Dr. Daniel Orit

Dr. Daniel Orit

MBChB (MAK), MPH (MAK), MMed-Internal
Medicine (MAK), Fellowship in Field
Email: dorit@uniph.go.ug
Telephone:+256777322263 /+256702224706

Host Site: Ministry of Health,National Malaria Control Division (NMCD)

Host Mentor: Dr. Gerald Rukundo

ABOUT THE FELLOW

Physician, with additional training in public health,  field epidemiology, and has special interest in  infectious diseases surveillance and response.  He holds a Bachelor’s degree in Medicine and  Surgery (MBChB), a Masters of Medicine in  Internal Medicine, a Masters of Public Health and  a fellowship in Field Epidemiology.

Prior to joining the fellowship, Daniel worked as  a clinician in a regional referral hospital, for close  to a decade. Desiring to have a greater impact  on health outcomes of both individuals and  populations, he decided to transition his career  into the public health domain.

During the fellowship program, he was attached  to the National Malaria Control Division (NMCD)  of the Ministry of Health, whose mandate is to  provide quality assured services for malaria prevention and treatment to all people in Uganda.   While at NMCD, he monitored and evaluated

malaria indicators, conducted weekly surveillance  for malaria, reviewed surveillance data and made  recommendations to improve malaria control and  treatment interventions, conducted mentorships  and support supervisions, contributed to writing  weekly malaria bulletins, and review of malaria  epidemic surveillance and response guidelines.

As a fellow, Daniel led and participated in a  number of outbreaks (Strange neurological  illness (Denga Denga outbreak in Bundibugyo, Anthrax  outbreak in Isingiro, Mpox outbreak in Mayuge Mbarara, Measles outbreak in Kiryandongo),  and projects (Establishing mortuary surveillance  for early detection of emerging health threats,  Improving death notification and certification at  Soroti Regional Referral Hospital and determining  interval from TB diagnosis to treatment initiation  at high volume facilities in central Uganda),  including: evaluating surveillance systems,  conducting operational research for program  improvement, and implementing quality  improvement projects among others. From this  experience, he has improved his skills in outbreak  detection and response, scientific writing, oral  presentation, leadership skills, and routine  surveillance data analysis. Additionally, the  fellowship has broadened his view of health care  beyond the clinical environment and has taught  him to integrate both his clinical and public health  backgrounds.

  Achievements at the Host Site

• Consultant on the Presidential Malaria  Initiative Uganda Malaria Reduction Activity  (PUMRA) under USAID during the baseline  assessment in Northern Uganda, a key activity  to improve the malaria response in high burdened districts.
• Consultant on the Program for Accessible  health, Communication and Education (PACE)  activity during the landscaping activity to  address community-level stock-outs of  Integrated Community Case Management  (ICCM) commodities in Uganda.
• Led the writing and dissemination of the  weekly malaria bulletin.
• Supported routine weekly analysis of malaria  epidemic surveillance to monitor upsurges in  malaria cases.
• Participated in the review and development of  a scorecard system for key malaria indicators.  ● Participated in the preparation and execution  of the national malaria day colloquiums in  2022 and 2023.
• Trained health workers on drawing malaria  normal channels for disease surveillance.  ● Participated in conducting malaria death  auditsat health facilities.
• Participated in training of health workers on  malaria case management using the current  guidelines.

Fellowship program specific achievements

• Won a TEPHINET grant to pilot a study focusing  on establishing an improved mortuary  surveillance system for early detection of  emergency health threats in Uganda.
• Led one outbreak investigation: Strange  neurological illness (Denga-Denga) affecting  young females in Bundibugyo District.
• Participated in other outbreak responses and  public health emergencies, including: Cholera  outbreak in Namayingo District,Anthrax  outbreak in Ibanda District, Mpox outbreak in  Mayuge and Mbarara districts.
• I evaluated the anthrax surveillance systems in  Isingiro District.
• Trained and mentored one cohort of the  Intermediate-Field Epidemiology Training  Program.
• Conducted a descriptive analysis of  surveillance data on “Trends of intermittent  preventive treatment utilization for malaria in  pregnancy, Uganda, 2017–2022”. Currently the  manuscript is under peer review.
• Additionally, the results from the descriptive  analysis, served as a basis for a continuous  quality improvement project being  implemented at Buvuma HC IV with support  from the Infectious Disease Institute  implementing partner in Buvuma District.
• Conducted an epidemiological study  on evaluating the effects of mass drug  administration for malaria on malaria  morbidity and mortality indicators during the  Ebola outbreak in Kasanda District, Uganda,  November 2022.
• Conducted a study on Survival status and  predictors on neonatal mortality among  neonates admitted in the NICU Soroti Regional  Referral Hospital (SRRH), 2022–2024.
• Implemented a quality improvement  project on Improving Death Notification  and Certification at SRRH, Using a Quality  Improvement Approach, 2023–2024.
• Conducted a study on establishing an  improved mortuary surveillance system for  early detection of emergency health threats  in Uganda.
• Authored five manuscripts: I am the lead  author in one and co-authored four which are  under peer review.
• Presented my work at four conferences  including: the 9th and 10th National Field  Epidemiology Conference, the 18th JASHC  conference, and the 2024 World Malaria Day  Scientific Colloquium.
• Published two articles in the UNIPH quarterly  bulletin and was an editor of volume 8, issue  4, Oct-Dec 2023, Uganda National Institute of  Public Health Epidemiological bulletin.
• Wrote and published an article titled “Malaria  during pregnancy: Challenges in control and  need for urgent action” in the New Vision  paper.

Summary of Epidemiological Study: 

 Title: Evaluating outcomes of mass drug  administration for malaria during the Ebola  outbreak in Kasanda District, Uganda,  November 2022–January 2023  

Background: Ebola and malaria both present as  febrile illnesses, making diagnosis difficult. During  Ebola Virus Disease (EVD) outbreaks, suspected  malaria cases are often reported as Ebola alerts  which strains the health system thus increasing  malaria-related morbidity and mortality. Mass  Drug Administration (MDA) of antimalarials can  reduce malaria morbidity in emergencies like  EVD outbreaks. During the 2022 EVD outbreak  in Mubende and Kasanda Districts, round one of  MDA was implemented. We aimed to assess the  outcome of MDA in Kasanda District.

Methods: We abstracted data on coverage and  impact of round one of MDA for malaria from the  antimalarial Dihyroatemesisnin-Piperaquine (DP)  drug distribution records tool, EVD alerts record  tool and District Health Information System 2  (DHIS2) for the 5 implementation sub-counties  of Kasanda District. Data on trends of malaria  morbidity indicators (total malaria cases, total  positivity rates, OPD suspected malaria fevers),  EVD alerts and coverage during the pre-MDA  (weeks 33-week 48, 2023) and intra-MDA (week  49, 2023-week 6, 2024) periods were obtained  from the above-listed tools. We estimated  MDA coverage as the proportion of persons  who received DP. MDA outcomes on malaria  morbidity indicators and EVD alerts during pre MDA versus intra-MDA period were estimated  as a relative percent change using an interrupted  time series regression model.

Results:Round one MDA coverage in the targeted  5-sub-counties was 88% (122,704/139,437). The  total malaria cases decreased by 6.7% (95% CI  4.2% -12.3%) during week 1, and further declined  in week 6 post-MDA by 43% (95% CI 34% –  52%). Test positivity rate declined by 13% (95%  CI 7% -16%) during week 3 and declined further  throughout all MDA weeks. Outpatient cases  with suspected malaria fevers decreased by 23%  (95% CI 17% -35%) during week 1 and declined  further throughout MDA weeks. The Ebola alerts  decreased by 8.8% (95% CI 5.2% -15.1%) at week  1 and declined further 79% (95% CI 63% – 88%)  by MDA week 6.

Conclusions: One round of MDA during  EVD outbreak in Kasanda District resulted in  a significant reduction of malaria morbidity  indicators. The MDA implementation approach  is an appropriate public health intervention in the  context of EVD epidemic outbreak, especially in  malaria-endemic areas like Kasanda District.

Keywords: Mass Drug Administration, Sudan  Ebola Virus Disease, Malaria trend indicators.

Key lessons learnt during the fellowship

• Oral presentation skills: dissemination of  findings, scientific conferences (national and  international), colloquiums.
• Outbreak investigation and institution of  effective control measures.
• Best practice approaches to public health emergencies.
• Scientific writing and communication skills:  abstracts, manuscripts, newspaper articles,  editing of bulletins.
• Data management, analysis (using Epi info,  STATA, QGIS), and interpretation.
• Designing and implementing of projects.
• Leadership and team management skills
• Community engagement
• Editorial and writing skills for scientific  articles.

Next Steps

With the competencies gained, I hope to  continue serving within the Ministry of Health  or related organizations and programs in the  realization of improved global health security and  prompt response to public health emergencies  and threats.

Pictorial