Godfrey Nsereko

BPharm (MUK), MPH (UMU), PgD-PPM (UMI), Field Epidemiology
Fellow (UPHFP)
Tel: +256-776-011-475 / +256-701-111-475
Email: nserekomps@musph.ac.ug, nsereko.godfrey@gmail.com

Host Site: National Malaria Control Program (NMCP), Ministry of Health

Host Mentors: Dr. Jimmy Opigo, Program Manager, NMCP, Dr. Daniel Kyabayinze, Deputy Program Manager, NMCP and Dr. Damian Rutazaana, Malaria Epidemiologist, NMCP

ABOUT THE FELLOW

Godfrey Nsereko is a Pharmacist and Public Health and Management specialist. He holds a Bachelor of Pharmacy from Makerere University, a Master of Public Health from Uganda Martyrs University and a Post-graduate Diploma in Project Planning and Management from Uganda Management Institute. Godfrey has 10 years demonstrable experience in public health management and leadership. He has interest in both infectious disease and noncommunicable disease epidemiology. Prior to joining the fellowship program in January 2018, Godfrey worked with a USAID funded social and commercial marketing organization, Uganda Health Marketing Group, as the Chief Pharmacist and Technical Support Manager. He also worked as a national coordinator for a UHMG-PATH Sayana Press Pilot Introduction and Evaluation Project under the same organization, and also as a Regional Pharmacy Manager in West Nile region. During the fellowship program, Godfrey was assigned to the National Malaria Control Program, Ministry of Health, under the Departments of Surveillance, Monitoring and Evaluation, and Operational research (SME-OR) and Epidemic Preparedness and Response (EPR)

  Achievements at the Host Site

While at NMCP, Godfrey achieved the following:

• Contributed to Policy development through dissemination of a policy brief on cost-effective ways to prevent malaria transmission in endemic Uganda
• Led investigation and response to malaria outbreaks in 2018-2019. As a result of the investigations, some affected local communities were mobilized to use simple cost-effective methods (such as repurposing old mosquito nets as curtains, closing doors early and wearing long sleeve clothing to minimize vector contact) to fight malaria in the communities
• Part of the core team that established a novel Technical Working Group, for Epidemic Preparedness and Response, to steer early detection and prompt response to malaria outbreaks and epidemics in Uganda. As part of this team, I championed review of malaria epidemic preparedness and response guidelines
• Participated in Malaria Program Review(MPR) and subsequent strategic planning in preparation for new strategic direction towards malaria elimination in Uganda.
• Participated in drafting and review of the M&E operations plan for the LLIN Universal Coverage Campaign 2020
• Conducted weekly malaria morbidity and mortality surveillance. Using centrally aggregated data in the DHIS2, we conducted routine analysis and disseminated key highlights to national and sub-national levels to inform further decision making and action Developed and updated malaria program specific systems for collection, analysis, detection and response to malaria upsurges and epidemics. This was under direct stewardship of the malaria epidemiologist of NMCP
• Conducted descriptive analysis of hospitalizations due to malaria in pregnancy in Uganda between 2012 and 2017. We conducted this study to examine the burden of malaria hospitalizations among pregnant women. We anticipate that results of this study will lead to enhancing core interventions for malaria in pregnancy.
• Lead editor of 3 quarterly malaria bulletins that are widely disseminated to malaria stakeholders. The bulletin highlight: key morbidity, mortality and interventional indicators at national and district level; recent advances in prevention, control and treatment of malaria; programmatic intervention updates; and plans for the future
• Participated in capacity building plans for regional and district based systems strengthening for malaria control. This was especially in the area of malaria surveillance and coordination.
• Participated in launch of Parliamentary Forum on Malaria and Mass Action aganst Malaria in April 2018 by H.E The President of Uganda
• Participated in delivering 2 World Malaria day celebrations in Mpigi (2018) and Alebtong (2019) District.
• Made international presentation on Malaria outbreak investigations and response in the 68th EIS conference, Atlanta, GA
• Presented the Malaria Epidemic Situation to High Level Visit delegation to Uganda in September 2019
• Conducted a quality improvement study on improving adherence to Malaria Test, Treat and Track policy among health workers in Kassanda HCIV, Kassanda District.
• Conducted a planned study on Predictors of Malaria in Pregnancy deaths in 3 West Nile Districts in 2018.

Fellowship program specific achievements

Emergency Response
Lead Investigator:

• Malaria Outbreak Facilitated by Heavy Rains and Inappropriate Preventative Measures in Nwoya District, Northern Uganda March – May 2018
• Malaria Outbreak Facilitated by increased breeding sites in Gomba District, Central Uganda March – February
• Participated in an Ebola Virus Disease outbreak in Kasese District, June 2019
• Conducted an HIV rapid assessment titled “Investigation of increased Intimate Partner Violence (IPV) following Assisted Partner Notification (APN) at HIV clinics in Uganda, 2018”

Co-investigator:

• Cholera in Kyangwali Refugee Settlement, Hoima District, February 2018
• Cholera in a School in Hoima Municipality, Hoima District, February 2018
• Intussusception among children under 5 in Kampala and Wakiso Districts, March 2018
• Extra Pulmonary TB in Karamoja region, June 2018
• Malaria Deaths in Kabarole Region, July 2018
• Ebola Virus Disease Preparedness in 5 high risk districts in western Uganda, August 2018

Scientific communication

• Published 1 Abstract Published online (World Academy of Science, Engineering and Technology International Journal of Medical and Health SciencesVol:13, No:2, 2019)
• Published in the local newspaper an article titled “Oral Cholera vaccine needed for most vulnerable populations in Uganda”: Published in Uganda‟s New Vision in April 2018
• Published Letter of the Day: “Need for cholera vaccination of most at risk populations: Published in Uganda’s Daily monitor newspaper”.
• Published two articles in the Uganda National Epidemiological Bulletin
• Made 3 oral presentations at National conferences
• Made 2 poster presentations at international conferences (68th EIS FETP Intl Nights 2019, Atlanta, GA, USA and ICREID 2019, Addis Ababa, Ethiopia)

Policy Brief

• Developed and disseminated a policy brief titled “Develop Mass Behavioral Change Communication Messages on Cost-Effective Malaria Prevention Methods”. The implementation of this policy will mean that even the least privileged of communities in Uganda can utilize available resources and knowledge to control malaria transmission at household level.

Public Health Surveillance

• Conducted a descriptive analysis of public health surveillance data titled “Malaria in Pregnancy Hospitalization in Uganda 2012-2017”. We analyzed trends of admissions of pregnant women with malaria. We observed an increasing trend in malaria in pregnancy hospitalizations despite malaria decreasing in the rest of the population. We recommended strengthening interventions in most affected parts of the country.
• Conducted a quality improvement project titled “Improving Adherence to Malaria Test and Treat Policy in Kassanda HCIV, Kassanda District, April- November 2019”. Following an observed decline in adherence to malaria test, treat and track policy in the health facility, we initiated a proposal to implement this quality improvement project with the staff of the facility. We registered marked improvement in testing before treating patients and cessation of treating RDT and microscopy negative patients with antimalarial drugs.

Public Health Leadership Achievements

As part of public health leadership development domain of the fellowship program, Godfrey achieved the following:

• National Trainer on Ebola Preparedness and Response, Contact Tracing and Surveillance
• Regional supervisor of malaria surveillance and coordination activities in the NMCP
• Provided technical assistance in data collection tool development using ODK and Kobo Collect platforms
• Co-led grant writing and project planning for 2 currently awarded grants under PHFP (The Malaria Test, Treat and Track of the Global Fund and Ending Pandemics projects)
• Showcased PHFP role to US/CDC/MoH delegation during EVD preparedness efforts in Bundibugyo district Sept 2018
• National Stop Transmission of Polio (NSTOP) Officer
• Awarded an opportunity to participate in AFENET Grant writing workshop in Abuja, Nigeria September 2018
• National trainer of the 3rd edition of Integrated Disease Surveillance and Response

Summary of Epidemiological Study: 

 Title: Malaria Outbreak Facilitated by Appearance of Vector-Breeding Sites after Heavy Rainfall and Inadequate Preventive Measures: Nwoya District, Northern Uganda, February–May 2018

Background:  Malaria is a leading cause of morbidity and mortality in Uganda. In April 2018, malaria cases surged in Nwoya District, Northern Uganda, exceeding the action thresholds. We investigated this outbreak to estimate the magnitude, identify exposure factors for transmission, and recommend evidence-based control measures.

Methods: We defined a malaria case as onset of fever in a resident of Anaka and Koch Goma sub-counties, and Nwoya Town Council, Nwoya District with a positive Rapid Diagnostic Test or microscopy for malaria from 1 February to 25 May 2018. We reviewed medical records in all health facilities of affected sub-counties to find cases. In a case-control study, we compared exposure factors between case-persons and asymptomatic controls matched by age and village. We conducted entomological assessments on vector-density and behavior.

Results: We identified 3,879 case-persons(attack rate [AR] =6.5%) and two deaths (case-fatality rate=5.2/10,000). Females (AR=8.1%) were more affected than males (AR=4.7%) (p <0.0001). Of all age-groups, the 5-18 year age-group (AR=8.4%) was most affected. Heavy rain started in early March 2018 and a propagated outbreak followed in the first week of April 2018. In the case-control study, 55% (59/107) of case-persons and 18% (19/107) of controls had stagnant water around households for several days following rainfall (ORM-H=5.6, 95%CI=3.0-11); 25% (27/107) of casepersons and 51% (55/107) of controls wore full extremity covering clothes during evening hours (ORM-H=0.30, 95%CI=0.20-0.60); 71% (76/107) of case-persons and 85% (91/107) of controls slept under a long lasting insecticide-treated net (LLIN) 14 days before symptom onset (ORM-H=0.43, 95%CI=0.22-0.85); 37% (40/107) of case persons and 52% (56/107) of controls used at least one LLIN per 2 household members (ORM-H=0.54, 95%CI=0.30-0.97). Entomological assessment indicated active breeding sites; Anopheles gambiae sensulato species were the predominant vector.

Conclusion: Increased vector breeding sites after heavy rainfall, and inadequate malaria preventive measures caused this outbreak. We recommended increasing coverage for LLINs and larviciding breeding sites in the area.

Key lessons learnt during the fellowship

• Integrated Disease Surveillance and Response
• International Health Regulations 2005
• Data analysis and use for decision making
• Public Health Alert verification and making spot reports
• Making epidemiological reports and technical presentations
• Mentoring and training health workers
• Disease outbreak investigations and response
• Contingency planning for public health emergencies
• Publication and dissemination of work among peers and stakeholders
• Ability to write grants for funding
• Identification and highlighting of funding gaps to attract funding
• Stakeholder/Partner engagement for resource mobilization purposes
• Better understanding of donor/funder requirements prior and during project funding
• Project monitoring, evaluation and reporting

Pictorial