Host Site: Reproductive and Infant Health Division, Ministry of Health
Host Mentor: Dr. Robert Mutumba
ABOUT THE FELLOW
Stella Martha Migamba is a field epidemiology fellow with special interest in Maternal and Child health, as well as disease emergency preparedness and response. She holds a Master of Public Health from Makerere University and a Bachelor of Science in Nursing from Mbarara University of Science and Technology. Before joining the fellowship programme, she worked with the Infectious Diseases Institute and University Research Co., LLC, USAID RHITES EC where she implemented projects in HIV and Maternal Child Health.
During the fellowship, she was attached to the Reproductive Health Department of the Ministry of health where she conducted mentorships, support supervisions, and contributed to writing of national reports, workplans, and guidelines. She has authored a number of documents that demonstrate advanced scientific writing skills, including bulletin articles, newspaper articles, manuscripts, and website articles which enhanced her writing skills. She is also a mentor and trainer with the FETP Intermediate Program, and a trainer with the FETP Frontline Program.
Achievements at the Host Site
Participated in creating the Reproductive and Infant health communication strategy, July 2021. Its aim was to provide partners with a roadmap of how to support advocacy for safe motherhood.
Reviewed the MPDSR facility-based mentorship concept and terms of reference for the regional MPDSR mentorship, August 2021Participated in a National Training of Trainers in provision of medical-legal support to Sexual Gender Based Violence victims/ survivors and finalisation of a guide on medical forensic evidence management, 22-24 September 2021
Participated in a joint ministerial dialogue by the Association of Obstetricians and Gynaecologists of Uganda (AOGU) on Sexual Reproductive Health and Rights with representatives of line ministries (MoH, MoES, and MoGLSD) to disccuss RH policies and desired data capture and utilization changes
Participated in workplan harmonization meetings for the Reproductive and Infant Health Division of the Ministry of Health in July, 2021 aimed at streamlining the Division’s activities
Participated in organization of the second National Safe Motherhood Conference, September-October 2022
Part of the team that reviewed SEMA RH’s (Shaping Equitable Market Access for Reproductive Health) workplan and defined country priorities for implementation, September 2022
Fellowship program specific achievements
Surveillance data analysis:
Conducted a descriptive analysis to determine the trends and spatial distribution of in-patient neonatal sepsis in Uganda from 2016 to 2020
Quality improvement project:
Implemented a quality improvement project in Iganga Hospital to improve perinatal deaths notification and review (June to November 2022).
HIV Project:
Conducted an HIV project to assess the effect of point-of-care (POC) early-infant diagnosis testing (EID) on HIV results turnaround time and linkage to antiretroviral therapy at 10 health facilities.
Epidemiological studies
Did an epidemiological study to determine risk factors associated with deaths among hospitalized pregnant women with COVID-19 in Uganda, June 2020 to August 2021
Protective factors against Ebola virus infection among high risk contacts during an outbreak in Mubende and Kassanda districts, Uganda, 2022
Outbreak investigations
Team lead for the yellow fever break investigation in Wakiso, Masaka, Kasese and Buikwe Districts in March, 2022; presented investigation findings in Incident Management Team (IMT) and National Task Force (NTF) meetings
Co-investigated:
Black water fever in Mbale, Soroti, and Jinja from 14 June to 6 July 2021
Cholera outbreak investigation in Nakivale Refugee Settlement in Isingiro district in November, 2021
Malaria in Iganga in March 2021
Ebola outbreak investigation in Mubende and Kassanda districts in October and November 2022
Other projects
Conducted malaria normal channels training among district health team members in six districts of Bukedi Region, Eastern Uganda and disseminated malaria data quality assessments.
Supervised the catch-up vaccination project under Africa Field Epidemiology Network (AFENET) in Nakasongola District,June to September, 2022.
Facilitated workshops for FETP Frontline and currently trainer and mentor of the FETP Intermediate Program of UNIPH
Participated in a grant writing workshop, 16- 20 August, 2021
Participated in the Uganda scientific communications training, 30 August- 3 September, 2021
Participated in a 4- weeks Public Health Bulletin Writing (PHBW) workshop from 31 January- 28 February, 2022
Assessment of readiness of health facilities to manage the second wave of COVID-19
Evaluation of the performance of laboratory services in the COVID-19 response in September 2021
Evaluation of the implementation of Xpert MTB/RIF Ultra assay testing, September 2021
Supervision of data collection for the integrated community case management endline survey from 31 October – 19 November, 2021
Investigation of malaria deaths in eight selected districts, June 2022
Conference presentations
Oral presentation: Trends and Spatial Distribution of Neonatal Sepsis, Uganda, 2016-2020, at the National Field Epidemiology Conference, Kampala, 2021
Oral presentation: Trends and Spatial Distribution of Neonatal Sepsis, Uganda, 2016-2020, at the 16th Joint MAKCHS and 28th UNACOH Annual Scientific Health Conference, September 2022
Oral presentation: Risk factors associated with deaths among hospitalized pregnant women with COVID-19 in Uganda, June 2020 to August 2021, at the National Field Epidemiology Conference, Kampala, 2022
Poster presentation: Trends and Spatial Distribution of Neonatal Sepsis, Uganda, 2016-2020, at the second international Conference on Public Health in Africa (CPHIA) 2022 in Kigali, Rwanda, 13-15 December 2022
Poster presentation: Risk factors associated with deaths among hospitalized pregnant women with COVID-19 in Uganda, June 2020 to August 2021, at the second international Conference on Public Health in Africa (CPHIA) 2022 in Kigali, Rwanda, 13-15 December 2022
Written Communication
Bulletin articles
Trends and Spatial Distribution of Neonatal Sepsis, Uganda, 2016-2020: UNIPH Quarterly Epidemiological Bulletin, Volume 7, Issue 2, April- June 2022
Risk factors associated with deaths among hospitalized pregnant women with COVID-19 in Uganda, June 2020 to August 2021: UNIPH, Volume 7, Issue 4, October- December 2022
Rapid Antiretroviral Therapy initiation following roll out of Point-of-Care Early Infant Diagnosis Testing in Uganda, 2018-2021: UNIPH, Volume 7, Issue 4, October- December 2022
Newspaper articles
“Hepatitis can’t wait: A call for elimination” published as letter of the day in The New Vision on Thursday 22 July, 2021. This article was written to commemorate world hepatitis day 928 July, 2021) and aimed at raising awareness about vaccination for hepatitis B.
“Newborn infections: A preventable cause of neonatal deaths” was published in The New Vision on 1 June, 2021. The intention was to explain the importance of preventing newborn infections in the prevention of newborn deaths.
Website article
“The role of field epidemiologists in ensuring resilient health systems” was published on TEPHINET’s website to commemorate World Field Epidemiology Day on 7ptember, 2022
Manuscripts
Lead author
Trends and spatial distribution of neonatal sepsis, Uganda, 2016- 2020– under peer review
Risk factors associated with deaths among hospitalized pregnant women with COVID-19 in Uganda, June 2020 to August 2021 –under peer review
Rapid Antiretroviral Therapy initiation following roll out of Point-of-Care Early Infant Diagnosis Testing in Uganda, 2018-2021–undergoing review
Co-author
Ownership and use of long-lasting insecticidal nets three months after a mass distribution campaign in Uganda, 2021- published in BMC Malaria Journal
Trends and geospatial distribution of stillbirths in Uganda, 2014-2020- submitted to BMC Pregnancy and Childbirth journal
Trends and distribution of birth asphyxia incidence in Uganda, 2017-2020- submitted to PLOS One journal
Readiness of Health Facilities to Manage COVID-19 in Uganda, June 2021- submitted to BMC Health Services Research journal
Black Water Fever among children in Districts of Bugisu, Bukedi, and Busoga Regions in Eastern Uganda, January 2019 – July 2021- under review
Loss to Follow-up Among People Living with HIV on Tuberculosis Preventive Treatment at Four Regional Referral Hospitals, Uganda, 2019–2021- under review
Malaria Outbreak facilitated by agricultural activities, residing near water logged areas and participating in late night campaign activities: Nabitende Subcounty, Iganga District, December 2020-February
Summary of Epidemiological Study:
Title: Risk factors associated with deaths among hospitalized pregnant women with COVID-19 in Uganda, June 2020 to August 2021
Authors: Stella M. Migamba1, Bruno Ssemwanga2, Allan Komakech1, Benon Kwesiga1, Daniel Kadobera1, Lilian Bulage1, Alex R. Ario1, Julie R.
Affiliations
1Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
2Reproductive and Infant Health Department, Ministry of Health, Kampala, Uganda
3Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Kampala, Uganda
Background: Pregnant women are at higher risk than other COVID-19 patients for severe COVID-19 disease. Few studies have been done to understand risk factors for death among COVID-19- infected pregnant women in Africa. We investigated risk factors for death among hospitalized pregnant women with COVID-19 in Uganda.
Methods: We abstracted demographic and clinical characteristics from files of pregnant women admitted during any trimester with confirmed SARS-CoV-2 infection at eleven hospitals in Uganda. We conducted an unmatched case-control study among hospitalized pregnant women with COVID-19 during June 2020-August 2021; cases were those who died while controls were those who recovered and were discharged during the same period. We enrolled 33 cases and 109 controls. We analysed risk factors for death using multivariable logistic regression adjusted for age, trimester, parity and presence of comorbidities because these factors have previously been associated with COVID death or maternal death.
Results: Of 33 cases and 109 controls, 32 (97%) cases and 73 (67%) controls were hospitalised in 2021 (p=0.01). Thirty-two (97%) cases and 85 (78%) controls had COVID-19 symptoms at admission (p=0.04). Nineteen (58%) cases and nine (8%) controls had severe or critical COVID-19 disease at admission (p<0.001). The median length of hospitalisation for cases was 3 days (IQR: 1-6) while that for controls was 7 days (IQR: 4-11) (p<0.001). Odds of seeking care from another medical facility before admission were higher among cases than controls (ORunadjusted= 3.0, 95% CI: 1.1-7.9). Having severe disease at admission increased odds of death (ORadj= 16, 95% CI: 4.0-69), while admission for ≥ 6 days was protective (ORadj= 0.15, 95% CI: 0.03-0.81).
Conclusion: Pregnant women with COVID-19 who died had higher odds of being admitted with symptomatic, severe disease compared with those who survived. Earlier facilities cases visited could have delayed referral to the hospitals where they died few days after hospitalisation. Orienting facilities on referral of pregnant women with COVID-19 could improve their clinical outcomes.
Scientific communication using abstracts, manuscripts
Public speaking
Mentoring
Data presentation / graphical data presentation
Programming of data collection tools onto software
Bulletin writing and editing skills
Responding to disease outbreaks
Designing, implementing and monitoring projects
Mentorship
Support supervision
Next Steps
In the next 3 months after graduation, I will lead a team to implement a project to improve perinatal death notification and review in 9 districts of Bunyoro Region. In addition, I will mentor health workers in various areas of maternal child health, and on the surveillance data analysis and use to improve health programs. Furthermore, I intend to continue training and mentoring frontline and intermediate field epidemiology training program fellows.
Pictorial
Stella (centre, with laptop) training Kibuku District Health Team members on how to draw malaria normal channels, November 2021, in Eastern Uganda
Stella (standing) training Frontline-FETP participants during workshop two in Jinja City, July 2022
Stella (in purple dress) sharing her work at second international Conference on Public Health in Africa (CPHIA) in Kigali, Rwanda in December 2022.
Stella (standing) retrieving patient files at Entebbe Regional Referral Hospital during data collection for the study to evaluate risk factors for deaths of hospitalised pregnant women with COVID-19.