Denis Okethwangu

MSc.HSM(UMU) BBLT (Mak), Field Epidemiology Fellow (UPHFP)
Email: doothuba@gmail.com
Telephone: +256782559568

Host Site: National Malaria Control Program- MOH

Host Mentors: Dr. Jimmy Opigo, Dr. Daniel Kyabayinze

ABOUT THE FELLOW

Denis Okethwangu holds a Bachelors Degree in Biomedical Laboratory Technology from Makerere University and a Masters in Health Services Management from Uganda Martyrs University. Before admission to the Fellowship Program, he served as Staff Officer in the Ministry of Defense and Veteran Affairs, working under the supervision of the Director of Medical Services and Quality Assurance. Prior to his appointment in the Directorate of Medical Services, he served as healthcare worker involved in service provision, including in difficult and hard-to-reach areas both within the country and beyond. He has undertaken a number of short courses, including data analysis using statistical and spatial packages like STATA, SPSS, EPI Info and QGIS; conducting a TB operational research; rapid health assessment in complex emergencies; and monitoring and evaluation.

  Achievements at the Host Site

• Produced and published several issues of the malaria quarterly bulletin
• Trained district Rapid Response Teams (RRT) in Soroti and Lira regions in outbreak detection, investigation and response
• Investigated malaria outbreaks in Kisoro and Nwoya Districts, and wrote reports with recommendations to stop the outbreak
• Conducted analysis on data from District Health Information System v2 to inform malaria control interventions
• Conducted analysis of the Demographic and Health Survey to identify factors associated with uptake of Intermittent Preventive Treatment for malaria in pregnancy

Program-specific deliverables

• Led a rapid health assessment of Bidibidi refugee settlement in Yumbe District
• Was principal investigator in the investigation of an outbreak of multidrug-resistant TB in Arua District associated with poor adherence to TB treatment and delayed initiation of TB treatment
• Took lead in investigating a meningitis outbreak in Masindi District caused by Neisseria meningitidis subgroup W, which was facilitated by close contact
• Conducted an epidemiological study to assess the predictors for severe malaria in Kabarole District, January 2017 to April 2018
• Conducted an epidemiological study to assess the predictors of malaria-related mortality among patients attending Fort Portal Regional Referral Hospital, Jan 2017-May 2018
• Conducted a TB operational study on Unfavorable Treatment Outcomes among Multidrug-resistant Tuberculosis Patients attending Lira and Arua Regional Referral Hospitals, 2013-2017
• Led a quality improvement project to improve healthcare workers’ adherence to the malaria test and treat policy in two health facilities in Iganga District, 2018
• Participated in the following outbreak investigations:
  • A cholera outbreak in Nebbi District associated with drinking unsafe water from the lake
  • Assessment of HIV services in Bidibidi refugee settlement
  • Outbreak of mumps among children in a children’s home in Wakiso District, which was associated with close contact among children
  • Investigation of malaria outbreak in Kisoro and Nwoya Districts

Conference presentations

• Oral presentation on A Rapid Health Assessment of Bidibidi Refugee Settlement in the National Field Epidemiology Conference, Kampala, 2017
• Oral presentation on Multidrug-resistant Tuberculosis in Arua District, 2013-2017 in the National Field Epidemiology Conference, Kampala, 2017
• Oral presentation on Malaria outbreak Associated with Human Activities around Regenerated Swamps in Kisoro District, in the National Malaria Scientific Colloquium, 2018
• Oral presentation on Prevalence and Risk Factors for HIV among Men who have Sex with Men in Ugandan Prisons, 2014-2015 in the National Field Epidemiology Conference, 2018
• Oral poster presentation on Malaria outbreak in Kisoro District, 2018 in the 7th Africa Field Epidemiology Network Conference, Maputo, 2018
• Poster presentation on Multidrug-resistant Tuberculosis in Arua District, 2013-2017 in the International Conference on Emerging Infectious Disease, Atlanta, 2018
• Poster presentation on Multidrug-resistant Tuberculosis in Arua District, 2013-2017 in the High Level Conference on Global Health Security Agenda, Munyonyo, 2017

Publications and manuscripts written

Manuscripts

• Manuscript on an outbreak of multidrug-resistant TB in Arua District associated with poor adherence to TB treatment and delayed initiation of TB treatment, 2013-2017: Submitted to BMC Infectious Diseases for peer review and publishing
• Manuscript on unfavorable treatment outcomes among multidrug-resistant tuberculosis patients attending Lira and Arua Regional Referral Hospitals, 2013-2017: Under internal review
• Manuscript on the predictors for severe malaria in Kabarole District, January 2017 to April 2018: Under internal review
• Manuscript on factors associated with uptake of optimal doses of intermittent preventive therapy for malaria among pregnant women in Uganda: analysis of data from the Uganda Demographic and Health Survey, 2016: Under internal review
• Manuscript on prevalence and factors for HIV among men who have sex with men in Ugandan prisons, 2014-2015: Under review

Other publications

• A Rapid Health Assessment of Bidibidi Refugee Settlement, March 2017: Epibulletin article published in the National Institute of Public Health quarterly bulletin
• Outbreak of multidrug-resistant tuberculosis associated with poor adherence to TB treatment and delayed treatment initiation, Arua District, Uganda, 2013-2017: Epibulletin article in the National Institute of Public Health quarterly bulletin
• Combating Resistance to Mosquito Net Insecticides: Alternative Approaches in Sustaining the Relevance of Vector Control Strategies: Policy brief published in the National Institute of Public Health quarterly bulletin.

Summary of Epidemiological Study: 

 Title: Factors associated with severe malaria and delayed healthcare seeking behavior in Kabarole District, 2017-2018

Authors: Denis Okethwangu1, Godfrey Nsereko1, Daniel Eurien1, Claire Biribawa1, Carol Nanziri1, Daniel Kadobera1, Jimmy Opigo2, Alex R. Ario1,3, 1Uganda Public Health Fellowship Program, 2National Malaria Control Program, Uganda Ministry of Health, 3Uganda National Institute of Public Health

Introduction:  Death due to malaria-related causes among children can go as high as thirty per cent. These deaths can be avoided as progression of malaria to its severe forms is preventable. Kabarole District is one of districts that have reported high rates of malaria-related deaths. We investigated to find out the magnitude of severe malaria, assess associated risk and evaluate factors associated with delayed healthcare seeking among patients attending Bukuuku Health Center IV.

Methods:  We defined severe malaria according to the WHO criteria. We identified our cases from Bukuuku Health Center IV from 1 January 2017 to May 2018. We then described cases by person, place, time and clinical characteristics. We conducted a case-control study to evaluate association between risk factors and severe malaria. We randomly selected controls from uncomplicated malaria patients who attended the same facility during the same period as cases. Controls were matched by age group and village of residence in a ratio of 1:1. In a subgroup analysis, we identified factors associated with delayed healthcare seeking.

Results:  We identified 115 severe malaria cases from January 2017 to May 2018. This constituted 8.6% of all malaria cases in the facility. Children <5 years old were more affected, with an attack rate of 21/1,000 (50/2,335) compared with 5.7/1,000 (65/11,395). Compared to males with an attack rate of 7.9/1,000 (53/6,350), females were more affected (AR: 8.9, 62/6980). Karago and Kazingo parishes were the most affected with attack rates >4.0/1,000. The highest number of cases was observed in May and December, 2017. We found that seeking care beyond 24 hours of developing symptoms of malaria (aOR=15, 95%CI: 3.0-77) was associated with severe malaria. We also found that getting the first treatment from a drug shop (aOR=16, 95%CI: 5.3-47) and from home (aOR=26, 95%CI: 4.1-163) were associated with delayed healthcare seeking.

Conclusion and Recommendations: The proportion of severe malaria relative to the total number of malaria cases is high. Severe malaria in the district is associated with delayed health care seeking, which is further associated by receiving first treatment either from a nearby drug-shop or home.

Lessons Learned

During the fellowship, I learnt and developed the following skill sets:
— Data analysis skills
— Designing an epidemiological study
— Evaluating a surveillance system
— Presentation skills
— Outbreak investigation
— Writing skills
— Networking skills

Next Steps

I hope to further my career in the field of Epidemiology or surveillance