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Allen Eva Okullo(MPH, BSC(ZOO)) Host MentorsDr. Albert P Okui (RIP) Dr. Jimmy Opigo Dr. Myers Lugemwa Academic MentorDr. Joan Kayongo |
ABOUT THE FELLOWAllen Eva Okullo has a Masters degree in Public Health from the International Health Sciences University, Kampala and a Bachelors Degree in Zoology/Pschology from Makerere University Kampala. During the fellowship period, she was placed under the National Malaria Control Program which was her first choice of preference, given her profound interest in malaria. Thus, not surprisingly, she has had a great deal of achievements. She regards her experience as having been very fulfilling and worthwhile. Prior to joining the UPHFP, she worked as a Technical Officer with a consultancy firm called Montrose. Her roles in this position involved managerial and technical support to health projects for the Ministry of Health and a wide range of multilateral and unilateral organizations. One of her fondest memories is that when she told her former boss at Montrose that she saw herself as an epidemiologist five years from the time. True to what she said, January 24th 2017 marks its fulfillment! Achievements at the host site
Program-specific achievements (key deliverables)
Summary of Planned study:Title: Factors associated with malaria illness in three districts of Northern Uganda, 2015 Introduction: Malaria continues to be a huge public health threat worldwide with an estimated 3.3 billion people at the risk of being infected. An epidemic of malaria was confirmed in 11 districts of the Northern part of Uganda in June 2015. Ten of the eleven districts had Indoor Residual Spraying for a minimum of five years but had not had spraying for six months in five of the districts and twelve months in five of the remaining districts prior to the epidemic. This study was conducted to identify factors associated with malaria illness in two epidemic and a non epidemic district of Northern Uganda in 2015 in order to make recommendations to alleviate future malaria epidemics. Methods: The study was a comparative cross sectional study which used both quantitative and qualitative methods of data collection. This involved the study of three districts, Arua and Gulu which had a malaria epidemic in 2015 and Moyo, a neighboring district which didn’t have an epidemic. Household interviews were conducted in the three districts to determine possible host behavioral and knowledge factors for malaria illness. Key Informant Interviews were conducted at the national and district level to assess systems and environmental factors that could be associated with malaria illness in the three districts. Logistic regression analysis was performed to identify factors which were associated with the risk of suffering from malaria in both the epidemic and the non epidemic district. Bivariate analysis was used to identify factors that were independently associated with the risk of an individual having malaria in either the epidemic district or the non epidemic district. Multivariate logistic regression analysis was used to identify factors that remain significantly associated with the risk of acquiring malaria in the epidemic and the non epidemic district. Qualitative data from KII’s was transcribed, key categories identified and organized into themes which were related to the objectives of the study. Results:The 2015 data quality audit conducted in Kabarole District found that the majority of our respondents were nursing assistants 32% (16/50) and enrolled nurses 26% (13/50). All the health centers’ reports were timely between January and June and from November to December. The timeliness and reporting rates remained above 60% between August and October. The mean health center verification factor was 87±27. Sixty five percent (32/49) of the health centers had consistent data, 27% (13/49) over reported and 4% (2/49) underreported. The factors that affect immunization data quality under the data dimension include; arithmetic errors 20% (10/49) and inability to have a single view of immunization data 53% (26/49). The other items used for tallying immunization data included exercise books and plain papers. Quality index (QI) scores varied at all levels of health service delivery. Mean QI for the 49 health centers that conduct immunization was 61% ±26. The factors that affected the data collection process were: Recording component; omission of tally sheet data into HMIS reports 29% (14/49), irregular update of vaccine and injection material control book (VIMCB) 22% (11/49), storing/ reporting; poor storage practices like lack of designated storage place, lack of files for keeping records, tally sheets not arranged in order, limited of access to records because incharge has moved with the key 6% (3/49), missing tally sheets 27% (13/49), monitoring and evaluation; inability to classify target population according to immunization strategy 100%, catchment area maps not displayed 61% (30/49), graphs showing coverage and drop out rates not displayed 41% (20/49), involvement of the community during planning rare done 4% (2/49). There was a weak positive correlation between the health center verifaction factor and quality index though this was not statistically significant (r=0.014; p=0.92). Conclusion: There is inadequate knowledge on transmission and prevention of malaria in the epidemic area studied. Programmatically, the epidemic has been attributed to withdrawal of IRS in Gulu and to both an influx of refugees and inflation of aggregated figures in DHIS2 for Arua. There is need to strengthen BCC on malaria in all the communities especially the epidemic districts of northern Uganda. There is need to enforce and implement an adequate withdrawal strategy during and after implementation of IRS. Emphasis should be put on accuracy of data presented in DHIS2 to adequately reflect actual figures. Lessons Learned, skills/competencies acquired and next steps:
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