Dr Mutebi Ronald Reagan

MBChB(MUST), MPH(Mak), DPPM(UMI)
Email: mutebi2r@musph.ac.ug
Telephone: +256-782905272

Host Site: Division of Health Information Management, MOH (DHI)

Host Mentor: Mr Mbaka Paul and Mr Ogwal Jimmy

ABOUT THE FELLOW

Ronald R. Mutebi holds a Post Graduate Diploma in Project planning and Management from UMI, 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. Before joining the advanced program, Ronald completed the Medium term fellowship of both Quality Improvement and Leadership and Governance from Makerere School of Public Health and over time, he has gained experience in health systems leadership and Public Health practices.

During my time as a Public Health Fellow, I was attached to the Division of Health Information (DHI) at the Ministry of Health. While at DHI, I have been involved in providing technical support at both national and sub national levels in the areas of reporting, data management in context of district local government, weekly disease surveillance, revision of HMIS tools, setting up validation rules, making health facility inventory, and Service Availability and Readiness Assessment (SARA) data analysis and report writing.

My stay in DHI coincided with revision of HMIS tools where my experience as a District Health Officer provide a much needed insight on strength and weakness of the existing HMIS tools and which enabled informed decisions on the various much needed changes . I was involved in support supervision and mapping out oral health services where I moved to various regions in the country, identifying best practices, providing solutions to emerging challenges as well as recommendations to key stakeholders.
I supported national Measles-Rubella Immunisation role out as a national trainer and supervisor in Western region. In addition, I supported COVID 19 response in greater Masaka Region of Uganda in areas of surveillance and contact tracing, case management, risk communication, infection control prevention and district readiness assessment. I have been able to lead two outbreak investigations and participate in five 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.

  Achievements at the Host Site

During the fellowship, I was able to support my host site in the following areas:

• Analysis and writing of weekly surveillance reports (033b) that enable timely detection of epidemics such Measles, Rubella, Cholera.
• Revision of HMIS tools, particularly providing my previous experience with the tools in District local Government. I further participated in development and setting of validation rules
• Quarterly analysis of data for the department of communicable diseases
• Training and supervision for the role out of new HMIS tools countrywide
• Analysis of SARA survey data base and was later part of the report writing team
• Generation of national wide health facility inventory

Fellowship program specific achievements

• Conducted descriptive analysis of dental caries and treatment procedures for dental cares in Uganda, 2015-2019. The analysis showed the spatial and temporal trends of dental caries in Uganda between 2015-2019. I subsequently developed a policy brief titled “A ground breaking opportunity to increase restorative oral health services in Uganda‟s Public Health facilities” published in the UNIPH quarterly bulletin.
• I further published a newspaper article; “Prevent tooth decay by eating the right foods” – New Vision, 30th December, 2019.
• Principal Investigator of “large food poisoning outbreak due to Jimson weed in Uganda‟s Karamoja region, 2019. This led to immediate withdraw of the implicated food which was replaced with another type that the investigation had showed to be safer. We recommended that organizations may consider strengthening their quality control checks in order to avoid future outbreaks
• Conducted aCOVID-19 assessment in fishing and border communities, Kyotera District. We found that there was COVID-19 community transmission in Ugandan fishing communities bordering Tanzania and the infections among women may have been acquired from sexual interactions while the males may have acquired through social, or business interactions with foreign fish traders. We concluded that early community screening enabled isolation of cases in time, contributing to control of COVID-19. We recommended that early screening in high risk communities may be the best way to control the spread of COVID-19.

Field Investigations conducted:

• Food poisoning outbreak in Lamwo District Malaria outbreak investigation in Kyotera district
• Measles outbreak investigation in Nakasongola district
• Leprosy out break investigation in Lira
• Led a quality improvement project “Improving a records and achieve system in Masaka Regional Referral Hospital. The project was aimed at a establishing a records and archival system so as to contribute to improved availability of medical reports. We streamlined communication flow and therefore movement of reports among stakeholders and achieve
• Conducted national TB Data Quality assessment in 32 TB treatment Centres from Wakiso, Mukono, Mbale, Tororo, Gulu, Kitgum, Masaka, Lyantonde, Kabarole and Kasese districts. We concluded that although TB data in DHIS2 was incomplete for all the reporting periods, the accuracy of available data was within the acceptable variation. We recommended that a nation TB data update exercise in DHIS2 may be done to enable availability of all reports
• Supported national COVID 19 response including surveillance, risk communication, and infection control prevention and districts readiness assessment in greater Masaka region
• Editor on one issues of the Uganda National Institute

Conference presentations

• Oral presentation on Large food poisoning outbreak in Karamoja region, March 2019 National Field Epidemiology Conference, Kampala, 2020
• Oral presentation on COVID-19 assessment among fishing and border communities Kyotera District: June, 2020 at the National Field Epidemiology Conference, Kampala, 2019

Publications and manuscripts written

• Large Outbreak of Jimsonweed (Datura stramonium) Poisoning due to Consumption of Contaminated Humanitarian Relief Food: Uganda, March-April 2019- submitted to the International Journal of Toxicology
• Evaluation of SARS-CoV-2 Transmission and Cross-Border Transmission Risk Factors among Fishing Communities in Kyotera District, Uganda: May-June, 2020 – Under internal review
• Spatial and temporal trends of dental caries and treatment services in Uganda” –under internal review
• 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 201.; alaria outbreak investigation in Kyotera district

Summary of Epidemiological Study: 

 Title: Large Outbreak of Jimsonweed (Datura stramonium) Poisoning due to Consumption of Contaminated Humanitarian Relief Food: Uganda, March-April 2019

Background: Jimsonweed (Datura stramonium) contains toxic alkaloids that cause gastrointestinal and central nervous system symptoms when ingested. This can be lethal at high doses. The plant may grow together with leguminous crops, mixing with them during harvesting. Due to persistent famine in Uganda‟s Karamoja region, area residents receive humanitarian food relief. On 13 March 2019, more than 200 case-patients were admitted to multiple health centres for acute gastrointestinal and neurologic symptoms. We investigated to determine the cause and magnitude of the outbreak and recommend evidence-based control and prevention measures.

Methods: We defined a suspected case as sudden onset of confusion, dizziness, convulsions, hallucinations, diarrhoea, or vomiting with no other medically plausible explanations in a resident of Napak or Amudat District from 1 March – 30 April 2019. We reviewed medical records and canvassed all villages of the 8 affected sub-counties to identify cases. In a retrospective cohort study conducted in 17 villages that reported the earliest cases, we interviewed 211 residents about dietary history during 11-15 March. We used modified Poisson regression to assess suspected food exposures. Food samples underwent chemical (heavy metals, chemical contaminants, and toxins), proteomic, DNA, and microbiological testing in one national and three international laboratories.

Results: We identified 293 suspected cases; five (1.7%) died. Symptoms included confusion (62%), dizziness (38%), diarrhoea (22%), nausea/vomiting (18%), convulsions (12%), and hallucinations (8%). The outbreak started on 12 March, 2-12 hours after Batch X of fortified corn-soy blend (CSB+) was distributed. In the retrospective cohort study, 66% of 134 persons who ate CSB+, compared with 2.2% of 75 who did not, developed illness (RRadj=22, 95% CI=6.0-81). Samples of Batch X distributed 11-15 March contained 14 tropane alkaloids, including atropine (25-50ppm) and scopolamine (1-10ppm). Proteins of Solanaceae seeds and Jimsonweed DNA were identified. No other significant laboratory findings were observed.

Conclusion: This was the largest documented outbreak caused by contamination of food with tropane alkaloids. Implicated food was immediately recalled. Tropane alkaloids should be routinely tested during food safety and quality checks.
Keywords: Jimsonweed, Food poisoning, Outbreak, Humanitarian, Uganda

Key lessons learnt during the fellowship

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

I plan on publishing all the work done during the fellowship period in peer review journals Use my knowledge, experiences and skills obtained before and during the Public Health fellowship period to serve at National and Sub-national level.

Pictorial