Dr. Alitubeera Phoebe Hilda

MSc.HSR (Mak), BDS (Mak), Field Epidemiology Fellow (UPHFP)
Tel: 0772 565590
Email: akuzehilda@musph.ac.ug

Host Site: Mental Health and Substance Abuse- MOH

Host Mentors: Dr. Sheila Ndyanabangi (RIP), Dr. Hasfa Lukwata

ABOUT THE FELLOW

Phoebe has a Bachelor of Dental Surgery, and a Masters in Health Services Research from Makerere University. She was attached to the Mental Health and Substance Abuse Control division at the Ministry of health.
She has extensive knowledge in epidemiology, biostatistics and qualitative research. Keen on employing evidence-based approach to all projects including grant writing, data collection, data analysis, report writing, manuscript writing. Skills in organizing and conducting training workshops and seminars, effective communication skills with ability to disseminate research findings through captivating presentations.
She is highly motivated, energetic, hardworking research fellow with a consistent and successful track record of achieving of required outputs. A meticulous research manager with excellent capacity to function autonomously but also as part of a team with great interpersonal skills. Flexible with demonstrated ability to multitask to manage competing priorities while ensuring timely delivery of required outputs.

  Achievements at the Host Site

• A policy brief “Integration of Maternal Depression Screening and Treatment into Maternal Health Programs in Uganda”. Response to requirement by host site to prepare an article on depression for World Health day celebrations, 2017
• Descriptive study “Prevalence and trends of common mental neurological disorders in Uganda: an analysis of surveillance data, 2012-2016”. In direct response to host site requirement to participate in mapping and surveillance ofMental neurological and substance abuse (MNS) disorders. This followed a presentation to by the division to parliament of a proposed mental health bill where they were asked about the prevalence of MNS disorders and they did not know.
• I drafted the structured questionnaire for quantitative data collection, the key informant guide for qualitative data collection and budget for study on “Knowledge, attitudes and practices related to banned tobacco products according to the Uganda Tobacco Control Act 2015”. I also participated in writing of the report. The project aimed to assess the use of banned items such as e-cigarettes, shisha and other flavored tobacco products using data from enforcers.
• I spearheaded the start of the Uganda National Non-Communicable Diseases (NCDs) Quarterly Bulletin. I started it to address the growing need for visibility of work on NCDs by researchers, practitioners, policy makers, advocators and implementers.
• I was the Editor-in-chief of Uganda National Non-Communicable Diseases (NCDs) Quarterly Bulletin.
• I participated in development of tobacco control regulations
• I participated in the review of the alcohol control policy and updated it.
• I participated in drafting Alcohol control bill
• Concept note on psychosocial support in event of an Ebola outbreak. Psychosocial support has been recognized as a key element for Ebola preparedness.

Key Deliverables

• Descriptive study “Prevalence and trends of common mental neurological disorders in Uganda: an analysis of surveillance data, 2012-2016”.
• A policy brief “Integration of Maternal Depression Screening and Treatment into Maternal Health Programs in Uganda”.
• Newspaper article “Stop stigma against mentally ill people”
• Led outbreak investigations “Leptospirosis Outbreak in Kabale District, July 2017”, “Fatal Cyanide Poisoning Outbreak Caused by Consumption of Cassava Flour, Kasese District, September 2017”
• Participated in outbreak investigations “Cutaneous Anthrax outbreak investigation in Arua district, June, 2017”, “Methanol poisoning in Kawempe Division, Wakiso”.
• Participated in Evaluation of surveillance systems “Evaluation of tetanus surveillance in Uganda”
• Quality improvement project “Improving Alcohol and Drug Dependence Surveillance Data System using a Quality Improvement Initiative in Butabika National Referral Hospital, 2018”
• Presented at 2 international conferences, EIS, Atlanta, USA- “Fatal Cyanide Poisoning Outbreak Caused by Consumption of Cassava Flour, Kasese District, September 2017”, NCD symposium, Uganda-“Prevalence and trends of common mental neurological disorders in Uganda: an analysis of surveillance data, 2012-2016”.
• Presented at 3 National conferences, 2PHFP conferences and at JASC
• Manuscripts: 1 submitted to a peer reviewed journal, 1 under review by the secretariat, 2 still in the works.
• HIV project “Burden and correlates of mental health among HIV positive prisoners in Uganda, 2015”
• Epidemiological study/TB-OR “Prevalence and outcomes of TB infection by HIV status in Kampala city, Uganda- 2016”

Summary of Epidemiological Study: 

 Title: “Prevalence and outcomes of TB infection by HIV status in Kampala city, Uganda- 2016”

Background:  substance abuse co-morbidity and mortality is essential for monitoring mental health and evaluating health care delivery with the overall aim of improving patient care for estimating population impact of neuropsychiatric disorders. Resource mobilization for mental health services is dependent upon demonstration of need using routine statistics from data. In spite of this, population estimates of substance abuse hardly exist in our setting. We set up a functional electronic surveillance system at Butabika hospital ADU that can determine the burden of alcohol and drug dependence and associated factors, and assess the trends of alcohol and drug dependence.

Methods:  We used a quality improvement model that addresses three questions; what are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in improvement? We also performed plan-do-study-act cycles. The PDSA cycles are an iterative improvement process by which an intervention is conceived (Plan), and applied on a limited scale (Do), after which the results of this application are assessed (Study) and alterations are made to the intervention (Act) for reapplication to the improvement problem in the next PDSA cycle

Results: Baseline assessment using qualitative interviews with staff at ADU revealed that the previous surveillance system at ADU had only summary statistics which are based on HMIS requirements and is useful for administrative purposes but inadequate to serve the needs of the primary care-givers at the unit. Quantitative baseline assessment revealed that Butabika hospital as a whole has an electronic surveillance system, however the electronic database consists of only a few elements of the patients’ socio-demographic data and mainly serves to trace patient files. All sampled records in the electronic database had the patient name, age (128/128), while 61% had next of kin (N.O.K) although 75% (96/128) of corresponding files had this information. 7% (9/128) of records in electronic database had occupation but 63% (80/128) of the corresponding files had this information. All records in the electronic database lacked diagnosis, re-admission, co-existing neuro-psychiatric disorder, other co-morbidities, laboratory data and treatment received.

Conclusion;

Setting up the electronic surveillance system at ADU improved;

• Completeness (100%;128/128): data on number of re-admissions, family history of substance abuse/neuropsychiatric disorders, existing neuro-psychiatric co-morbidity, other co-morbidities like hypertension, primary ADU diagnosis, treatment given, length of hospital stay, type of discharge (official or escapee) are now all readily available.
• Validity (98%; 125/128): Summary statistics can now be generated directly from patient data using the software thus minimising errors.
• Timeliness (100% 128/128) : We reviewed patient files and entered data from records dating from January 2015 to September 2018. We trained ADU personnel to use and enter data in the electronic database. The primary responsibility of data entry will be assumed by nursing officers based on their duty schedule.

Key Skills and Competences acquired

• Learnt how to use mapping software QGIS for epidemiological illustrations.
• Learnt how to use Microsoft office publisher, which I used to create the NCD bulletin interface.
• Improved my scientific writing skills through drafting several proposals and a manuscript.
• Project management skills from TB-Operational Research and Quality Improvement studies.
• Outbreak investigation skills.
• Skills in evaluation of surveillance data.
• Skills in policy development from host site activities.
• Skills in scientific presentation from conferences at which I disseminated research findings.
• Skills in writing for non-scientific audiences through writing newspaper articles.

Next Steps

• An academician and epidemiologist with a keen focus on neuro-psychiatric and substance abuse disorders