Benigna G. NamaraMBChB, MPH, MMED (Mak), PGDME (UMI) & Advanced Field Epidemiology (UNIPH) Host Site: Division of Vector-Borne and Neglected Tropical Diseases, Ministry of Health
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ABOUT THE FELLOWI am Benigna Gabriela Namara, a microbiologist and epidemiologist holding a Bachelor’s degree in Medicine and Surgery, and Masters’ degrees in Public Health and Medical Microbiology from Makerere University. I also hold a postgraduate diploma in Monitoring and Evaluation from Uganda Management Institute and a fellowship in Advanced Field Epidemiology from the Uganda National Institute of Public Health. During the fellowship, I was hosted at the Division of Vector borne and Neglected Tropical Diseases (NTDS), at the Ministry of Health. Achievements at the Host SiteWhile at the division, I was introduced to the day to-day operations of the different NTD programs and partnerships that support them. This has taught me the value of advocacy, fundraising, and partnerships for combatting NTDs and has given me valuable insights on how to contribute to this agenda. While there I participated in several projects and activities including but not limited to: – Chaired a workshop to develop and update HMIS tools for Neglected Tropical Diseases – Chaired a workshop to develop manuals for training on Neglected Tropical Diseases for different health worker cadres – Chaired a workshop to discuss and plan sustainability of the supply chain for NTD commodities – Analysed and shared data on the frequency of occurrence of NTDs as reported in DHIS2 – Led the evaluation of NTD data in DHIS2 – Participated in the Onchocerciasis elimination celebration activities in Bushenyi District and Fort Portal City. – Participated in the Schistosomiasis Expert Committee meeting. – Co-chaired discussions with Implementing partners to discuss how to integrate missing NTD program data into DHIS2, existing challenges, and possible ways forward – Assisted with the review of the protocol for the upcoming Trachoma survey – Provided technical guidance for scientific writing and publication of NTD data Fellowship program specific achievementsOutbreak investigations I led three outbreak investigations: – Food poisoning outbreak at a secondary school in Mukono District, July 2023 – Mental illness among migrant domestic workers returning from the Middle East, 2019– 2023 – Mpox outbreak in Mayuge and Nakaseke districts, 2024 Participated in three other outbreak investigations: – Anthrax outbreak in Ibanda District, 2023 – Strange illness characterized by shaking legs inBundibugyo District, 2023 – Mpox investigation in Nakasongola, Mukono, Wakiso and Kampala districts, 2024 Descriptive studies Conducted three descriptive studies – Mass drug administration for schistosomiasis and soil-transmitted helminths: coverage and outcomes, 2013–2023 – Regional variation of TB diagnostic practices and treatment outcomes in Uganda, 2022 – Assessing trends of Water Hygiene and Sanitation indicators at household level and mortality from related diseases in a population-based cohort from Eastern Uganda, 2005–2022 Epidemiologic studies Conducted two epidemiological studies – Characteristics, treatment outcomes, and factors associated with death among patients with visceral leishmaniasis in Uganda, 2019– 2024 – TB diagnostic practices and associated factors in Uganda, 2022 Wakiso and Kampala districts, 2024 Descriptive studies Conducted three descriptive studies – Mass drug administration for schistosomiasis and soil-transmitted helminths: coverage and outcomes, 2013–2023 – Regional variation of TB diagnostic practices and treatment outcomes in Uganda, 2022 – Assessing trends of Water Hygiene and Sanitation indicators at household level and mortality from related diseases in a population-based cohort from Eastern Uganda, 2005–2022 Epidemiologic studies Conducted two epidemiological studies – Characteristics, treatment outcomes, and factors associated with death among patients with visceral leishmaniasis in Uganda, 2019– 2024 – TB diagnostic practices and associated factors in Uganda, 2022 Conferences Presented at four local conferences – Uganda Society for Health Scientists conference (UGSHS) – Joint Annual Scientific Health Conference (JASH) – The 9th National Field Epidemiology Conference – 10th National Field Epidemiology Conference Three of my abstracts were accepted at two reputable international conferences – The Union World Conference on Lung Health, 2024 – The International Conference on Infectious Diseases (ICID), 2024 Newspaper publications Wrote and published two newspaper articles – How Neglected Tropical Diseases become public health emergencies – The sexually transmitted infestations not even condoms will protect you from Bulletin publications Was an editor for the July–September 2023 issue of the NIPH bulletin Wrote and published three articles in the NIPH bulletin: – Food poisoning outbreak at a secondary school in Mukono District, July 2023 – Mental illness among migrant domestic workers returning from the Middle East Manuscripts Submitted five manuscripts for publication to peer-reviewed journals and they are under review – Food poisoning at Nakanyonyi Senior Secondary School in Mukono District, July 2023 – Trends of coverage and outcomes of Mass Drug Administration for schistosomiasis and soil-transmitted helminths in Uganda, 2013- 2023 – Diagnostic practices and associated factors among TB patients in Uganda, 2022 – Characteristics, Treatment Outcomes and Associated Factors among Patients with Visceral Leishmaniasis, Uganda, 2019–2024 – Incidence, perceptions, and experiences of mental illness among domestic workers returning to Uganda from the Middle East, 2019–2023 Continuous Quality Improvement (QI) projects – Implemented a QI project to improve Mortality surveillance and reporting at Kayunga Regional Referral Hospital, 2024 – Conducted a baseline assessment for mortality surveillance quality improvement at Arua Regional Referral Hospital, 2024 HIV study – Conceptualized and led a group HIV study to characterize persons newly diagnosed with HIV at four regional referral hospitals in Uganda, 2024 National surveys – Led a team to conduct an immunization coverage survey in Mityana District, 2024 – Led a team to conduct a COVID-19 excess mortality survey in Kayunga District, 2023 – Led a team in the North Central Region as part of a national survey to characterize Tuberculosis cases and conduct contact tracing across six regions, 2023 Other projects – Conducted CMEs on mpox at primary schools in affected districts and among humanitarian worker groups, 2024 – Conceptualized and designed a project to evaluate the IDI/CDC WASH Cares project, 2023 – Participated as a rapporteur at “The Uganda Multisectoral Internal Assessment for International Health Regulations” 25th–29th September 2023 Summary of Epidemiological Study:Title: Characteristics, treatment outcomes and factors associated with death among patients with visceral leishmaniasis, Uganda, 2019–2024 Background: Visceral leishmaniasis (VL) is endemic in Uganda afflicting mainly the Karamoja Region, bordering Kenya. The World Health Organization (WHO) targets to eliminate VL as a public health problem by reducing case fatality to <1%. However, the current burden of VL is largely undocumented rendering the target undeterminable. We describe VL patients in Uganda over the last 6 years, their treatment outcomes, and associated factors to inform targeted interventions towards meeting WHO’s target. Methods: We abstracted data of VL patients from January 2019–May 2024, from the main treatment center located in Amudat District, Karamoja, including: socio-demographics, clinical characteristics including co-morbidities, treatment and treatment outcomes. We determined factors associated with VL death. Results: Of 972 patients, 670 (69%) were male, 742 (76%) were ≤18 years and 373 (38%) were from Kenya. Most Ugandans were from Moroto District (434/599; 72%). The highest number of cases was in 2022 when 80% were Ugandan, while in previous years (2019–2021), more were Kenyan. Commonest symptoms were fever (98%), night sweats (77%), and abdominal swelling (72%), and the average duration of illness was 2.6 months (SD=0.3 months). Severe anemia was common (512/972; 53%) and among the patients tested for co-infections, 175/969 (18%) were co-infected with malaria and 185/593 (31%) Conclusion: This study reveals progress towards the elimination of VL as a public health problem in Uganda while highlighting the importance of cross-border transmission from Kenya. Screening and treatment of co-infections, especially HIV is necessary to mitigate death among VL patients. Keywords: Visceral Leishmaniasis, Uganda, characteristics, treatment outcomes, case fatality. Key lessons learnt during the fellowship
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