Robert Kaos Majwala

 MD (MUD), MA (Health Policy and Management), Field Epidemiology Fellow (PHFP) +256783317499 +25675841884
0kaosug@gmail.comdrmajwala@gmail.com rmajwala@musph. ac.ug

Host Site: National TB & Leprosy Program, Ministry of Health

Host Mentors: Dr. Frank Mugabe Rwabinumi, Dr. Stavia Turyahabwe

Academic Mentor: Dr. Bruce Kirenga, MakCHS

ABOUT THE FELLOW

Robert Majwala is a Ugandan health specialist with more than 7 years’ health care experience; He has been hosted at the National TB and Leprosy Control Program where he was charged with strengthening surveillance for drug resistant TB. Prior to joining the fellowship, he was working as a Division Medical Officer at Kampala Capital City Authority. He has experience in health systems management in public and non-governmental organization sectors, rural and urban health.He has previously worked with Doctors with Africa CUAMM as a technical advisor MNCH.

He is a trained medical doctor with masters in health policy, and management from Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. He has keen interest in use of epidemiological methods in solving global health challenges. He has skills in public health surveillance, outbreak investigations, maternal, neonatal and child health, monitoring and evaluation of health programs for quality improvement and epidemiology of infectious diseases including malaria, vaccine preventable diseases, tuberculosis (TB) and TB/HIV.

  Achievements at the host site

National TB and Leprosy Program – Host Institution

• Led an epidemiological investigation of a Tuberculosis outbreak in a boarding secondary
• school in Mukono District, October – November 2017
• Coordinated District TB and Leprosy Supervisor’s course 2017
• Led assessment of TB control among refugees in Uganda
• Participated in Global fund grant writing
• Participated in mentorships, support supervision, trainings in TB, TB/HIV
• Gave lecture at DTLS’ annual training in Buluba on TB burden and epidemiology in Uganda
• Together with the NTLP Program Manager, led discussions of programmatic implications of the 2016 TB prevalence survey
• Attended regional review meeting of the Integrated Tuberculosis-Diabetes Mellitus Care (ITDC) Project, Harare Zimbabwe (Nov. 2017)
• Participated in DHIS 2 roll out trainings as a trainer of trainers in Fortportal, Mbale and Kabale regions
• Participated in Programmatic Management of Drug Resistant TB support supervisions and mentorships
• Together with National TB Reference Laboratory, implemented a quality improvement project to improve weekly reports from Genexpert sites. Over a period of 2 years, reporting increased from about 40% in June 2016 to about 80% by November, 2017.
• Co-authored an abstract about programmatic implication of the 2016 TB prevalence survey that was presented the 46th conference on TB and Lung health in Guadalajara Mexico
• Presented a paper about TB outbreak in Secondary School in Mukono District at the Uganda Thoracic Society Scientific Meeting November 2017
• Reply to a misleading newspaper article in the Daily Monitor about use of Honey for TB
• Treatment, ‘Honey not alternative to TB treatment, Tuesday June 28, 2016: (http://www. monitor.co.ug/OpEd/Letters/Honey-not-alternative-for-TB-treatment/806314-3270356- 3w456w/index.html)
• Participated in technical working groups including programmatic management for drug resistant TB, pediatric TB
• Participated in reviewing and development of guidelines, standard operating procedures.

Program-specific achievements

• Led an outbreak investigation of a measles outbreak in Mayuge district, Eastern Uganda
• Participated in an epidemiological investigation of Rift Valley Fever Virus in Kabale district, March, 2016
• Led an epidemiological investigation into a reported outbreak of epilepsy in Ibanda District, South Western Uganda, July, 2016.
• Implemented a survey to determine prevalence of epilepsy in Ibanda District
• Participated in 1 cholera, 2 measles, 2 influenza virus disease epidemiological outbreak investigations
• Performed descriptive analysis of burden of epilepsy in Uganda using DHIS 2 data for period 2011 – 2015
• Submitted 1 manuscript to a peer review journal, 2 drafts available, writing is ongoing.
• Wrote a policy brief about ‘Policy and Programmatic Implications to Tuberculosis control in Schools following a Tuberculosis outbreak in a Secondary School in Mukono District, Oct. 2017

• Published articles in MoH Epidemiology Bulletin; 2(1st author), 6(co-author)
• Newspaper article in the daily monitor published on World TB day about the need to find missing TB cases, ‘we need to find missing Tuberculosis patients’. (http://www.monitor. co.ug/OpEd/Commentary/Need-find-missing-tuberculosis-patients/689364-386191812imw1z/index.html)
• Presented at 2 national and 2 international conferences. My abstract titled: A measles outbreak propagated by children congregating at water collection points: Mayuge District, Eastern Uganda, October 2016; that was accepted for presentation at the 66th Annual EIS conference April 24 – 27 2017, in Atlanta Georgia; was presented by a colleague as I was unable to travel due to competing priorities.
  

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Other Achievements

• January – October 2017: Participated in a 10 months’ (6ECTS credits) fellowship in Biosafety and biosecurity academia for controlling health threats, organized by: Bernhard Nocht Institute of tropical Medicine, Robert Koch Institute, Swiss Institute of Tropical Medicine & African Field Epidemiology Training Network January 2017 – October 2017 (Hamburg, Berlin and Kampala). Areas covered included disease surveillance, outbreak investigations, development of case studies using country specific contexts, international health regulations and management of biological incidents.
• Acquired a competency of development of case studies for training of different cadres of public health professionals in outbreak investigations, disease surveillance and biosafety/biosecurity

Summary of Epidemiologic Study:

 Title:    A measles outbreak propagated by children congregating at water collection points: Mayuge District, Eastern Uganda, October 2016

Background:   On 12 October, 2016 a measles outbreak was reported in Mayuge district. We investigated the outbreak to identify risk factors, evaluate vaccination coverage and vaccine effectiveness, and recommend evidence-based control measures

Methods:   We defined a probable case as onset of fever (≥3 days) and generalized rash, plus ≥1 of the following: conjunctivitis, cough, runny nose in a resident of Mayuge (population: 480,079). A confirmed case was a probable case with measles-specific IgM (+) not explained by vaccination. We reviewed medical records and conducted active community case-finding. In a case-control investigation involving probable cases and age- and village-matched controls, we evaluated risk factors for transmission during the case-person’s likely exposure period (7–21 days prior to rash onset). We estimated vaccine effectiveness (VE) using the formula: VE≈100 (1-ORprotective). We calculated vaccination coverage using the percent of controls vaccinated.

Results:    We identified 62 probable cases (attack rate [AR] =4.0/10,000), including 3 confirmed. Males and females had similar ARs. Children <5 years (AR=14/10,000) were the most affected of all age groups. The epidemic curve indicated a propagated outbreak. 32% (13/41) of case-persons and 13% (21/161) of control-persons went to one of the four water-collection sites (by themselves or with parents) during the case-patients’ likely exposure period (ORM-H=5.0; 95% CI=1.5– 17). The effectiveness of the single-dose measles vaccine was 75% (95% CI=24-92); vaccination coverage was 68% (95% CI=61-76).

Conclusion and Recommendations: Exposures at water-collection sites might have contributed to propagation of this outbreak. Low vaccine effectiveness and vaccination coverage facilitated measles transmission. We recommended intensifying measles vaccination for young children, advising residents with fever and rash to avoid going public gatherings including water-collection sites, and introducing a two-dose measles vaccine in routine vaccination schedule.

Key skills/competencies acquired:

• Establishment and strengthening surveillance systems
• Evaluation, analysis and interpretation of surveillance data
• Epidemiological investigations: Protocol development, and submission to IRB. Implementation of epidemiological studies, data management, analysis report writing and making actionable recommendations
• Response to a public health emergency including outbreak investigations
• Leadership: Alignment for purpose, motivation, support supervision, mentorship, ethics, protection of individuals in research, • Management: Mobilization of resources, planning and accountability, negotiation and ability to train others in the public health
• Capacity building: Training of others, mentorship
• Communication (Risk communication, written communication, presentation and use of technology for communication)

Next steps and career Career Path

I intend further my career in the practice of public health using, epidemiological skills that I have acquired during these 2 years of the field epidemiology fellowship. I see myself as a practicing field epidemiologist furthering efforts towards control of communicable and non-communicable disease.