Dativa Maria Aliddeki

Dativa Maria Aliddeki

MPH (SHUATS), BACE (KYU), Field Epidemiology Fellow (UPHFP)
mdaliddeki@musph.ac.ug,
mariedativah@gmail.com

Host Site:

Uganda National Expanded Program on Immunization (UNEPI)

Host Mentors:

Dr. Immaculate Ampaire
Dr. Alfred Driwale and
Dr. Bernard Opar

ABOUT THE FELLOW

Dativa Maria Aliddeki is an Epidemiologist with special interest in the area of emergency response management and coordination. She holds a BSc in Adult and Community Education from Kyambogo University and a Master of Public Health from the Sam Higginbottom University of Agriculture, Science and Technology – India.
She has 8 years of experience working in the Uganda health sector in the field of public health management and emergency response. Prior to joining the fellowship program, she worked as an Administrator at the Public Health Emergency Operations Center (PHEOC), Ministry of Heath, where she coordinated national level response to public health emergencies in Uganda. With a passion for public health emergency response, the fellowship offered her a unique opportunity to acquire all round knowledge on emergency response, both at national and district level. She joined the Uganda Public Health Fellowship Program in January 2018.
During her time on the fellowship program, she was placed at Uganda National Expanded Program on Immunization. Working with this team, she contributed to national efforts towards the control of vaccine preventable diseases in the country.

Achievements at the Host Site

Conducted weekly analysis of measles outbreak data in multiple districts. This weekly analysis informed UNEPI and the National Task Force for public health emergencies of the scope and magnitude of the outbreak, thereby informing response efforts.
National level supervisor and trainer during the introduction into routine immunization of the rotavirus vaccine in Kayunga District and the first time use of the Oral Cholera Vaccine (OCV) during a cholera outbreak in Hoima District. Under her supervision, the rotavirus vaccine was rolled out in all health facilities in Kayunga District and an 83% coverage of 2 doses of the OCV in 5 sub-counties of Hoima District was achieved.
Coordinated and participated in the assessment of Missed Opportunities for Vaccination in 20 districts of Uganda. In Buikwe District where she was a Team Leader, 104 caregiver exit interviews and 40 health worker Key Informant Interviews were conducted. Findings of this assessment informed
implementation of her Quality Improvement Project.
A member of the National Stop Transmission of Polio (NSTOP) team and conducted NSTOP surveillance activities in Nebbi and Mubende Districts. She followed up on reported suspected AFP cases and provided immunization support supervision for all vaccinating health facilities in the districts.
Compiled a national report of the first time use of the OCV in the country. This report provided the findings of the initial roll out of the OCV and informed subsequent phases of the OCV use in other cholera endemic districts in Uganda.

Fellowship program specific achievements

Emergency response and outbreak investigation

Lead Investigator:

A Food-borne Cholera Outbreak in a School Associated with Eating of Contaminated Fried Fish, Hoima District. Our investigation discovered that the sporadic cases of cholera in Hoima were linked to a secondary school where a student had travelled and brought fried fish from a fishing village with an ongoing cholera outbreak.
An Outbreak of Anthrax in Pawor Subcounty, Arua District. Our investigation findings linked this outbreak to slaughtering and consumption of cows that had died of unknown causes. We recommended proper disposal of all animals that die of unknown causes and liaising with the district veterinary office to provide an anthrax vaccine to all at risk cattle.
A Suspected Measles Outbreak in Oyam District, affecting both children and adults. Our investigation found that this outbreak was propagated by congregating in trading centres. In response, we worked with the District to conduct Periodic Intensified Routine Immunization (PIRI) in the affected subcounty for all children under 5 years and intensify routine surveillance and reporting of suspected measles cases.
Contact Tracing during the Ebola Virus Disease (EVD) Outbreak in Kisinga Subcounty, Kasese District. We identified 45 contacts that were linked to 2 confirmed EVD cases, both in Uganda and DRC. The contacts were subsequently vaccinated and followed for 21 days. None of these contacts developed symptoms of EVD.

Co-Investigator:

Cholera Outbreak in Kyangwali Refugee Settlement, Hoima District. We identified 2,122 case-patients, including 44 deaths (CFR: 2.1%). Our investigation found that this outbreak was associated with drinking contaminated stream water and thus recommended provision of safe and adequate water to the refugee population.
Malaria Outbreak in Butambala District. This outbreak was propagated by the presence of static water collection containers in households which acted as breeding sites for anopheles mosquitoes.
EVD Preparedness Assessment and Risk Mapping in Bundibugyo and Ntoroko Districts. During this assessment we conducted focus group discussions and key informant interviews to map out population movements between Uganda and the DRC. This information was used to prioritise EVD preparedness and response interventions, for example, locating of screening points for crossborder movement.

Scientific communication

A Foodborne Cholera Outbreak in a School Caused by Eating Contaminated Fried Fish: Hoima Municipality, Uganda, February 2018. This was presented at the 14th Joint Annual Scientific Conference, 2018, the 4th National Field Epidemiology Conference, 2018 and 2nd International Conference for Emerging and Re-emerging Diseases, Addis-Ababa, Ethiopia 2018

Risk Factors for Unfavourable Treatment Outcomes among Tuberculosis and TB/HIV co-infected Patients in Rhino Camp Refugee Settlement, Arua District – Uganda, 2015-2017, presented at the 5th Uganda National Field Epidemiology Conference, 2019

Written communication

Bulletin articles

Editor of the Uganda National Institute of Public Health (UNIPH) Bulletin, Issue 1, Volume 4, January – March 2019.
Policy Brief: Carrying of Home-Based Vaccination Records to Health Facilities or all Children under 5 years to Reduce Missed Opportunities for Vaccination; published in the UNIPH Epi bulletin, Issue 1, Volume 4, January – March 2019
Lessons Learned from the First Oral Cholera Vaccination in Uganda, May – July 2018: published in the UNIPH Epi-bulletin, Issue 3, Volume 3 July – September 2018.

Newspaper articles

Cholera outbreak in Hoima District; what Uganda should do: Newspaper article published online by the New Vision on 11 April 2018.

Manuscripts

A Food-borne Cholera Outbreak in a School Associated with Eating of Contaminated Fried Fish, Hoima District: Uganda, February-March
2018: Manuscript submitted to a peer reviewed journal.
Risk Factors for Unfavourable Treatment Outcomes among Tuberculosis and TB/HIV co-infected Patients in Rhino Camp Refugee Settlement, Arua District – Uganda, 2015-2017: Manuscript submitted for review and publication.
Achievements and Lessons Learned from the First Oral Cholera Vaccination in Uganda, May-July 2018: Manuscript submitted for review and publication.

Quality Improvement Project

Conducted a 7 month quality improvement project on reducing of Missed Opportunities for Vaccination at Mayuge Health Center III, Mayuge District. This project involved working with VHTs and health workers to screen all children below 5 years and ensure that those missing any vaccines are vaccinated before leaving the health facility.

Epidemiological Study

Conducted a study on Risk Factors for Unfavourable Treatment Outcomes among Tuberculosis and TB/HIV co-infected Patients in Rhino Camp Refugee Settlement, Arua District – Uganda, 2015-2017. Our findings found that refugee populations had a slightly higher risk of unfavourable TB treatment outcomes in comparison to the host population.
Conducted a study on Timeliness to Responding to Alerts of Suspected Viral Haemorrhagic Fever (VHF) case-patients to establish the proportion of suspected VHF casepatients that met the case definition and the factors associated with delays in time to responding to alerts of suspected VHF cases. Our study found that most suspected VHF cases did meet the case definition and that districts that delay in responding to suspected VHF cases were minimal in districts with a history of VHF outbreaks

Leadership and management

Wrote and won a 50,000 USD grant from Ending Pandemics to implement the Outbreak Timeliness Metrics in Uganda. This project arose from an identified gap of lack of data on the previous outbreaks that have occurred in Uganda. This information, if available, would help to evaluate our previous outbreak responses and highlight areas of improvement as well as act as a basis for predicting future outbreaks in Uganda.
Since October 2018, I have led a team of experts working on developing a disease outbreak surveillance system, so as to inform the country‟s outbreak detection and response efforts.

Summary of Epidemiological Study:

Title: Outbreak Condom Use among Adolescent Girls and Young Women Engaged in High-Risk Sexual Behavior: Kampala District, Uganda, 2013-2018

Background: Despite a steady decline in HIV prevalence in Uganda, Adolescent Girls and Young Women (AGYW) remain at a higher risk of HIV infection, compared to their male counterparts. One of the key strategies for HIV prevention among AGYW is correct and consistent condom use. We
determined the prevalence of and factors associated with condom use among AGYW engaged in high-risk sexual behaviour in Kampala City, Uganda to inform condom programming by MoH.

Methods: In a cross-sectional study, data were collected among AGYW attending the Good Health for Women Project clinic, a site opened in Kampala specifically for women at high-risk of HIV infection. We collected socio-demographic, clinical, and behavioural characteristics data for AGYW. We defined condom use as having used a condom during the last sexual encounter. Modified Poisson regression was used to identify factors associated with condom use.

Results: Of the 1,697 AGYW, 373 (22%)were HIV-positive. The overall prevalence of condom use was 70%. Persons aged 20-24 years were more likely to use condoms compared to those 15-19 years [Prevalence Risk Ratio (PRR) = 1.17, 95% CI: 1.02-1.33]. AGYW engaged in sex work (PRR=1.42, 95%CI: 1.06-1.90) and those working in beauty parlours (PRR=1.85, 95%CI: 1.36-2.53) were more likely to use condoms compared to those who were unemployed. AGYW who had multiple sexual partners in the last month were more likely to use condoms compared to those who had one partner (PRR=1.95, 95%CI: 1.21-3.14).

Conclusion; Approximately one in three AGYW at high risk of HIV infection do not use condoms. We recommend health education on condom use and strategic provision of youth-friendly free condom access points in these communities.

Key Skills Lessons Learnt

Outbreak investigation and response
Public health surveillance and emergency response, at district and national level
Project design, implementation, monitoring, and evaluation
Scientific writing and communication: policy briefs, newspaper articles, bulletin articles and PowerPoint presentations
Leadership and management

Next Steps

This fellowship has been offered Dativa an opportunity to build all round skills in public health management. She looks forward to using her experience to work towards improving emergency response, at district, national and international level.