Angella Musewa

Angella Musewa

Bachelor of Biomedical Laboratory Technology (BLT),
MSc Clin Epi & Biostat
Email: musewaa@musph.ac.ug
Tel:+256702422679

Host Site: National Animal Disease Diagnostics and Epidemiology Centre, Entebbe Uganda

Host Mentors: Dr. Deo Ndumu Birungi, Dr. Joseph Serugga and Mr. Martin Esau

ABOUT THE FELLOW

Angella Musewa holds a Bachelor of Biomedical Laboratory Technology (BLT) and Master of Science in Clinical Epidemiology and Biostatistics from Makerere University. During her two years of the fellowship, she has gained skills in writing, leadership, communication, reporting of public health events, coordination, management and analysis of public health surveillance data. In addition, I gained competencies in preparing policy briefs, using epi-info & STATA. I prepared several articles for publication in the Ministry of Health quarterly epidemiological bulletin, technical reports and manuscripts. I have gained experience, organizing meetings/ trainings, conducting epidemiological investigations and quality improvement projects. I have gathered skills and expertise in extracting, cleaning and analyzing secondary. Prior to joining the fellowship, Angella completed a fifteen weeks graduate fellowship in infectious Disease Management supported by USAID and Minnesota University – implemented by Makerere University School of Public Health and College of Veterinary Medicine, Animal Resources and Biosecurity. Angella led outbreak investigations under the One Health Student‟s clubs supported by One Health Central and Eastern Uganda. Angella worked with the International Livestock Research Institute (ILRI) as a research associate on Safe Food Fair projects and the Small Holder Pig Value Project. Angella has been involved in investigations of various disease outbreaks including Marburg, Rift Valley Fever, Crimean Congo Viral Hemorrhagic Fever, Cholera, and Anthrax. Angella was involved in the development a National Trainers manual for one health district frontiers and is currently a national trainer for one health district frontiers and Integrated Disease Surveillance and Response.

Achievements at the Host Site

Analyzed surveillance data on Trends and Distribution of Anthrax cases in Uganda 2003- 2017. Given our findings, a policy brief entitled reclassify anthrax from a private good disease to a public good disease was developed and published in the quarterly epidemiological bulletin as well as the host site.
Analyzed data on a sero-survey study conducted across the country on RVF in cattle, sheep and goats in 2016. A manuscript was developed and currently under peer review.
Presented Foot and Mouth Disease data on maps showing the affected districts in Uganda over a certain period of time (2017-2018). These maps have been put on display at NADDEC and are used to monitor the trends of Foot and Mouth Disease in Uganda as well as progress towards its control in cattle.
Participated in the young scientists‟ symposium on One health with a focus on infectious Diseases in Africa- held in Durban May 2019. During this symposium, the One health working group for Africa formulated a one health communique on which I am representing Uganda. I am in-charge of writing and reporting one health events from Uganda on a quarterly basis which are later published.
Participated in a three weeks course in advanced field epidemiology in Gothenburg Sweden, September 2018. Given this training, on return, I was able to analyze data and applied all the knowledge gained into data management. I was able to design a data base for RVF serological data collected given the knowledge obtained.
Represented NADDEC during a stakeholder‟s meeting on outbreak response and prevention at Uganda Virus Research Institute, February 2019. The challenges NADDEC is facing regarding timely response were voiced and subsequent meeting were held to discuss the way forward.
Participated in a FAO meeting on Institutional networks and policy framework for One Health in Uganda, May 2018. A training manual was drafted which is currently used for training one health district front liners in Uganda.
Trained frontline extension staff in Ntoroko district on Animal Disease Surveillance and Reporting for One Health 25th – 27th April, 2018.
Participated in a dissemination meeting for In-Service Veterinarians supported FAO while they were sharing their findings from their field placements to their facilitators ahead of certificate awarding in May 2019.
Designed a data base for the serosurvey of RVF in cattle, sheep and goat for data entry in epi-info. This database is currently used to retrieve data on RVF sero-prevalence.

Fellowship program specific achievements

Made a presentation on Fatal Rift Valley Fever Outbreak Caused by Exposure to Sick Animals: Western and Central Uganda, July 2018 during the high level visit of the US Secretary of Health, Minister for Health- Uganda among other delegates from the US and Uganda.
Participated in a simulation exercise on Crimean Congo Viral Hemorrhagic Fever at Kiswa Health Centre III, during a visit of the CDC director in Uganda, July 2018.

Lead Investigator:

Fatal Rift Valley Fever Outbreak Caused by Exposure to Sick Animals: Western and Central Uganda, July 2018.
Outbreak of Cutaneous Anthrax Associated with Handling Meat of Dead Cows: Engari Sub-County, Kiruhura District, Southwestern Uganda, May 2018.
Cluster of Sudden Deaths due to Carbon Monoxide Poisoning in Malaba Township, Tororo District, Uganda, August 2018.

Co-Investigator:

Cholera outbreak in Kampala along Nalukolongo channel, February 2019.
Crimean Congo Viral Hemorrhagic Fever in multiple districts in Central and Western Uganda, June 2018- January 2019.
Cholera outbreak in Kyangwali Refugee settlement in Hoima district, February 2018.
Ebola Risk mapping and assessment in Kagadi and Rubirizi districts, May 2019.

Wrote a policy Brief on reclassification of anthrax from a private good disease to a public good disease in the Uganda National Institute of Public Health, Volume 4 Issue 1 April 2019

Conducted TB Operations Research on: Turnaround Time (TAT) for Microbiological Testing of Tuberculosis in Routine Clinical Practice and Time to
Patient Initiation on Treatment, Iganga Hospital, 2012-2017. Findings from this project highlighted significant delays in TAT from sample collection to reporting Xpert MTB/RIF results and treatment initiation. We designed a quality improvement project aiming at improving Turnaround Time for
Microbiological Testing of Tuberculosis in Routine Clinical Practice and Time to Patient Initiation on Treatment, Iganga Hospital, 2012-2017. This was successful implemented to completion, and the causes of delays were identified and recommendations to overcome them were instituted.

Conducted an HIV study on Prevalence and predictors for virological Nonsuppression among HIV-Positive patients in Uganda Jan 2016- March
2017

Analyzed surveillance data on Trends and Distribution of Anthrax among Humans and Animals in Uganda, 2003- 2018.

Conducted an epidemiological investigation on Risk factors for mortality among Human African Trypanosomiasis Patients admitted at Lwala Hospital, Kaberamaido District, 2004 – 2014.

Conference Presentations

Fatal Rift Valley Fever Outbreak Caused by Exposure to Sick Animals: Western and Central Uganda, July 2018 at the 10th TEPHINET Conference in Atlanta Georgia, October 2019.
Turnaround Time for Microbiological Testing of Tuberculosis in Routine Clinical Practice and Time to Patient Initiation on Treatment, Iganga Hospital, 2012-2017 at the 4th National Field Epidemiology Conference in Kampala, October 2019.
Outbreak of Cutaneous Anthrax Associated with Handling Meat of Dead Cows: Engari Sub-County, Kiruhura District, Southwestern Uganda, May 2018 at the 3rd National Field Epidemiology Conference held in Kampala, November 2019.

Manuscripts

Outbreak of Cutaneous Anthrax Associated with Handling Meat of Uganda Public Health Fellowship Program – Field Epidemiology Track Cohort 2018 44 Dead Cows: Engari Sub-County, Kiruhura District, Southwestern Uganda, May 2018.
Fatal Rift Valley Fever Outbreak Caused by Exposure to Sick Animals: Western and Central Uganda, July 2018
Cluster of Sudden Deaths due to Carbon Monoxide Poisoning in Malaba Township, Tororo District, Uganda, August 2018

Epi-bulletin articles

Cluster of Sudden Deaths due to Carbon Monoxide Poisoning in Malaba Township, Tororo District, Uganda, August 2018
Fatal Rift Valley Fever Outbreak Caused by Exposure to Sick Animals: Western and Central Uganda, July 2018 at the 10th TEPHINET conference in Atlanta Georgia, October 2019.
Outbreak of Cutaneous Anthrax Associated with Handling Meat of Dead Cows: Engari Sub-County, Kiruhura District, Southwestern Uganda, May 2018.
Reclassify Anthrax from Private Good Disease to Public Good Disease.

Newspaper Articles

Published a Newspaper article in new vision on 12 August 2018, on “Beware of Rift Valley Fever in Uganda.”

Summary of Epidemiological Study:

Title: Fatal Rift Valley Fever Outbreak Caused by Exposure to Sick Animals: Western and Central Uganda, July 2018.

Introduction: Rift Valley Fever (RVF) is a viral hemorrhagic fever that can be fatal to humans and livestock. During June–October 2018, an upsurge of RVF cases occurred in western and central Uganda. We investigated to estimate the scope of the outbreak, identify exposure factors, and recommend evidence-based control measures.

Methods: We defined a probable case as acute onset of unexplained fever with thrombocytopenia or leukopenia, plus ≥1 of: unexplained bleeding, blurred vision, or unexplained death during June–October 2018 in a resident of eleven affected districts. A confirmed case was a probable case with a positive serum test for RVF by RT-PCR. We reviewed medical records, searched communities for cases and sampled animals in affected districts. In a case-control study, we compared exposures of cases and age-, sex-, and neighborhood matched controls.

Results: We identified 19 cases (17 confirmed, 2 probable); 13 (68%) died. The attack rate (AR) was 19 times as high in males (8.7/1,000,000) as in females (0.46/1,000,000). Of the 18 case-patients included in the case-control study and 90 controls, 10 case-patients (56%) and (8.0%) had a history of butchering/cutting/carrying sick/dead livestock (ORMH=22, 95%CI=4.6- 110). Exposure to raw meat from healthy livestock was protective against RVF (ORMH=2.1, 95%CI=0.36-31). Of 100 livestock serum samples, 72 (72%) were IgM-positive for RVF.

Conclusion: This outbreak was caused by exposure to raw meat from sick/dead livestock. RVF infection in area livestock appeared to be widespread. We recommended banning the processing of meat from sick/dead livestock.

Key lessons learnt during the fellowship

Improved communication skills; Train district veterinary officers openly and with confidence Presentation skills; presented my investigations at both local and international conferences
Improved scientific writing skills (proposal/protocol writing, manuscript writing)
Project Management (Gained experience in conducting projects to completion)
Improved data analysis skills especially advanced analysis
Expanded professional Network (Got to know a number of persons instrumental in my profession)
Ability to Multitask
Improved analytical skills (Deeper understanding of elements)
Public speaking (with a lot of opportunity to present to different fora and researchers)

Next Steps

The Africa One Health University Network (AFROHUN), formerly OHCEA Regional Secretariat appointed me as the AFROHUNUganda Country Manager. My tasks shall be to:

Coordinate AFROHUN- Uganda‟s agenda and provide strategic guidance to the country.
Coordinate with university leadership, including Deans and University top management, within and across member institutions.
Strengthen national level coordination with government and other stakeholders. Strategic partnership engagement including but not limited to government, private sector, civil society, and community.
Broaden the scope of operation (One Health) and reporting beyond, disciplines, institutions, and countries
Support the process of bringing on board new institutions and actors.
Provide leadership and support to programme management and capacity development.
Identify programming gaps and develop strategies to address them.
Manage timely dissemination of programme reports to the Regional Secretariat and stakeholders.
Identify scientific publication ideas and support teams to write publications.