Sherry Rita Ahirirwe

Sherry Rita AhirirweEmail: sahirirwe@musph.ac.ug
Telephone: +256 707 064 889/+256777 955 921

Host Site: Division of health information

Host Mentor: Mr. Paul Mbaka

ABOUT THE FELLOW

Sherry Rita Ahirirwe is and experienced epidemiologist with a Master of Science Degree in Public Health. She has experience in monitoring and evaluation with a demonstrated history of working with non-profit organizations. She is skilled in digital data collection and management using Kobo toolbox as well as exploratory data analysis with R in addition to mapping skills in QGIS. She has a strong passion for community empowerment.

During the fellowship program, Sherry was attached to the Division of Health Information within the department of Planning, Financing and Policy in the Ministry of Health.

Through the fellowship program, Sherry has attained skills in leadership, outbreak investigation and response including data analysis, visualization, interpretation and use. She led two outbreak investigations and participated in four others. She is a national trainer of Monitoring & Evaluation officers and district bio_statisticians on generation of knowledge products and populating indicators in the national health observatory.

  Achievements at the Host Site

• Supported the data management needs of the Points of Entry pillar
• Participated in the Health Information, Innovation and Research (HIIRE) TWG monthly meetings
• Provided technical support to Biostatisticians on use of the COVID-19 Vaccination Registry to help improve capture and reporting of COVID-19 vaccination data
• Conducted various data quality assessments of vaccination data in selected districts
• Supported UNEPI in documenting COVID-19 vaccination challenges in districts
• Extracted and collated geospatial data from DHIS2 and other sources for the upcoming population data for action GRID3 project
• Facilitated training of VHTs on Community Based Disease Surveillance,
• Participated in the roll out of Points of Entry preparedness and response plans
• Participated in the biannual and annual health sector performance report writing.
• Through partnership with WHO:
  • Facilitated training of M&E officers and District Biostatisticians on generation of knowledge products and populating indicators in the national health observatory
  • Trained data collectors on the assessment of continuity of health services tool
• Completed online training on DHIS2 fundamentals which advanced my skills in data abstraction and visualisation within DHIS2
• Trained as a National Rapid Responder by WHO, July 2022

Fellowship program specific achievements

Led 2 outbreak investigations (listed here) and participated in 10 others

• Investigation of a strange illness in Kyotera district, December 2021
• Investigation of human tungiasis cases in Sheema District, November 2021-February 2022
• Provided support to the Uganda Rapid Mortality Surveillance Project through
• Abstraction and analysis of mortality data from DHIS2
• Abstraction and analysis of data from NIRA’s mobile civil registration and vital statistics system
• Analyzed public health surveillance data
• Increased all-cause mortality at regional referral hospitals in Uganda, during the pandemic period (2020-2021)

Implemented two quality improvement projects

• Improving capture and reporting of HIV testing data at Kitalya Maximum Security Prison
• Improving reporting malaria deaths data via the district health information system (DHIS2), Agago District

Trained 42 district officials in Toro and Bunyoro regions on development of malaria normal channels for monitoring of malaria upsurges and response measures

Written communication

Published one newspaper article titled:

• “Let’s be mindful of the environment as we fight COVID-19”

Published two articles in the Uganda national institute of public health (UNIPH) quarterly bulletin:

• Investigation of human tungiasis cases in Sheema District, Uganda, November 2021 to February 2022
• Increased all–cause mortality at regional referral hospitals in Uganda during the COVID–19 pandemic (2020–2021)

Edited Issue 3 volume 6 of the UNIPH bulletin

• Wrote two manuscripts as lead author and co-authored 5 others.

-Conference presentation

International conferences

• Second International Conference on Public Health in Africa (CPHIA), Kigali, December 2022. ‘

• • investigation of human tungiasis cases, in Sheema District was presented orally.
  • ‘increased all–cause mortality at regional referral hospitals in Uganda during the COVID–19 pandemic (2020–2021)’

National conferences

• 7th National Field Epidemiology conference
• 8th National Field Epidemiology conference

Summary of Epidemiological Study: 

 Title: Increased all–cause mortality at regional referral hospitals in Uganda during the COVID–19 pandemic (2020–2021)

Authors: Sherry Rita Ahirirwe 1*, Andrew Kwiringira1, Benon Kwesiga1, Lilian Bulage1, Daniel Kadobera1, and Alex Riolexus Ario1

*Corresponding author: Sherry Rita Ahirirwe, +256707064889, sahirirwe@ musph.ac.ug

Affiliations

1Uganda Public Health Fellowship Program, National Institute of Public Health, Ministry of Health, Kampala, Uganda

Background: Understanding the true burden of deaths associated with the COVID-19 pandemic is challenging in Uganda due to testing limitations and inadequate mortality surveillance systems. One approach to estimating pandemic-associated deaths is to calculate excess mortality (EM) at hospitals. We described temporal trends in all-cause mortality at regional referral hospitals (RRHs) in Uganda and estimated EM during two years of the pandemic compared with five years of historical data (2015–2019).

Methods: Monthly aggregate deaths, admissions, and reporting rates data were abstracted for 15 RRHs from the Ministry of Health (MOH) District Health Information System (DHIS2) from 2015–2021. We used logistic regression to model temporal trends in all-cause mortality from 2015–2021. We estimated EM by calculating actual in-hospital deaths/10,000 admissions in 2020 and 2021 and comparing them to expected rates using the upper bound of the 95% confidence interval of historical average (2015–2019). Excess deaths were divided by the expected deaths upper threshold to calculate EM percentage.

Results: With reference to 2015, there was a significant increase in all-cause mortality at RRHs in 2020 (AOR=1.20, 95%CI 1.16–1.23; p<0.001) and 2021 (AOR=1.46, 95%CI 1.42–1.50; p<0.001). Mortality significantly exceeded the upper threshold of expected deaths at RRHs during 2020 in April (7%), May (2%), June (25%), August (10%), October (4%), and November (4%). From June to November 2021, EM was recorded each month (57%, 25%, 22%, 1%, 10%, 6%, respectively). The highest EM peaks were recorded in June for both years, but the excess deaths proportion during the peak in 2021 was double that of 2020. Statistically significant EM was recorded at 11 (73%) of the 15 RRHs in 2020 and 13 (86%) in 2021.

Conclusion:All-cause mortality at RRHs increased during the pandemic period (2020-2021). We observed EM at RRHs during the pandemic period when compared to historical data. MOH can track the mortality burden using EM to inform targeted control measures that avert preventable deaths.

Keywords: Trends, all–cause mortality, excess mortality, COVID–19, Uganda

Key lessons learnt during the fellowship

During the fellowship, I learnt and developed the following skill sets:

• Outbreak investigation and response including institution of interventions
• Evaluation of surveillnace systems
• Designing and implementing quality improvement projects
• Data management, analysis and interpretation using such sofware as EpiInfo, STATA, R and QGIS
• Facilitating trainings
• Scientific writing (for Abstracts, Manuscripts and short articles)
• Presentation skills and dissemination of findings

Next Steps

• hope to further develop my skills in exploratory data analysis and visualization with R for reproducible analyses. Perhaps begin an R ladies chapter in Uganda.
• Continue championing public health by contributing to planning and development of health policy in Uganda.

Pictorial