Dr. Irene B. Kyamwine

MBChB (MUST), MSc (ULB), Field Epidemiology Fellow (UPHFP)
Email: ikyamwine@musph.ac.ug
Tel: +256 781711102

Host Site: Nutrition Division, Ministry of Health

Host Mentors: Ms Samalie Namukose

ABOUT THE FELLOW

Dr. Irene B. Kyamwine a Field epidemiologist with a background in Medicine. I hold a Master of Public Health from Université Libre de Bruxelles, school of public health. During my time as a public health fellow, I have been attached to the Nutrition Division, Ministry of Health. I have developed confidence in myself and learnt to work in a dynamic environment.

I have conceptualized, designed and implemented projects like the “Patterns of malnutrition among pregnant women in Apac District, Uganda”. These have built my confidence and competence in designing research protocols and implementing them.

I have led two outbreak investigations and participated in 4 others. I have also, been part of the COVID 19 response and control activities. These have developed my competences in responding to emergences and working in a fast-paced environment.

Throughout this two year period, I have led and coordinated projects both at the fellowship program and my host site. This has improved my leadership, training and coordination skills. Undertaking these activities and a number of data analysis projects improved my skills in data analysis using statistical and spatial packages like STATA, EPI Info and QGIS.

  Achievements at the Host Site

• The fellow coordinated and trained on International Classification of Diseases 11 (ICD 11) for National and regional teams across the country.
• Led the information, education and communication (IEC) and secretarial team in the commemoration of world breastfeeding week 2019.
• Coordinated and participated the Maternal and Child Health Nutrition Leadership.
• Led National COVID-19 training teams for National, Regional Referral, Prisons and other stakeholders across the country.
• Participated in revision of the Maternal Infant Young Child and Adolescent Nutrition (MIYCAN) and Micronutrient guidelines and prepared costed action plans for the same.
• Participated in the development of the President‟s Initiative on Healthy eating and Physical activity.
• Participated in Fitness and Nutrition project conception activities.
• Participated on the revision of the regulations for marketing of breastmilk substitutes.
• Participated in the nutrition e-health preparedness assessment for Karamoja region.
• Conducted district orientation of the District health teams, and District Task Force on COVID-19 in the Eastern region and Supported these districts to set up alert management and rapid response teams.
• Participated in Lira Region surveillance and contact tracing activities for COVID-19.

Fellowship program specific achievements

• The fellow conducted analysis on data from DHIS2 to assess the patterns of malnutrition among pregnant and lactating women in Uganda, 2015-2018.
• Team lead/Principal investigator in the investigation of a malaria outbreak investigation in Zombo District.
• Team lead/Principal Investigator in the investigation of Rubella Outbreak in Nakaseke District
• Participated in the following outbreaks: A Leprosy outbreak investigation in Lira district.; A Jimsonweed Poisoning outbreak due to consumption of contaminated humanitarian relief food.; Tuberculosis investigation in Nakapiripirit District.; Diagnostic discrepancy in Prisons
• Led a quality improvement project “Improving reporting for nutrition among pregnant women attending antenatal clinics in Teboke Health Centre III, Apac District.”
• Conducted an epidemiological study on “Prevalence and predictors of malnutrition among pregnant women attending antenatal clinics in Apac District”
• The fellow has also been an editor of the Uganda National Institute of Public Health (UNIPH) bulletin.
• Participated in the following studies: ; Epidemiological Analysis of the cholera situation in Uganda.; Yield of HIV testing in pregnancy and postnatal period.; COVID 19 feasibility and acceptability study of the Ministry of Health case report form
• Participated in screening for COVID 19 at Entebbe international airport.
• Participated in screening for Ebola during the Uganda Episcopal Conference of 2019 in Namugongo, Wakiso District.
• Attended a one week course on Public Health in Emergencies organized by World Health organization and TEPHINET.
• HIV study: “Breastfeeding patterns and mother-to-child transmission of HIV in Uganda, PMTCT Impact evaluation study 2017-2019.”

Summary of Epidemiological Study: 

 Title: Patterns of Malnutrition among Pregnant and Lactating Women in Uganda, 2015-2018: Analysis of Nutrition Surveillance Data.

Background: Maternal nutrition is closely linked to survival and development of children during the first 1000 days of life. The Uganda Nutrition Action Plan (UNAP), implemented from 2011 to 2016, was aimed at ensuring adequate nutrition for all with a focus on infants, young children, and mothers. However, in 2019, the rate and distribution of malnutrition specific to pregnant and lactating women was still unknown. We described annual trends and distribution of malnutrition among pregnant and lactating women (PLW), Uganda, 2015-2018, to inform programming on targeted malnutrition interventions.

Methods: We analyzed nutrition surveillance data from the District Health Information System (DHIS2) for all PLW from 2015 to 2018. We used WHO standard thresholds to determine the severity of malnutrition in the population and calculated prevalence of malnutrition among PLW by year and region, drawing choropleth maps to demonstrate the geographic distribution of malnutrition among PLW. We used logistic regression to assess trends of malnutrition.

Results: During 2015-2018, 268,636 PLW had acute malnutrition (prevalence=5.5%). Of the 15 regions of Uganda, Karamoja (prevalence=21%) and Lango (prevalence=17%) registered the highest prevalence while Toro (prevalence=2.7%) and Kigezi (prevalence=2.0%) registered the lowest prevalence. The national annual prevalence of malnutrition among PLW declined by 31% from 2015-2018 (OR=0.69, p<0.001). Regions in the north had increasing trends of malnutrition over the period [Lango (OR=1.6, p<0.001) and Acholi (OR=1.2, p<0.001)], as did regions in the east [(Bugisu (OR=3.4, p<0.001), Bukedi (OR=1.4, p<0.001), and Busoga (OR=1.3, p<0.001)]. The other 11 regions showed declines.

Conclusion: The trend of malnutrition among PLW nationally declined during the study period. Lango and Acholi regions, both of which were experiencing a state of emergency during this period, had both high and rising rates of malnutrition, as did the Karamoja region, which experienced the highest malnutrition rates. We recommended that Ministry of Health increases focus on nutrition monitoring for PLW and conduct an analysis to clearly identify the factors underlying malnutrition specific for PLW in these regions.

Key Skills Lessons Learnt

During the fellowship, I learnt and developed the following skill sets:

• Outbreak Investigation
• Scientific writing; Manuscripts, Abstracts

Policy Briefs and Newspaper article

• Critical thinking
• Editorial skills for scientific articles
• Data analysis skills
• Designing and implementing Quality Improvement Projects
• Evaluating a surveillance system
• Presentation skills
• Writing skills

Next Steps

After successfully completing the fellowship, I plan to continue my career in field epidemiology in the government or private sector to address public health disparities and influence policy. I plan on publishing all the work done during the fellowship period in peer review journals. In addition, I plan to continue my education by completing a doctoral degree in epidemiology.

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