Dr. John Kamulegeya

MBChB (M.U.S.T), MPH (Mak), Field Epidemiology Fellow (UPHFP)
Email: jkamulegeya@musph.ac.ug
Tel. +256 772006546

Host Site: Uganda Expanded Program on Immunization (UNEPI)

Host Mentors: Dr. Alfred Driwali and Dr. Immaculate Ampaire

ABOUT THE FELLOW

John Kamulegeya is a cohort 2019 advanced field epidemiology fellow and holds a Master of Public Health from Makerere University, School of Public Health and a Bachelor of Medicine and Bachelor of Surgery degree from Mbarara University of Science and Technology. I have over time gained special interest in vaccine preventable diseases (VPD). During my time as a Public Health Fellow, I have been attached to Uganda National Expanded Program on Immunisation (UNEPI) at the Ministry of Health.

At UNEPI, I have been involved in providing technical support at both national and sub national levels in the areas of; 1) routine Immunisation, 2) VPD disease surveillance, 3) outbreak investigations and response, 4) planning, implementation, monitoring and evaluation of yellow fever sub national immunisation days (SIA) and Measles-Rubella / Polio national mass campaigns. I was involved in developing of national operational field guidelines for 2020 Yellow Fever and 2019 Measles-Rubella and polio Vaccination Campaigns and supported national investigations and analysis of Adverse Events Following Immunisation (AEFIs) in both campaigns.

I supported national wide 2019/2020 districts analysis of routine immunisation performance data using RED categorisation and writing of UNEPI Newspaper pull out which was published as a New Vision September 2019. I have been coopted as a member of the National AEFI committee, UNEPI data and surveillance subcommittee and the COVID-19 Vaccination National Coordination Committee. My attachment and exposure at UNEPI has greatly improved my public Health professional capacity in the area of vaccine preventable diseases.

In addition, I supported national COVID 19 response in 17 districts in Ankole and Eastern regions of Uganda to effectively carry out COVID 19 surveillance and contact tracing, case management, risk communication, infection control prevention and districts readiness assessment. I have been able to lead two outbreak investigations and participate in four other outbreak investigations and response.

The fellowship has greatly improved my practical skills in scientific writing, presentation, outbreak investigation and response, estimation of burden of disease and data analysis using packages such as STATA, EPI Info and QGIS. I have also under taken short course in International Program in Public Health Leadership-IPPHL to improve my managerial and leadership skills.

  Achievements at the Host Site

• Supported writing and editing of UNEPI New paper pull out on Measles-Rubella vaccine roll out plan and districts immunisation performance for FY 2018/2019
• Supported/ Lead nationwide epidemiological investigations and analysis of Adverse Events Following Immunisation (AEFIs) in the October 2019 Measles-Rubella(M-R) and Polio national mass campaign during which ministry of health introduced M-R vaccine into Uganda routine immunisation schedule
• Lead Measles outbreak investigations in Nakasongola district
• Supported bnational and districts planning, trainings, implementation and monitoring of Sub national yellow fever immunisation campaign in west Nile- August 2020 and Measles-Rubella/Polio national campaign in October 2019
• Supported development of national operational field guidelines for Yellow Fever and Measles-Rubella and polio Vaccination Campaigns
• Supported national trainings for district officers on routine immunisation, surveillance and outbreak investigations and response
• Participated in districts EPI technical support supervision
• Supported national level training and GAVI grants proposals
• Supported national training of trainers for districts Rapid Response Teams (RRT)
• Supported districts of Nakasongola, Nakaseke, Moyo and Obongi to analyse and use their immunisation data using RED categorisation.
• Member/supported EPI data and surveillance technical sub committee
• Member /supported national Adverse Events Following Immunisation committee
• Participated in weekly UNEPI meetings
• Participated in COVID-19 Vaccines National Coordination Committee planning meetings

Fellowship program specific achievements

• Editor on one issues of the Uganda National Institute of Public Health (UNIPH) bulletin.
• Conducted descriptive analysis of Regional distribution and trends Rubella Cases in Uganda, 2007-2017 using data from DHIS2
• Team lead/Principal Investigator of Cholera Outbreak in Congested Kyaka II Refugee Settlement, Kyegegwa District: Uganda, July 2019
• Team lead/Principal Investigator, Adverse events following Measles-Rubella and polio mass immunization campaign, December 2019
• Participated in the following outbreaks: Rubella outbreak investigation in Semuto Sub county, Nakaseke district.; Malaria outbreak investigation in Kole district.; Measles outbreak investigation in Nakasongola district.; Leprosy out break investigation in Lira
• Participated in study “Using the BABIES Matrix to Determine Patterns of Pregnancy Birth Outcomes in Naguru Regional Referral Hospital, Kampala, Uganda, Nov 2018-March 2019”
• Lead a quality improvement project “Improving knowledge and Reporting of Adverse Events Following Immunisation (AEFI) by Health Care Workers in Nakasongola District ”
• Conducted HIV study on “Uptake of Voluntary male medical circumcision in Uganda, 2014-2018” using DHIS2 data
• Supported national COVID 19 response including surveillance, risk communication, and infection control prevention and districts readiness assessment in western (11 districts) and Eastern regions (5 districts) of Uganda.
• Facilitated in post EIS conference training of BABIES Matrix story Board methodology at Emory University, Atlanta. Trainees included Masters of global health students at Notre Dame University and FELTP graduates from Uganda, Nigeria and Kenya.
• Facilitated training on use of a B.A.B.I.E.S matrix (Birth weight by Age-at-Death Boxes for Intervention and Evaluation System), a Maternal and perinatal death audit mechanism that links pregnancy outcome with intervention process to participants from 11 African countries at Suez canal University, Egypt
• Supported writing of grant proposal for AFENET/Global Collaborating Center in Reproductive Health to operationize BABIES matrix in Africa
• Participated in a Vaccine hesitance grant proposal
• Wrote a policy brief on Uptake of Human Papilloma Vaccination (HPV) in Uganda: Barriers and Opportunities
• Attended a 2 weeks training on International Public health leadership and policy analysis conducted by Evans School of Public Policy at University of Washington ,Seattle, USA in June

Conference presentations

• Poster presentation on Cholera Outbreak Investigation in Congested Kyaka II Refugee Settlement, Kyegegwa District at the
• Oral presentation on Adverse events following Measles-Rubella and polio mass immunisation campaign, December 2019 at the National Field Epidemiology Conference, Kampala, 2020
• Oral presentation on Cholera Outbreak Investigation in Congested Kyaka II Refugee Settlement, Kyegegwa District: Uganda, July 2019 at the National Field Epidemiology Conference, Kampala, 2019

Publications and manuscripts

• written Cholera Outbreak in Congested Kyaka II Refugee Settlement, Kyegegwa District: Uganda, July 2019: Epibulletin article published in the National Institute of Public Health quarterly bulletin
• Uptake of Human Papilloma Vaccination (HPV) in Uganda: Barriers and Opportunities,: Epibulletin article in the National Institute of Public Health quarterly bulletin
• Co-authored four articles in the Uganda National Institute of Public Health (UNIPH) bulletin: On-going transmission of Leprosy and inadequate control measures in Lira and Alebtong Districts, Uganda Issue2 vol4 April- june 2019.; Malaria outbreak investigation in Kole district.; Using the BABIES Matrix to Determine Patterns of Pregnancy Birth Outcomes in Naguru Regional Referral Hospital, Kampala, Uganda, Nov 2018-March 2019
• Cholera Outbreak in Congested Kyaka II Refugee Settlement, Kyegegwa District: Uganda, July 2019: Under internal review
• Adverse events following Measles-Rubella and polio mass immunisation campaign, December 2019 : Under internal review
  Published Newspapers articles
• Congenital Rubella Syndrome (CRS) – The silent cause of Congenital Heart defects and child delayed development.
• Health workers at increased Occupational risk for COVID 19

Summary of Epidemiological Study: 

 Title: Uptake of Voluntary Medical Male Circumcision in Uganda, 2014-2018

Background: Medical male circumcision (MMC) has been shown to reduce female-to-male sexual transmission of HIV by approximately 60%. It is recommended as a key component of combination HIV prevention in countries with a high HIV prevalence and low levels of male circumcision. In 2010, Uganda ministry of health adopted VMMC as part of the national comprehensive HIV prevention strategy. This study aimed to describe the national uptake of VMMC from 2014 to 2018 so as to make evidence based recommendations to improve its implementation in Uganda.

Methods: We conducted a retrospective descriptive analysis of VMMC data from the DHIS2 for the period 2014-2018. We described trends and analyzed VMMCs performance by circumcision method, client age group, pre-circumcision HIV testing and counseling (HTC), postoperative reviews, and postoperative adverse events (AEs).

Results: A total of 2,160,335 males (41%) of the targeted 5,000,000 circumcisions were done in the period 2014-2018. Majority of VMMCs were done by surgical circumcision (99.5%) while only 0.5% were by device method. Central region had the highest circumcision rate of 20/1000 males followed by Northern (18/1000) western (16/1000), and Eastern regions (12/1000) respectively. There was a general steady increase in number of VMMC done from 4,984in 2014 to a maximum of 826,761 in 2017 with a slight decline to 602,577 in 2018. The overall post-operative adverse events (AE) rate was 6.7/1000 circumcisions. There was a general decline in AE following circumcision from 18.6 in 2015 to 4.9/1000 circumcisions in 2018. Overall HIV positivity rate among persons tested before circumcision was 0.8%, highest in 2014 (3.2%) and lowest in 218 (0.4%).

Conclusion: Despite a steady increase in number of person circumcised, the numbers were below the target. Central region had the highest circumcision rates followed by western, Northern and Eastern regions respectively. There is need to Enhance VMMC efforts in the country with special focus on East and Northern regions of Uganda.

Key Skills Lessons Learnt

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

• Outbreak Investigation and respose
• Scientific writing; Manuscripts, Abstracts, Policy Briefs and Newspaper article
• Data analysis skills
• Designing and implementing Quality Improvement Projects
• Evaluating a surveillance system
• Presentation skills
• Writing skills
• Networking and leadership skills

Next Steps

Leveraging on my knowledge, experiences and skills obtained before and during the Public Health fellowship period, I hope to further my career in the field of Epidemiology through service at both National and international levels. I plan on publishing all the work done during the fellowship period in peer review journals

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