Joy Kusiima 

MBChB (Mak), MHSR (Mak), Field Epidemiology Fellow (PHFP) +256777912696jobbaale@gmail.com

Host Site

 Uganda Cancer Institute

Host Mentors

 Dr. Jackson Orem, Ms Nakaganda Annet

Academic Mentor

 Assoc Prof Rhoda Wanyenze

ABOUT THE FELLOW

 Dr. Kusiima Joy holds a bachelor’s degree in medicine and surgery, a master’s degree in health services research and a postgraduate diploma in project planning and management. Prior joining the fellowship programme, she worked as a project manager for a cooperative agreement titled: Enhanced surveillance in most at risk populations in the government of Uganda. This was a CDC funded project under Makerere School of Public health. While on the Public Health Fellowship Programme she was hosted at the Uganda Cancer Institute.

  Achievements at the host site

These are the host specific institutional deliverables which she has been involved in during the two-year period;

1. Strengthened the Mayuge Cancer Registry by drafting the protocol, overseeing data collection and offering support supervision on cancer surveillance and registration to health workers in this region.
2. Analyzed the electronic database of records at the Uganda Cancer Institute, drafted a
3. report and disseminated the findings.
4. Analyzed records from the Comprehensive Cancer Control Programme (CCCP).
5. Supported a research protocol titled “ Processes and barriers to accessing timely cancer treatment at the Uganda Cancer Institute” this included drafting standard operating procedures for this protocol and responding to reviewer’s comments ,overseeing submission to the ethical review board , training research participants, ,chairing and coordinating research meetings.
6. Supported the establishment of the Uganda National Cancer Control Programme by organizing meetings, making presentations and writing minutes following subsequent meetings.

Program-specific achievements

The following are the programme specific deliverables Kusiima worked on during the two year period:

1. Led three outbreak investigations. These included; a typhoid verification exercise in Nakaseke District, a measles outbreak in Buvuma district, avian flu in districts surrounding shores of Lake Victoria, cluster of non-specific tumors in Isingiro District.
2. Presented at the 6th East African Health Scientific International Conference which was held in Burundi.
3. Presented in three local conferences: The Joint Annual Scientific Health Conference and the 2ndand 3rd National Field Epidemiology Conferences
4. Published three newspaper articles:The need to strengthen laboratory systems; 10th March 2017; Herbal remedies and supplements not recommended for cancer patients; the New Vision of 27th Feb 2017; why you should be skeptical about the typhoid test; the New Vision of 23 Dec 2016.
5. Published three articles in the MOH quarterly epidemiological bulletin: False typhoid report due to inadequacies in typhoid surveillance; falsely reported cluster of tumors in Isingiro District; Missed opportunities in cancer diagnosis.
6. Conducted a quality improvement project in Nakaseke District titled;” Improving typhoid reporting in Nakaseke district using continuous quality improvement science”
7. Prepared a policy brief recommending the introduction of Typhoid Rapid Diagnostic tests to aid typhoid screening.
8. For the epidemiological study, she conducted secondary data analysis using data from the Non-Communicable Disease baseline survey. The study was titled; “Uptake and correlates of cervical cancer screening services in Uganda”
9. Submitted a manuscript titled “High burden of HIV, Syphilis and schistosomiasis and low uptake of health services among fishing communities in the Lake Kyoga region”.
10. Analyzed the electronic database to describe characteristics of patients seen at the Uganda Cancer Institute.

 Summary of Epidemiological Study:

 TITLE:  Uptake and correlates of cervical cancer screening services in Uganda
Introduction: In Uganda, cervical cancer is the commonest cause of cancer deaths in women. Available screening services are avenues for early cancer detection and prevention. Uganda has no organized cancer screening program but some opportunistic cancer screening is provided by various providers. Therefore, nationally representative data on uptake of screening services for cancer of the cervix in Uganda is scarce.Using secondary data, we estimated uptake of screening services for cancer of the cervix.

Methods:    his secondary analysis was done using data collected from all women 18-69 years who participated in the 2014 Non Communicable Diseases (NCD) risk factor baseline survey. From the main NCD data set, we abstracted variables on: social demographic characteristics (age, residence, marital status, religion), cancer risk factors such alcohol and tobacco consumption, health seeking behaviours such as having as having blood pressure, blood sugar, blood cholesterol done prior the survey and whether a woman had screened for cancer of the cervix. We used proportions/ confidence intervals to estimate uptake of cervical cancer screening services and logistic regression models to estimate correlates of cervical cancer screening services in Uganda.

Results:  Of the 1831 participants, 22.2% (n=406) were ≤ 24 years, 74% (n=1358) were from the rural region, 41.1% (751) had primary education as the highest level of education, 62.4 %( 1,141) had a form of employment, and 66.9% (n=1225) were married. Uptake of cervical cancer screening services was similar among respondents in the urban (13%) and rural area (8.7%) AOR:0.9 (0.6 – 1.5).It was higher; in the 50-54yr age group (15%) compared to the 25-29 age group (9.3%); aOR; 2.3(95%; CI 1.2 – 5.1), among respondents with tertiary education status (18.6%) compared to those with no formal education (6.7%); aOR; 3.0 (95% CI: 1.5 – 6.5), and higher among those who had blood pressure measurements done (13%)compared to those who had never had a blood pressure measurement done(5.1%); aOR 2.1 (95% CI; 1.4- 3.1)

Conclusion and Recommendations: We report low uptake of cervical cancer screening in the general population calling for a need for organised screening programmes across all regions to improve coverage. Integrating cancer screening services when screening for other non-communicable diseases such as hypertension and diabetes will improve uptake of cancer of the cervix

Key Skills and Competencies acquired:

Over the past two years, I have acquired the following competencies:

• Conducting and leading outbreak investigations
• Performing rapid health assessments in complex situations i.e. refuge situations
• Analyzing both surveillance and secondary data
• Conducting projects in continuous quality improvement
• Communicating effective across different audiences. This includes presenting in both national and international conferences, writing scientific documents.
• Improvement in writing skills; this includes writing for scientific and non-scientific audiences
• Technical expertise in networking and stakeholder management.
• Working with different team members and managing crises

Future Expectations: Over the next phase of my life, I will build a career in research with bias to epidemiology, surveillance systems and outbreak investigations. I hope this will contribute to formation of evidence based policies and interventions as far as health care and disease control is concerned. In line with the global health security agenda, I would like to build competencies of field epidemiology among health service providers.