Dr. Lawrence Tumusiime

Dr. Lawrence Tumusiime

MBChB (GUM), MPH (UMU), Advanced Field Epidemiology Fellow (UPHFP)
Email: tumusiime@uniph.go.ug
Telephone: +256779712458/ +256750027210

Host Site: Reproductive and Child Health Department

Host Mentor: Dr. Mutumba Robert

ABOUT THE FELLOW

Dr. Lawrence Tumusiime is an accomplished field  epidemiologist. He holds a master’s degree in  Public Health with a medical background. With  particular interest in public health approach to  maternal and child health interventions.

During the fellowship, he was attached to the  Reproductive Health Division (RHD) under the  Maternal and Child Health (MCH) department of  the Ministry of Health. RHD is mandated to guide  the planning, standardization, implementation,  monitoring, and evaluation of Reproductive  Health services provided by the government,  nongovernmental organizations (NGOs), faith based organizations (FBOs), community-based  organizations (CBOs), private for-profit sectors  and communities in Uganda.

Through the in-service training, he attained great  skills in leadership, outbreak investigation, andresponse including data analysis, interpretation, and use. He led three outbreaks and participated  in two others. He was also involved in several  national document formulations including the MISP /SRH Addendum to the National Disaster Risk  Management Plan, Human Rights-Based Action  Plan for Family Planning/Sexual Reproductive  Health, Adolescent &Youth health implementation  guidelines and ANC SOP, National MPDSR Trainer’s  guide and targeted orientation of Regional MPDRS  Coaches/Mentors, management guidelines of  small sick newborn babies, and development of  guidelines for establishing a standard neonatal intensive care unit.

  Achievements at the Host Site

At the Reproductive Health Division, I participated  in and led several projects and activities including  but not limited to:

– Participated in the review and update of  Adolescent & Youth health implementation  guidelines and Antenatal Care Standard Operating Procedures May 30- June 2, 2023.

– Participated in the review of management  guidelines of small sick newborn babies, and  the development of guidelines for establishing  a standard neonatal intensive care unit.

– Supported finalizing the Draft National MPDSR  Trainer’s guide and targeted orientation of  Regional MPDRS Coaches/Mentors. We  finalized the National MPDSR Trainers’ Guide  and updated, Standardized MPDSR Training  Slides to guide MPDSR training activities in the  country.

– Undertook the national Training of Trainers  (ToT) on new reproductive health commodities  (Heat Stable Carbetocin, Tranexamic Acid,  Combipack, and Hormonal IUD); from June 26  to June 30, 2023.

– Participated in the review and Integration of  the Minimum Initial Service Package (MISP) for  Sexual and Reproductive Health (SRH) into the  National Emergency Disaster Preparedness  and Response Plan

– Participated in the validation of the draft  Human Rights Based Approach (HRBA) Action  plan for Sexual Reproductive Health

– Participated in the mentorship on  comprehensive emergency obstetric and  newborn care, and supported functionality  of theaters at health centers at level IV in the  West Nile region

– Coordinated the rollout of new and lesser used commodities (Heat Stable Carbetocin  and Tranexamic acid) for post-partum  hemorrhage prevention and treatment.

Fellowship program specific achievements

Led three outbreak investigations: 

– Anthrax outbreak associated with  consumption and handling of meat from  suddenly dead cattle, Kabira Sub-County,  Kyotera District, Uganda, June–December  2023

– Unusual Deaths Investigation, Kyotera District,  Uganda, August 2023

– Mpox case investigation in Mityana, Kampala,  Wakiso, and Mukono districts, October 2024

Participated in two other outbreak investigations: – Anthrax outbreak associated with handling  and consuming meat from animals that died  suddenly, Ibanda District, Uganda, May 2023 – Mpox case investigation in Bwera town,  Kasese District, September 2024.

Analyzed surveillance data from DHIS2 on trends  and distribution of maternal sepsis, Uganda, 2018- 2022

Presented at four local conferences and one  international

– Trends and distribution of maternal sepsis,  Uganda, 2018-2022 at the 9th National Field  Epidemiology Conference and 2nd Uganda  National Digital Health Conference

– Anthrax outbreak associated with  consumption and handling of meat from  suddenly dead cattle, Kabira Sub-County,  Kyotera District, Uganda, June–December  2023, at the 22nd Uganda Society of Health  Scientists Conference and the 10th National  Field Epidemiology Conference

– New and Lesser Used Medicine for Post Partum Hemorrhage in Uganda, a Case Study  of Rwenzori Region, 2024 at theGlobal Health  Practitioner Conference 2024

Was a lead author for Issue 3 Volume 8 July-Sept  Uganda Public Health Bulletin  

Wrote and published two articles in the Uganda  Public Health Bulletin 

– Anthrax outbreak associated with  consumption and handling of meat from  suddenly dead cattle, Kabira Sub-County,  Kyotera District, Uganda, June–December  2023

– Trends and distribution of maternal sepsis,  Uganda, 2018-2022

Designed and implemented a QI study on  improving Mortality Reporting through Death  Notification at Hoima Regional Referral Hospital in  Uganda, Using a Quality Improvement Approach,  January–June 2024

Did an HIV epi study on Incidence and Predictors  for Mother to Child Transmission of HIV in Uganda,  January 2022 to December 2023: A Retrospective  Cohort Study of Kampala City and Wakiso District

Participated in the excess mortality survey  on ‘Estimating the Impact of COVID-19 on All Cause Mortality in Uganda’. I supervised the data  collection process in the Kabaale District in Kigezi  region

Participated in the Tuberculosis survey on  Surveillance and Characterization of Tuberculosis  across Six Regions of Uganda, 2022

Conducted an epidemiological study on  Determinants of Puerperal Sepsis among Women  at Public Health Facilities of Nwoya District,  Northern Uganda, 2024

Submitted two manuscripts for publication to  peer-reviewed journals

– Anthrax outbreak associated with  consumption and handling of meat from  suddenly dead cattle, Kabira Sub-County,  Kyotera District, Uganda, June–December  2023, submitted to one health outlook journal

– Trends and distribution of maternal sepsis,  Uganda, 2018-2022, submitted to the  International Journal of Gynecology and  Obstetrics

Participated in training and mentorship of FETP Frontline health workers across the country Presented in one and participated in 3 National  Task Force meetings.

Participated in the Uganda cross-sectional min national survey to determine immunization  coverage and factors associated with  immunization uptake in Uganda, August 2024

Summary of Epidemiological Study: 

 Title: Anthrax outbreak associated with consumption  and handling of meat from cattle that suddenly  died in Kyotera, Uganda, June–December 2023 

Background: In November 2023, Kyotera District  reported a strange illness, characterized by itching,  rash, swelling, and skin lesions which was later  confirmed as anthrax. We investigated to assess  its magnitude, identify potential exposures, and  propose evidence-based control measures.

Methods: A suspected cutaneous anthrax case  was defined as acute onset of skin itching or swelling  plus ≥2 of: skin reddening, lymphadenopathy,  headache, fever or general body weakness in a  resident of Kabira sub-county, June–December  2023. A suspected gastrointestinal anthrax case  was defined as acute onset of ≥2 of: abdominal  pain, vomiting, diarrhea, mouth lesions or neck  swelling in a resident of Kabira sub-county, June– December 2023. A confirmed anthrax case was  a suspected case with Bacillus anthracis PCR positive results. To identify cases, we reviewed  medical records and conducted community  active case-finding with the help of village health  team members. We conducted a case-control  study and used logistic regression to identify risk  factors of anthrax transmission.

Results:  We identified 63 cases (46  suspected and 17 confirmed); 48 (76%) were male.

Of these, 55 cases (87%) were cutaneous and 8  (13%) were gastrointestinal, with a mean age of  42 years. Overall attack rate was 3.1/1,000; males  were more affected (AR=4.5/1,000) than females  (AR=1.5/1,000). Case-fatality rate was 19% (n=12).  Among the suspected cases, 18 (29%) sought care  from health facilities; 33 (52%) were managed by  traditional healers. Compared to individuals who  neither ate meat nor had contact with dead animals,  those who had contact and consumed meat had  higher odds of anthrax infection (OR=20.9, 95% CI:  8.8-49.8), followed by those who only consumed  meat (OR=5.81, 95% CI: 2.12-15.9).

Conclusion:The anthrax outbreak in Kyotera  District was primarily attributed to the  consumption and handling of meat from cattle  that had suddenly died. Poor health-seeking  behavior and seeking care from traditional healers  likely contributed to the high CFR. Implementing  inspection protocols for cattle before slaughter,  instituting widespread vaccination campaigns  against Bacillus anthracis in livestock, and  community sensitization on healthcare seeking  might prevent future outbreaks.

Keywords: Anthrax, Cutaneous, Gastrointestinal,  Outbreak, Uganda

Key lessons learnt during the fellowship

During the fellowship, I learnt and developed the  following skill sets:

– Outbreak investigation and response,  including the implementation of interventions – Evaluation of surveillance systems – Designing and implementing projects for  quality improvement

– Data management, analysis, and interpretation  using such software as STATA, EpiInfo, and  QGIS

– Scientific writing (for Abstracts, Manuscripts,  Policy Briefs and short articles)

– Presentation skills and dissemination of  findings

– Networking and lobbying skills

– Training and mentoring skills

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 to strengthen the global health security agenda

Pictorial