Nabatanzi Sandra

MSc CEB

Public Health Emergency Operations Center, Ministry of Health
Telephone: +256 776955322
Email: sandranabatanzi@musph.ac.ug / sandranabatanzi@gmail.com

Host Site: Public Health Emergency Operations Center- Ministry of Health (PHEOC)

Host Mentor: Dr. Issa Makumbi

ABOUT THE FELLOW

Sandra Nabatanzi is holds a Master of Science in Clinical Epidemiology and Biostatistics degree from Makerere University, School of Medicine. Sandra joined the Uganda Public Health Fellowship Programme in January 2019 and was hosted at the Public Health Emergency Operations Center (PHEOC), Ministry of Health for two years. Sandra was part of the PHEOC team that enhanced overall capacities to manage and respond to public health emergencies; strengthen surveillance through improved surveillance structures for early detection, response and recovery of epidemics. While at the PHEOC, Sandra coordinated simulation/ functional exercises; led outbreak assessments and evaluations; coordinated capacity building initiatives at national and district level on enhanced surveillance, incident management, rapid response among others; participated in development of National guidelines, standard operating procedures and emergency response plans; as a National rapid responder, she has led outbreak investigations for various infectious diseases as well as preparing outbreak response information products including situation reports and national outbreak analytical reports. During my stay at the PHEOC, I mentored five interns in response and management of public health emergencies using the incident management system.

  Fellow’s Achievements

Outbreak management and response;

• Sandra was a team member of the national rapid response team hence conducted outbreak investigations, contact tracing and alert management and verification roles. She led an outbreak investigation on suspected food poisoning in Palabek refugee settlement, Lamwo district which was later confirmed to have been caused by consuming relief food that was contaminated with Atropine from Jimson weed. Immediate public health actions by the Ministry of Health and partners were mounted including confiscation of the implicated food. This drastically controlled the outbreak as there were no further cases reported. This investigation highlighted the urgent need for stringent controls on relief food inspections.
• She also took lead in the COVID-19 health facility operational readiness assessment in the urban setting of Kampala and Wakiso Districts, Uganda in April 2020. Gaps in COVID-19 operational readiness in health facilities for patient management, logistics and surveillance in both Kampala and Wakiso were identified. The Ministry of Health undertook the following public health actions following the assessment; 1) provision of COVID-19 guidelines to health facilities; 2) continuous health worker orientations on surveillance, laboratory, case management, infection prevention and control and logistics; 3) provision of personal protective equipment to health facilities and provision of vehicles to districts. The assessment highlighted the need for continuous orientation of health workers and availability of critical supplies to manage COVID-19 as key in order to achieve reasonable readiness scores in health facilities.
• She also participated in 2 additional outbreak investigations;
  • Leprosy in Lira District, 2019
  • Ebola Virus Disease outbreak in Kasese district, June 2020

Surveillance system analysis and evaluation

• Conducted an analysis on epidemiological characteristics and trend of suspected measles in Uganda, 2011 – 2018 using routine surveillance data. This analysis identified greater Kampala as the most affected region. An overall increase of suspected measles was observed between 2011 and 2018; a decline in suspected measles cases was noted following mass immunization. Recommendations on regularizing mass measles-rubella vaccination in addition to routine schedules were made.

Surveillance activities

• Ebola screening and heightened surveillance at the symposium of episcopal conferences of Africa and Madagascar that was held at the Namugongo Catholic Shrine in 2019.
• COVID-19 screening at Namirembe Cathedral during the enthronement of the 9th Arch Bishop of the Church of Uganda, March 2020
• COVID-19 screening at Entebbe International Airport, April 2020
• Facilitated the African Regional Public Health Emergency Operations Center functional exercise in 2019. This intense exercise tested the functionality of the PHEOC‟s capacity to respond to emergencies.
• She was also the principal investigator on a study to determine factors associated with early sexual debut in Uganda, 2017. The factors associated with early exposure to sexual initiation include; low wealth index; peer pressure from friends; absence of parents; history of physical violence; being female and low education level.

Communication, presentations, publications and awards

• Sandra was an editor of the Uganda National Institute of Public Health (UNIPH) bulletin. The UNIPH bulletin provides health professionals and public health experts an authoritative, timely, and influential source of information and recommendations for actions to minimize public health threats.

Published Bulletin articles

• Epidemiological Characteristics and Trend of Suspected Measles, Uganda, 2011 – 2018 in the UNIPH bulletin
• Lessons learnt from the completed National Measles, Rubella and Polio Mass campaign, 16th – 20th October 2019 in the UNIPH bulletin
• Sustained vigilance, preparedness and response to all public health emergencies amidst COVID-19 Pandemic in the UNIPH bulletin
• Is Uganda ready for its next outbreak: Getting ahead of the next pandemic
• Automating early warning system for timely detection of outbreaks in Uganda. The solution to rapid response and containment of public health emergencies is early detection in the UNIPH bulletin
• COVID-19 Health Facility Operational Readiness Assessment in the urban
  setting of Kampala and Wakiso district, April 2020” in the Kampala City Council Authority (KCCA) bulletin.

Published Newspaper article

• Wash your hands to reduce the spread of infections” which was published in the New Vision on 15th September 2019.
  Awards achieved Runner up for the Heroes in Health Awards, 2020 under the category Ebola prevention and control.

Conference presentations:

• Epidemiological Characteristics and Trend of Suspected Measles, Uganda, 2011 – 2018 at the National Field Epidemiology Conference, Kampala, 2019
• COVID-19 Health Facility Operational Readiness Assessment in the Urban Setting of Kampala and Wakiso Districts, Uganda April 2020 at the National Field Epidemiology Conference, Kampala, 2020
• Preparedness efforts in Uganda and control of imported Ebola Virus Disesase, June 2019 at the Epidemic Intelligence Service (EIS) conference in Atlanta

Manuscripts

• Epidemiological Characteristics and Trend of Suspected Measles, Uganda, 2011 – 2018
• COVID-19 Health Facility Operational Readiness Assessment in the Urban Setting of Kampala and Wakiso Districts, Uganda April 2020
• Food Poisoning Outbreak Caused by Consumption of Contaminated Food with Jimson Weed Lamwo District, Uganda
• Preparedness efforts in Uganda and control of imported Ebola Virus Disease, June 2019

Summary of Epidemiological Study: 

 Title: COVID-19 Health Facility Operational Readiness Assessment in the Urban Setting of Kampala and Wakiso Districts, Uganda, April 2020

Background: Health facilities play a critical role in surveillance for and management of COVID-19 cases. On 21 March 2020, the Ministry of Health activated its coordination structures to respond to the pandemic. On 28 April 2020, we assessed health facility operational readiness for COVID-19 at 59 heath facilities [government, private not-for-profit (PNFP), and private for-profit (PFP) hospitals, and Health Centers (HC) II, III, and IV] in the capital district of Kampala and neighboring Wakiso.

Methods: The World Health Organization COVID-19 readiness assessment tool was adapted for Uganda to assess health facilities. Health facilities were assigned readiness scores based on capacity to address COVID-19 needs in 1) surveillance and laboratory, 2) case management and Infection Prevention and Control (IPC), and 3) logistics. Readiness scores were derived using principal component analysis (PCA) and reported as quintiles.

Results: Overall, 14 (24%) health facilities were in the top readiness quintile for case management and IPC, 13 (22%) for logistics and 12 (21%) for surveillance and laboratory. PFP had the most facilities (7/29; 25%) in the top combined readiness quintile; government (2/13; 17%) and PNFP (2/17; 13%) had the fewest. Five (25%) HCII facilities, three (20%) hospitals, three (17%) HCIII, and no HCIV were in the top combined readiness quintile. Kampala district had 14% of the facilities in the top combined readiness quintile compared to Wakiso (33%); Kampala also had more facilities in the bottom quintile (29%) compared with Wakiso (0%). Kampala consistently had the most facilities in the bottom quintile across surveillance and laboratory (26%), case management and IPC (26%), and logistics (27%).

Conclusion: Few health facilities in Kampala and Wakiso districts were operationally ready for COVID-19 across any of the metrics evaluated; however, Kampala was consistently less prepared than Wakiso. As a result of our evaluation the Ministry of Health provided COVID-19 guidelines to health facilities, trained health workers in case identification, surveillance, laboratory, patient management, and IPC, and provided personal protective equipment and ambulances to transport confirmed cases to isolation units. Assessment of readiness elsewhere may allow other districts to also identify critical gaps in preparedness.

Key words:
COVID-19, Uganda, Health Facility, readiness, assessment, surveillance, laboratory, case management, infection prevention and control, Uganda COVID-19 heath facility operational readiness feedback meeting with the district health officer and surveillance focal person, Wakiso District, April 2020

Key lessons learnt during the fellowship

• Scientific writing
• Data management and analysis skills
• Presentation skills
• Outbreak investigation skills
• Cost analysis studies
• Evaluating surveillance systems
• Implementing quality improvement projects
• Critical thinking and organizational skills
• Leadership skills
• Networking skills with colleagues and experts in similar field

Next Steps

Ground myself in field epidemiology through service in International organizations and universities among others. Additionally, to publish the work done during the training in peer reviewed journals.

Pictorial