Dr. Mariam KomugishaBVET (MUK), MPH (MUK), Advanced Field Epidemiology Fellow Host Site: Department of IntegratedEpidemiology, Surveillance and Public Health Emergencies (IES & PHEs)
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ABOUT THE FELLOWIam an accomplished epidemiologist. I hold a Master of Public Health with a background in Veterinary Medicine with interests in zoonotic diseases and the implementation of the One Health approach to public health. During the fellowship, I was attached to the Department of Integrated Epidemiology, Surveillance and Public Health Emergencies (IES), whose mission is to strengthen surveillance, for early detection of diseases and conditions, streamline reporting mechanisms, and timely investigation of disease outbreaks at all levels to ensure timely initiation of appropriate public health response. Through the in-service training, I have attained great skills in leadership, outbreak investigation, and response including data analysis, interpretation, and use. I have led one outbreak and participated in four others. I have also been involved in several national document formulations including the framework for multi-hazard preparedness and response to public health emergencies (EMPRPHE), September 2023. The training has empowered me with great knowledge and skills in public emergency coordination and response. I have attained leadership skills, worked with big data sets, and interpreted them for proper use. I also supported the event-based surveillance (EBS)surveillance, for early detection of diseases and conditions, streamline reporting mechanisms, and timely investigation of disease outbreaks at all levels to ensure timely initiation of appropriate public health response. Through the in-service training, I have attained great skills in leadership, outbreak investigation, and unit at the PHEOC where I 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 development of the framework for multi-hazard preparedness and response to public health emergencies (EMPRPHE), September 2023. – Participated in the ‘National training of trainers on National technical guidelines of the 3rd Edition IDSR’. – Facilitated health worker training in on 3rd edition Integrated Disease Surveillance and Response (IDSR) technical guidelines in Ngora, Mbarara and Bududa districts. – Participated in the scoping mission workshop on Epidemic Preparedness and Response (EPR) flagship initiatives in Uganda. – Presented on IDSR and surveillance of animal bites reporting during a workshop on application of One Health approach in rabies surveillance August 29-30, 2023 – Supported the team working on the zoonotic disease technical area during an internal Joint External Evaluation – Conducted the district and health facility technical surveillance support supervision using the supervision tool Site Improvement Monitoring tool (SIM) in Fort Portal City to identify gaps following IDSR training and identify opportunities for improvement. – Actively participated in the meeting on the ‘Integrated Disease Surveillance work plan dissemination’ held at Imperial Royale hotel, Kampala on June 8, 2023. – Participated in the AVoHC-SURGE training organised by the Ministry of Health in collaboration with the World Health Organisation. Fellowship program specific achievementsLed one outbreak investigation: – Rift Valley fever outbreak among animal handlers in Nakaseke District, 2023 Participated in four other outbreak investigations: – Anthrax outbreak in Ibanda District – Mpox outbreak in Kampala City and Mityana District – Ebola Sudan Virus Disease outbreak in Mubende and Kassanda districts Analyzed electronic Public Health Emergency Management surveillance data: – On trends and distribution of Rift Valley fever outbreaks in humans in Uganda, 2016– 2023 Presented at three local conferences – The 9th ,10th National Field Epidemiology and 1st National Laboratory Leadership Conference (NFEC). – The Uganda Society for Health Scientists Annual Scientific Conference (USHS), August 2024. Wrote and published two newspaper articles – How drug misuse in livestock farming affects human health – Work together to end deadly but preventable rabies by 2030 Editor of the Uganda Public Health (UPHB) bulletin issue 2 volume 9, 2024, and published 3 articles: – Outbreak of Rift Valley fever among herdsmen linked to contact with infected fluids in Nakaseke District, July 2023 – Descriptive analysis of Rift Valley fever outbreaks in humans in Uganda, 2016–2023 – Birth preparedness and complication readiness among pregnant women in a population-based cohort in Eastern Uganda, 2006–2018 Designed and implemented a QI study on the Improvement of the reporting rate of suspected and confirmed animal rabies in Luwero District,Uganda Manuscripts (lead author): – Outbreak of Rift Valley fever among herdsmen linked to contact with body fluids of infected animals in Nakaseke District, Central Uganda, June–July 2023-Under peer review at PLOS global public health – Trends and distribution of Rift Valley fever outbreaks in humans in Uganda reported through the electronic Public Health Emergency Management, 2016–2023-Under review Co-authored 3 other manuscripts Summary of Epidemiological Study:Title: Trends and distribution of Rift Valley Fever Outbreaks in Uganda, 2016–2023 Background: Rift Valley Fever (RVF) is a viral zoonosis that occurs sporadically in Uganda. Several RVF outbreaks have been reported in Uganda but little is known about its patterns and distribution. We evaluated the trends and spatial distribution of RVF outbreaks in Uganda from 2016 to 2023 to guide programming. Methods: We analyzed RVF surveillance data from the electronic Public Health Emergency Management (ePHEM) database of the Uganda Ministry of Health (MoH) from 2016–2023. The database is an open-source, multilingual, modular application used by the National Public Health Emergency Operation Centre (PHEOC) to manage all the outbreaks in the country. The Integrated Disease Surveillance and Response (IDSR) guidelines define a confirmed RVF case as any patient testing positive for either anti RVF immunoglobulin M(IgM) Enzyme-Linked Immunosorbent Assay (ELISA) antibodies or Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test. We abstracted data of all RVF cases reported between 2016–2023. We did descriptive analysis and tested trends using the Mann-Kendall test. Results: Forty-three RVF outbreaks were reported resulting in 340 cases (116 confirmed) and 42 deaths in Uganda from 2016–2023. The western region reported the highest number of cases 302 (89%), and deaths 31(74%). There was a non-significant increase (p=0.73) in the number of RVF outbreaks reported from 1 in 2016 to 8 in 2023 with most outbreaks (13) reported in 2018. RVF outbreaks occurred in all four regions of the country, with the highest number reported in the western region 27 (63%), followed by the central region 12 (28%). Twenty-six (60%) of the outbreaks were reported in the cattle corridor districts with Mbarara 4 (9%) and Kiruhura 4 (9%) districts reporting the highest number of outbreaks. Most outbreaks 29 (67%) were reported during the annual dry season of January to February and June to August. Conclusion:There was an increase in the number of reported outbreaks of RVF in Uganda annually since 2016. The continued spread indicates a need for more widespread risk communication about RVF in both humans and animals particularly in regions and districts reporting a high number of outbreaks. We recommend strengthening RVF surveillance during the rainy season to better understand the true burden of the disease. Keywords: Rift Valley fever, outbreak, trend, spatial distribution, Uganda Key lessons learnt during the fellowship
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