSR). Participated in the review and amendment of the Public Health Act to align it with the national technical guidelines of the IDSR.
Fellowship program specific achievements
Led one outbreak investigation: Rift Valley Fever outbreak in Kiruhura District.
Participated in other outbreak responses including: Ebola Virus Disease outbreak, COVID-19 cases at Mulago and Entebbe hospitals,
Participated in other activities of public health importance including:
Readiness of health facilities to respond to second wave of COVID-19
Plague risk and readiness assessment in six border districts of West Nile Region
Evaluating the performance of laboratory services in COVID-19 response in Uganda,
Integrated Community Case Management (iCCM) endline survey in Moyo District
Training on malaria normal channels and malaria data quality audit (DQA) dissemination in Teso Region
Evaluation of mosquito nets ownership and coverage in Buikwe District
Conducted descriptive analysis of timeliness and completeness of weekly surveillance reporting on epidemic prone diseases in Uganda, 2020–2021 using data from the District Health Information System version 2 (DHIS2).
Conducted an HIV project on Description and determinants of testing recent on a rapid test for recent infections among people newly diagnosed with HIV, Uganda, 2019-2021 using Electronic Medical Records (EMR) data.
Implemented a quality improvement project on improving timeliness and completeness of weekly surveillance reporting on epidemic prone diseases in Jinja District, June–November, 2022.
Conducted an epidemiological study on factors associated with COVID-19 vaccine uptake among people with non-communicable diseases, Uganda.
Trained two cohorts of FETP-frontline whose goal is to improve the MoH’s epidemiologic capacity at district and local level.
Written Communication
Wrote 8 manuscripts; led 3 (titles list here) and co-authored 5 others
‘Timeliness and completeness of weekly surveillance data reporting on epidemic prone diseases, Uganda, 2020–2021’‘
The necessity of One Health approach in preventing human Rift Valley Fever infections, Uganda’
‘Description and determinants of testing positive on a rapid test for recent infections among people newly diagnosed with HIV, Uganda, 2019-2021’
Published two articles in the New Vision newspaper:
Sickle cell disease is preventable’
Protect your mental health amidst COVID-19 pandemic’
Edited and published in the Uganda National Institute of Public Health epidemiological bulletin volume7 issue1.
Rift Valley Fever Outbreak in Kiruhura District, May-June 2021’
‘Weekly surveillance data reporting on epidemic prone diseases, Uganda, 2020–2021’.
Conference presentations
Presented at national and international conferences: 7th and 8th National Field Epidemiology Conference
8th East African Health Scientific conference
16th Joint Annual Scientific Health Conference
Summary of Epidemiological Study:
Title: Human and Animal Rift Valley Fever outbreak investigation, Uganda Public Health Fellowship Program – Field Epidemiology Track – Cohort 2021 Graduation 7 Kiruhura District, Uganda, May–June, 2021
Background: Rift valley fever (RVF) is an endemic viral zoonosis in Uganda. Sporadic outbreaks have been reported to occur in the cattle corridor. On May 14, 2021, a 19-year-old female from Kasaana Village, Kiruhura District died; testing by reverse transcription polymerase chain reaction (RT-PCR) was positive for RVF. We investigated to determine the magnitude of the outbreak, source of infection, and recommend evidence-based control measures.
Methods: A confirmed case was defined as detection of RVF virus nucleic acid by RT-PCR or serum IgM antibodies by enzyme-linked immunosorbent assay (ELISA) in a resident of/visitor to Kasaana Village from April 24-June 24, 2021. We tested blood samples from 25 persons (3 with RVF symptoms, 2 neighbors of the index case, and 20 randomly-selected villagers) using RT-PCR or ELISA, and 57 livestock (33 randomly-selected cows and 24 goats from 4 village farms reporting any animals with RVF symptoms) by ELISA. We collected data on demographics, history of RVF symptoms, and animal-related activities. We characterized cases epidemiologically.
Results: We identified 6 confirmed case-patients in Kasaana village (2 RT-PCR-positive, 4 IgM-positive); one died (case fatality rate=17%). Four (67%) were female; median age was 23 years (range, 19–42 years). All cases kept cows and goats. Two case-patients reported headache, fever, and hematemesis. The index case-patient, who milked cows on her family farm, had hemorrhagic symptoms consistent with RVF starting 1 week before death. She presented to six health facilities during that week but was only diagnosed after death. Eight case animals; three (9%) cows and five (21%) goats were IgM-seropositive for RVF.
Conclusion: This RVF outbreak likely resulted from contact with infected animal products. Earlier diagnosis might have prevented the index case-patient’s death. We conducted health education among Kasaana villagers, and recommended training of health workers at facilities within the region to emphasize the importance of early diagnosis of haemorrhagic fevers.
Key lessons learnt during the fellowship
During the fellowship, I learnt and developed the following skills:
Outbreak investigation and institution of interventions
Editorial and writing skills for scientific articles
Data management, analysis and interpretation
Presentation skills and dissemination of findings
Designing and management of scientific projects
Networking and lobbying
Leadership and team management skills
Next Steps
I hope to apply skills gained during the Public Health Fellowship Program to serve in relevant public health organizations. I am interested in applying my expertise and experience in surveillance and infectious diseases control, and activities that contribute to Uganda’s health security objectives.
Pictorial
Hildah Tendo Nanskombi (with a scoop) with other Advanced-FETP fellows examining stagnant water for mosquito larvae during the malaria outbreak in Iganga District, 2021
Hildah (standing in checked trouser) during map annotation with participants in the preparedness and risk assessment for plague in West Nile Region, 2021
Hildah Tendo Nanskombi (in blue mask near the tree) interviewing one of the family members to a case in the Rift Valley Fever Outbreak, Kiruhura District, 2021
Presentation of the Rift Valley Fever Outbreak investigation at NFEC, 2021
Hildah Tendo Nanskombi (in pink dress) with her colleague interviewing health workers about health facilities’ preparedness to respond to the second wave of COVID-19 at a health facility in Gulu District, 2021