Host Site: Public Health Emergency Operations Center (PHEOC)
Host Mentor: Dr. Issa Makumbi, 2. Joshua Kayiwa
ABOUT THE FELLOW
Robert is an accomplished epidemiologist. He is a holder of a Master of Public Health with a medical background. He has particular interests in global health security, statistical modeling, and artificial intelligence.
During the fellowship, he was attached to the Public Health Emergency Operations Center (PHEOC) which acts as a central coordinating unit of all public health emergencies in Uganda. The PHEOC is responsible for preparedness coordination, response, and recovery from public health emergencies.
The training has empowered Robert with great knowledge and skills in public emergency coordination and response. He has attained astute leadership skills, worked with big data sets, and interpreted them for proper use. He also supported the event-based surveillance (EBS) unit at the PHEOC where he monitored and triaged public health signals in the communities thereby contributing to early detection, preparedness, and response to public health emergencies.
Achievements at the Host Site
Participated in the Ebola Sudan virus disease outbreak response in Mubende and Kassanda districts (20th September to 30th November 2022).
Participated in drafting the concept for the National Simulation Exercise to assess Uganda’s readiness capacity for EVD.
Trained Village Health Teams in the event-based system (EBS) in Mukono, Kampala, and Wakiso districts.
Participated in Integrated Disease Surveillance and Response training in Kabarole District to build capacity of district surveillance focal persons.
Participated in data quality assessment (DQA) exercise in Kasese, Bundibugyo, Kyenjojo, Kabarole districts, and Fort Portal City.
Facilitated health worker training in Kasese District in enhanced surveillance and reporting.
Designed and implemented Quality Improvement Projects on the improvement of data quality in Kagando Hospital, Kasese District.
Fellowship program specific achievements
Led two outbreak investigations:
Methanol poisoning outbreak in Arua City and Madi Okollo District, 2022
Chicken pox outbreak in Kampala District, 2023
Participated in seven other outbreak investigations:
Ebola Sudan virus disease outbreak in Mubende and Kassanda districts
Scabies outbreak in Tororo District
Severe malaria outbreak in Namutumba District
Anthrax outbreak in Baduda District
Covid-19 outbreak in Nyakabande refugee transit center
Yellow fever outbreak in Masaka, Bundibugyo and Wakiso districts
Analyzed DHSI2 surveillance data:
On timeliness and completeness of reporting of monthly surveillance data in Uganda from 2020/2022
On organophosphate poising trends and spatial distribution in Uganda 2016/2022
Participated in training and mentorship of the FETP-Frontline health workers across the country.
Written Communication
Authored 5 manuscripts as lead author and 14 others as co-author:
Timeliness and completeness of monthly disease surveillance data reporting, Uganda, 2020–2021, published in the Pan African Medical Journal
Assessment of healthcare worker resilience at the epicenter of the 2022 Sudan virus disease outbreak in Uganda: implications for future preparedness- Under review
Factors associated with Loss to Follow-Up among adults aged 40 years and above living with HIV in Mid-Western Uganda 2020 – 2022-Under review
Assessment of Factors Influencing Reporting of Public Health Signals by Village Health Team members in the Event Based Surveillance System in Kabarole district, Uganda- Under review
Methanol poisoning caused by adulteration of alcohol at the production stage in a factory in northwestern Uganda, August 2022- Under review
Organophosphate poisoning distribution, temporal and spatial trends, Uganda, 2017- 2022- Under review
Edited the Uganda National Institute Public Health (UNIPH) epidemiological bulletin issue 1 volume 8, 2023, and also published 6 articles in the same.
Timeliness and completeness of monthly disease surveillance data reporting, Uganda, 2020 – 2021
Factors associated with Loss to Follow-Up among adults aged 40 years and above living with HIV in Mid-Western Uganda 2020 – 2022
Assessment of Factors Influencing Reporting of Public Health Signals by Village Health Team members in the Event Based Surveillance System in Kabarole district, Uganda
Determinants of workplace resilience among healthcare workers at the epicenter of the Sudan virus disease outbreak response in Uganda, 2022
Methanol poisoning caused by adulteration of alcohol at the production stage in a factory in northwestern Uganda, August 2022- Under review
Conference presentations (4 national and 2 international):
22nd annual Scientific Uganda Society for Health Scientists (USHS), Kampala, July 2023. won an award for best abstract presenter
8th and 9th National Field Epidemiology Conference (NFEC), Kampala, January 2023
17th Joint Annual Scientific Health (JASH) Conference, Kampala, September 2023
12th annual East African Health and Scientific Conference (EAHSC), Kigali, Rwanda, September 2023
3rd International Conference on Public Health in Africa (CPHIA), Lusaka, Zambia, November 2023
Summary of Epidemiological Study:
Title: Assessment of healthcare worker resilience at the epicenter of the 2022 Sudan virus disease outbreak in Uganda: implications for future preparedness
Background: Healthcare workers’ (HCWs) mental resilience can be challenged during times of adversity, including outbreaks. On September 20, 2022, the Uganda Ministry of Health declared a Sudan virus disease (SVD) outbreak. We assessed the level and determinants of resilience at the workplace among HCWs in the most affected districts (Mubende and Kassanda districts) in Uganda.
Methods: During March 2023, we conducted a cross-sectional survey among all HCWs (clinical and non-clinical) working during September 20, 2022 – January 23, 2023 (the outbreak period) in the three health facilities with Ebola treatment units (ETUs) in Mubende and Kassanda districts. Risk perception was assessed using 12 statements with a 4-point Likert-type scale. We assessed resilience using the Connor-Davidson Resilience Scale (CD-RISC-10). Resilience was dichotomized into ‘not resilient’ (score 1-29) and ‘resilient’ (score 30-40). Logistic regression was used to identify factors associated with resilience.
Results: Of 429 eligible HCWs, 400 (93%) were interviewed. Mean age was 35 (range: 20-58) years; 222 (56%) were male and median work experience was 8 years (range:1-38). One hundred and ten (28%) were support staff and 72 (18%) were nurses; 344 (86%) worked >40 hours per week. Overall, 93 (23%; 95%CI: 19-25%) were resilient. Three hundred and fifty-six (89%) expressed fear of contracting SVD and 356 (89%) expressed concern about stigma at their workplace if they became infected. Resilience was associated with age >40 years (adjusted odds ratio [AOR]=2.1; CI=1.3-3.5), work experience >10 years (AOR=2.2; CI=1.1- 4.7), working >40 hours per week (AOR=6.8; CI=2.1-23), and receiving Ebolavirus-specific counselling (AOR=3.3; CI=1.7-6.5).
Conclusion: Most HCWs at SVD ETUs in highly-affected districts in Uganda faced resiliency challenges during the outbreak, related to their infection risk and treatment by others if they became infected. Counseling and mental health support to HCWs and addressing concerns that bring them a high risk of infection could improve on their resilience during future outbreaks.
Key words: Resilience, Heath care workers, stress, Ebola
Key lessons learnt during the fellowship
Conduct outbreak investigation and response activities
Design and implementation of interventional projects
Big data analytics and interpretation
Scientific writing and presentation
Leadership
Training and mentorship skills
Evaluation and strengthening of disease surveillance systems
Next Steps
With the skills and competencies I have gained, I hope to further my career in the field of epidemiology, disease surveillance, and data analytics in order to strengthen the global health security agenda.
Pictorial
Dr. Robert Zavuga (center pointing) conducting a household sensitization session during the yellow fever outbreak investigation in Masaka District, 2022
Dr. Zavuga looking at a bottle containing adulterated alcohol at the factory’s production site during the methanol poisoning investigation in Arua City and Madi-Okollo District, 2022.
Dr. Zavuga (on the right) washing his hands during a severe malaria field outbreak investigation in Namutumba District, 2022.
Dr. Robert Zavuga (on the Right) reviewing surveillance health information files with FETP-Frontline trainees during a data quality assessment and mentorship exercise in Bwera Hospital, Kasese District, 2023.