Zainah Kabami

Zainah Kabami

BSc, MPH, FETP
Email: zkabami@uniph.go.ug OR zkabami@musph.ac.ug
Telephone: +256758630580, +256787405314

Host Site: National Public Health Emergency Operations Centre

Host Mentor: Joshua Kayiwa

ABOUT THE FELLOW

Zainah holds a Health Care Assistant Diploma, Bachelor’s in Public Health and Master’s in Public Health with a particular interest in zoonotic diseases. Prior to joining the fellowship, she worked as an Epidemiologist with the COVID-19 Incident Management Team. During the fellowship, she was attached to the National Public Health Emergency Operations Centre, the central coordination unit for preparedness and response to public health emergencies in the country. Through the fellowship, she has developed great skills in leadership, outbreak investigation and response, data analysis, interpretation and use. She led two outbreaks and participated in four others. She participated in national document formulations including the Monkeypox preparedness and response plan, Ebola preparedness and response plan, and the Joint External Evaluation reports.

  Achievements at the Host Site

Supported Event Based surveillance

• IDSR training and support supervision
• ArcGIS training of trainers in Jinja District
• Participated in capacity building for Regional Public Health Emergency Operation Centers.
• Participated in the conceptualization of the National Simulation Exercise to assess Uganda’s readiness capacity for Ebola.
• Participated in the Joint External Evaluation, both as a subject matter expert (internal assessment) and a report writer for both the internal and external assessments.
• Supported the development of the Monkeypox and Ebola preparedness and response plans.
• Editorial team member for the Ebola national situation report.

Fellowship program specific achievements

• Led two outbreak investigations.

• •  Anthrax in Bududa District.
  • Rift Valley Fever in Mbarara District

• Participated in four other outbreak investigations

• • Severe Malaria in Namutumba District
  • Food poisoning in Pakwach District
  • Nodding syndrome in Kitgum District
  • Sudan Virus Disease in Mubende District

• Conducted a descriptive analysis of the trends and spatial distribution of Measles cases reported through the case-based surveillance system between 2016 and 2020.
• Designed and implemented an HIV quality improvement project to improve integration of Non-Communicable Diseases (Hypertension and Diabetes) and HIV treatment in Bwizibwera HC IV, Mbarara District.

• • Authored and published three manuscripts in peer reviewed journals:
  • “Rift Valley Fever Outbreak, Mbarara District, Western Uganda”.
  • “Epidemiology of cases of Sudan Virus Disease in Uganda, August – November 2022” in Lancet Global Health” – Under review
  • “Investigation of an Anthrax Outbreak in Bududa District, Eastern Uganda, January- May 2022: Implications for prevention and control” in PAMJ.

• Published two newspaper articles:

• • Awareness of the bird flu pandemic.
  • Public sensitization on the EVD outbreak in DRC at the time
• Edited and published in the for the National quarterly public health bulletin Issue 3 Volume 7.
• ‘The first ever reported anthrax outbreak in Bududa District, Eastern Uganda, February – May 2022.’

• ‘Epidemiological characteristics and trends of measles cases reported through the case-based surveillance system in Uganda, 2016 – 2020.’
• ‘US CDC Director’s visit to the NIPH, July 2022.’
• ‘UPHFP shines at the Uganda Society’s of Health Scientists Conference, August 11-12 2022.’

Summary of Epidemiological Study: 

 Title: Spatial distribution of cases in Bugweri district, during a malaria outbreak June 2020

Background: The Sudan Virus is one of four Ebola viruses pathogenic for humans, and has the potential to cause a devastating pandemic. On September 20, 2022, the Uganda Ministry of Health (MoH) declared an outbreak of Sudan virus disease (SVD), representing the eighth SVD outbreak, and the 52nd Ebola Disease outbreak globally. We describe the epidemiological characteristics, transmission dynamics, and progression of disease among cases.

Methods: We classified cases as suspected, probable, or confirmed using the standardized MoH case definitions. We identified cases through community case search, contact tracing, medical records review, and the alert management system. We collected data on patient demographics, exposures, clinical characteristics, and outcomes. We conducted descriptive epidemiology and estimated the basic reproduction number (Ro).

Results: Among 164 cases (142 confirmed, 22 probable) from nine districts, median age was 29 years (IQR: 20-38), 95 (58%) were male, and 77 (47%) died. Symptom onsets ranged from August 8-November 27, 2022, and the outbreak officially ended on January 11, 2023. The highest proportion of patients were peasant farmers (44%). Symptom data were available for 160 (98%) patients; Fever (135, 84%), vomiting (93, 60%), and weakness (89, 56%) were the commonest symptoms. Bleeding was uncommon (13, 8%). Case-fatality rate was higher in females (54%) than males (42%), and highest in children <10 years (74%). Median incubation was 6 days (IQR: 5-8), median time from onset to discharge was 17 days (IQR: 10-21), and onset to death was 10 days (IQR: 7-23). Mubende (14/100,000) and Kassanda Districts (16/100,000) had the highest attack rates. Most cases represented household (66%) and healthcare-associated transmission (25%). Overall Ro was 1∙25.

Conclusion: Despite delayed detection, the outbreak was rapidly controlled, possibly potentiated by a low Ro. Females and children were at highest risk of death. Household and healthcare-associated transmission drove the largest part of the outbreak.

Key lessons learnt during the fellowship

• Outbreak investigation and response
• Designing and implementing Quality Improvement Projects
• Data management, analysis and interpretation using EpiInfo, STATA and QGIS
• Scientific writing (Abstracts, Manuscripts, and Policy Briefs)
• Presentation skills
• Networking and lobbying skills
• Multi-tasking (Simultaneously working on several projects)
• Next Steps
• Zainah hopes to continue to contribute to the reduction of disease burden in Uganda through active engagement in research, surveillance and application of epidemiological principles within a national or international organization

Pictorial