Dr. Rek John

Dr. Rek John

MBChB (MUST), MSc Epidemiology (LSHTM), FETP Graduate
Email: jcedrek@gmail.com
Telephone: +256782387857

Host Site: National Malaria Elimination Division, Ministry of Health, Uganda

Host Mentor:1. Dr. Jimmy Opigo, Dr. Catherine Maiteki

ABOUT THE FELLOW

I hold a Bachelor’s Degree in Medicine and Surgery  – Mbarara University of Science and Technology  and a Master’s in Epidemiology – London School  of Hygiene and Tropical Medicine, University  of London. With the Advanced FETP, I am now a  well-grounded epidemiologist. My passion lies  in supporting malaria elimination efforts, through  innovative surveillance, data-driven strategies,  and epidemiological practices.

During the fellowship, I was attached to the National  Malaria Control Division, now, the National Malaria  Elimination Division (NMED). The NMED provides  overall leadership for malaria control in Uganda.  Through the in-service training at the NMED, I  have attained great skills in leadership, outbreak  investigation, and response including data analysis  and interpretation, advocacy, multisectoral  coordination, and engagement. Additionally, I


  Achievements at the Host Site

  • Revitalized the production and dissemination  of weekly surveillance reports.
  • Initiated production of the monthly malaria  surveillance status update report.
  • Participated in the rapid assessment of the  malaria situation in the country following the  2022 malaria outbreaks across the country.
  • Participated in the country’s malaria strategic  plan mid-term review
  • Led the data analysis and preparation of  presentations for the malaria expert review  meeting.
  • Nominated to lead the development and  presentation of malaria information products  at the Ministry of Health Strategic Committee  meetings.
  • Presented at several strategic committee  meetings, providing updates on the malaria  situation in the country.
  • Nominated to support the Incident  Management System (IMS), with data analytics,  surveillance, and epidemiology during the  malaria outbreak response in 2023
  • Led a team to implement a rapid assessment  of the malaria surveillance system – to support  the IMT response to the outbreaks.
  • Led the development of the malaria epidemic  response SOPs. The SOPs will be disseminated  and rolled out to the rest of the country in Q1  of 2025.
  • Led a study to characterize severe malaria  complications in patients admitted with  malaria in the malaria epidemic districts, a  demand from the Ministry of Health strategic  committee meeting.
  • Participated in the Global Fund Grant Cycle 7  application process, and successfully wrote  a concept note for sustenance of malaria  sentinel surveillance sites across the country.  This was funded
  • Participated in the national malaria commodity  quantification activity
  • Participated in the antimalarial resistance  strategy development activities
  • Contributed to the development of the Uganda  Malaria Elimination Strategy
  • Contributed to the malaria surveillance system  assessment efforts, to inform the next malaria  strategic plan
  • Developed an outbreak detection online tool,  using monthly data to complement the weekly  data detection method
  • Developed materials for district-led malaria  outbreak response. These were deployed in  Serere, Kibuku, Butaleja, Bugiri, and Amolatar  districts
  • Trained district leaders and malaria partners  on malaria outbreak investigation, community  parasite prevalence surveys and mortality  surveillance in the context of malaria outbreaks
    • Participated in a panel discussion at the MiM  8th Pan African Conference, April 2024, Kigali,  Rwanda
    • Nominated to attend four training activities: – Kigali, Rwanda: WHO Malaria Epidemiological  Stratification workshop, December 2023. – Dakar, Senegal – Science of Defeating  Malaria, Harvard University and University  Cheikh Anta Diop of Dakar, June 2023.
  • – Pnong Peng, Cambodia: South to South  Malaria Surveillance Practice Exchange,  National Centre for Parasitology, Entomology  and Malaria Control (CNM), March 2024.- New Orleans, USA – Malaria Molecular  Surveillance, Imperial College, London,  November 2024.

Fellowship program specific achievements

  • Led one outbreak investigation: Cholera  outbreak in Namayingo District, June 2023.
  • Participated in three other outbreak  investigations:

– Anthrax outbreak in Ibanda District, April 16  to 29, 2023

– Mpox outbreak in Mukono District, Kampala  Metropolitan Area, October 30–November  9, 2024

– Mpox outbreak in Nakasongola District, Sept  30 to Oct 13, 2024

  • Analyzed surveillance data to describe Malaria  in Kampala Capital City Authority between2020 and 2023
    • Presented at two local conferences  – The 9th and 10th Field Epidemiology  conferences
    • Published three newspaper articles – Death by Malaria: Understanding the disease  path to fatality.

    – Why you should care about health data  reporting from your health service provider.  – Malaria likes travelers even more. Take extra  precautions.

    • Published two articles in the NIHP bulletin  – Cholera outbreak associated with drinking  contaminated lake shore water, Namayingo  District, Uganda July – August 2023.

    – Increasing cases of Malaria in Kampala City,  Uganda. Descriptive analysis of

    surveillance  data, Jan 2020 to Dec 2023.

    • Conducted a Continous Quality Improvement  study “Utilizing Quality Improvement to  Improve Medical Certification of Cause of  Death at Lira Regional Referral Hospital in  Uganda”
    • Conducted an HIV epidemiological study on  the incidence and risk factors of Infant HIV  infections in Kampala and Wakiso districts of  Uganda, 2022 – 2023.
    • Submitted a manuscript for publication to a  peer-reviewed journal titled ‘Cholera outbreak  associated with drinking contaminated lake  shore water, Namayingo district, Uganda, July

    August 2023.


Summary of Epidemiological Study: 

 Title: Multiple Complications in Patients Admitted  with Severe Malaria in Epidemic Districts of  Uganda, May to July 2023: An Epidemiological  Study 


Background: Severe malaria, manifesting as a  dysfunction of one or more organs, is a fatal form  of malaria and is one of the leading causes of  morbidity and mortality in Uganda. Between 2021  and 2023, Uganda experienced malaria epidemics  in over 50 districts, resulting in high admissions and  reported deaths. This study aimed to characterize  severe malaria manifestations in hospitalized  patients from the malaria epidemic districts in  Uganda.

Methods: We analyzed data from a line list of  all patients hospitalized due to malaria in 27 high volume health facilities in 11 epidemic districts  between May and July 2023. Patient demographics,  clinical characteristics, pre-hospital treatments,  severe malaria manifestation, and treatment  outcomes were described as proportions. Using  multivariable regression, we identified risk factors  for multiple complications.

Results:

We line-listed 1,936 patients. The  median age was 5 years (range 1-89), 54% (1,044)  were <5 years old, and 51% (994) were females.  The case fatality rate was 0.7% (14). Sickle cell  anemia was the most common comorbidity in  77% (83/107) of patients with comorbidities. Most  patients reported a fever (97%, 1,882), and 48%  (924) had received pre-admission treatment for  their symptoms. Unknown medicines accounted  for the most pre-admission treatments received  at 47% (550), in addition to oral paracetamol,  24% (281), and antimalarials 20% (236). Up to  75% (1443) of the patients had danger signs. 2,715  complications were reported80% (2,157) were in  children <10 years, and 74% (2017) presented as ≥2  complications. The most common complications  were low blood sugar, 22% (609), severe anemia,  19% (510), jaundice 12% (321), and blackwater fever  11% (306). Independent risk factors for multiple  complications were age; <5 years [aOR=2.2, 95%  CI=1.6-3.1] and 5≤15 [aOR=2.7, 95% CI=1.9-3.9]; having comorbidities [aOR=4.4, 95% CI=1.8-11];  and a danger sign of severe malaria at admission  [aOR=10.1, 95% CI=7.6-13.5].

Conclusion: Multiple complications of malaria  were common but mainly in children in the malaria  epidemic settings. Younger age, comorbidities,  and danger signs were predictors for multiple  complications. Clinical teams must fully assess  patients for all possible malaria complications for  effective treatment.


Key lessons learnt during the fellowship

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

  • Outbreak Investigation and response
  •  Evaluation of surveillance systems
  • Designing Quality Improvement Projects
  • Designing and implementing projects
  •  Data management, analysis, and interpretation  using EpiInfo and STATA
  • Creating, editing, visualizing, analyzing, and  publication of geospatial data using QGIS
  • Scientific writing (for Abstracts Manuscripts,  Policy Briefs, and short articles)
  • Presentation skills and dissemination of  findings
  • Developing a policy brief
  • ● Leadership, Teamwork, Multisectoral  engagement, Community engagement, and  lobbying skills

 


Next Steps

Following the fellowship, I am better placed to  identify public health challenges, highlight them  to relevant authorities, and lead change. I am  therefore embarking on a change process to lead  mentorship, surveillance, and research for malaria  elimination in Uganda.


Pictorial

Rek (standing) during district entry meeting
with the District Health Officer Kapchorwa
to introduce the Mortality Surveillance
Study, and study team, March 2023

Team meeting to review the days’ activities
following field visits for the Mortality
Surveillance Study in Kapchorwa District:
March 2023

Rek (extreme right) sharing malaria
surveillance data to inform the development
of the Uganda Malaria Death Reduction
strategy at the World Health Organization
Head Quarters, Kampala, December 2024

Attending the leadership course in
Science of Defeating Malaria at CIGASS
(International Centre for Research and
Training in Applied Genomics and Health
Surveillance, University Cheikh Anta Diop of
Dakar, June 2023.

Dr. Rek (first left) during the South to South
Surveillance Practice Exchange program
field visit at SiemPang Health Centre, Stung
Treng Province, Cambodia

Dr. Rek (with tag) and a fellow FETP from
Cambodia pose for a photo during a field visit
to learn from Village Malaria Workers and
Mobile Malaria Workers