Elizabeth B. Katana

Advanced Field Epidemiology (UPHFP), MSc CEB
(Mak), BSMR (Mak)
Email:ekatana@musph.ac.ug
Telephone: +256780384997

Host Site: Kampala Capital City Authority,Directorate of Public Health and Environment (City Hall, Kampala)

Host Mentor: Dr. Daniel Ayen Okello

ABOUT THE FELLOW

I hold a Master of Science in Clinical Epidemiology and Biostatistics from the Clinical Epidemiology Unit, School of Medicine, College of Health Sciences at Makerere University. During the two years of this fellowship, I have learned and built skills in field epidemiology and community engagement in both rural and urban settings. I have appreciated the role of several statistical methods and research design approaches in field epidemiology, public health, and clinical practice. Some of these approaches included mapping, sampling, project management, policy reviews and development, study designs, research methods, data collection techniques, data management, scientific writing, and reporting. I prepared articles for publication and dissemination in the Ministry of Health quarterly epidemiological bulletin, technical reports, and manuscripts. I have gained experience in organizing meetings and trainings, conducting epidemiological investigations and quality improvement projects, and enriched my skills and expertise in abstraction, collection, cleaning, analyzing and triangulating survey data. Before joining the fellowship, I participated in field epidemiological investigations and support supervision for antimicrobial resistance (AMR) surveillance at regional referral hospitals in Eastern Uganda with the Infectious Diseases Institute-Global Health Security Programme (IDI-GHSP). I also participated in Tuberculosis surveillance including community and hospital investigations for Drug-Resistant Tuberculosis in the Karamoja region and monitoring and evaluation of iCCM activities and reporting functions of Village Health Teams in Nakapiripirit district while working with Doctor’s with Africa (CUAMM).

  Achievements at the Host Site

• KCCA is a semi-autonomous governing body of Kampala Capital City on behalf of the central government. The Directorate of Public Health and Environment at KCCA has the mandate to facilitate and provide support to ensuring healthy and productive citizens, and a clean, habitable and sustainable community for Kampala. One of its five core functions is to plan, conduct research, develop and monitor the implementation of strategies on epidemiology and disease control including emergency management, vaccination/immunization, testing treatment, and health impact assessment surveys.
• Following the inception of the COVID-19 pandemic in March 2020, I participated in the establishment of an Emergency Operations Center (EOC) for COVID-19 response and surveillance at the KCCA Directorate of Public Health and Environment.
• As part of the EOC team, I actively participated in the establishment of an emergency toll-free call center at KCCA that aimed at enhancing the COVID-19 response and ensuring continuity of access to essential health and social services in Greater Kampala during the COVID-19 response and lockdown, March to June 2020.
• During this time, as part of the EOC and call centre team, I actively participated in a project on the use of photovoice and community survey for rapid assessment of compliance to COVID-19 prevention measures in Kampala Metropolitan during the early phase of easing the lockdown restrictions in April 2020
• Basing on the findings from the project on compliance to COVID-19 prevention measures, I participated in the development of protocols for the phased COVID-19 lockdown lifting in Kampala
• To ensure compliance to the COVID-19 prevention measures and adherence to the developed lockdown lifting protocols, I participated in a project on the use of the human-centered design (HCD) approach to increase uptake of COVID-19 preventive measures and develop community-led surveillance among dwellers of informal settlements in Kampala Metropolitan
• To strengthen community surveillance for COVID-19, I investigated the risk factors for COVID-19 illness among community surveillance teams in Kampala Metropolitan
• To control the risk factors for COVID-19 illness among the community surveillance teams, I monitored their use and availability of COVID-19 Personal Protective Equipment (PPE) in the five divisions of Kampala
• I participated in COVID-19 Infection Prevention and Control (IPC) measures surveillance and development of IPC protocols for health facilities in Kampala in collaboration with the Infectious Disease Institute Kampala
• Following the increased community transmission and confirmation of multiple clusters of COVID-19 cases in Kampala Metropolitan in August 2020, I investigated clusters of COVID-19 at formal workplaces in Kampala (large offices including banks, motor vehicle dealerships and media houses)
• Investigated clusters of COVID-19 at informal workplaces in Kampala (factories, construction sites, markets, arcades and taxi parks)
• Following investigation of these clusters, I participated in strengthening and monitoring COVID-19 surveillance at Kampala arcades and taxi parks

Fellowship program specific achievements

• Lead Investigator on the following outbreak investigations:
• COVID-19 clusters at Kampala private hospitals, August to September 2020
• COVID-19 workplace clusters at formal and informal workplaces in Kampala, July to September 2020
• Co-Investigator on the following outbreak investigations:
• Measles in Nakivaale refugee settlement in Isingiro district in February 2020
• An outbreak of COVID-19 at a clothing and textiles factory in Buikwe district, September 2020
• COVID-19 case investigations (community and health facilities) in Kampala, Kayunga, Mukono, Wakiso and Mukono districts, August to September 2020
• COVID-19 death investigations in Kampala Metropolitan, February 2021
• Participated in the COVID-19 Health Facility Operational Readiness Assessment in the Urban Setting of Kampala and Wakiso Districts, Uganda, April 2020
• To inform COVID-19 Health Facility Operational Readiness, I participated in a project on estimating the cost of managing COVID-19 patients in Uganda from March to June 2020
• Participated in the ICP-COVID (International citizen project) initiated by researchers at the University of Antwerp and MakSPH to conduct surveys on adherence to the public health measures and their impact on the COVID-19 outbreak in April 2020
• Policy brief on compulsory screening of measles vaccination status among under-fives to reduce missed opportunities of vaccination (MOV)
• Conducted an HIV study on Evaluating the implementation of integrated HIV and Cervical Cancer (CaCx) management at Baylor supported HIV clinics in western Uganda
• Conducted a Quality Improvement project on; Improving iCCM/VHT Data Quality and Reporting in Adjumani District
• Conducted an epidemiological investigation on; Determinants of non-retention in care (Loss to follow up) among newly diagnosed Hypertension and/or Diabetes Mellitus patients at Kangulumira HC IV, Kayunga District, 2018 – 2019

Conference Presentations

• Using photovoice and community surveys to assess compliance to COVID-19 prevention measures during the early phase of easing the lockdown restrictions, Kampala Metropolitan, May 2020: 6th Uganda Annual National Field Epidemiology Conference November 4, 2020
• Level of and factors associated with failure to access social and essential health services among Ugandans during the COVID-19 lockdown, April 2020: East African FETPs Conference on COVID-19 Response, November 18-19, 2020
• Violence and discrimination among Ugandan residents during the COVID-19 lockdown: Infectious Disease Institute (IDI), Kampala, Research Forum, August 2021
• Use of toll-free call center for COVID-19 response and continuity of essential services during the lockdown in Greater Kampala, 2020: 7th Uganda Annual National Field Epidemiology Conference on October 2021
• Use of toll-free call center for COVID-19 response and continuity of essential services during the lockdown in Greater Kampala, 2020: 8th East African Health and Scientific Conference, November 2021

Publications and manuscripts written :

• Katana E, Amodan BO, Bulage L, Ario AR, Fodjo JNS, Colebunders R, et al. Factors associated with access to food and essential medicines among Ugandans during the COVID-19 lockdown: a cross-sectional study. Journal of Interventional Epidemiology and Public Health [Internet]. 2021 Oct 28 [cited 2021 Nov 10];4(4). Available from: https:// www.afenet-journal.net/content/series/4/2/4/full/ Katana E, Amodan BO, Bulage L, Ario AR, Fodjo JNS, Colebunders R, Wanyenze RK. Violence and discrimination among Ugandan residents during the COVID-19 lockdown. BMC Public Health. 2021 Mar 8;21(1):467. 3. Under journal review: Use of toll-free call centre for COVID-19 response and continuity of essential services during the lockdown in Greater Kampala, 2020 Epi-bulletin articles in the National Institute of Public Health quarterly bulletin:
• A cluster of COVID-19 at a formal workplace, Kampala Central, August 2020: description of cases and response measures: Volume 6| Issue 2| April – June 2021
• A cluster of COVID-19 at a secondary hospital, Kampala, Uganda, during phase four of the epidemic: Volume 6| Issue 1| January – March 2021
• Incidence and factors associated with experiencing violence or discrimination among Ugandans during the COVID-19 lockdown, April 2020: Volume 5| Issue 3| July – September 2020
• Level and failure to access food and essential health services among Ugandans during the COVID-19 lockdown, April 2020: Volume 5| Issue 3| July – September 2020
• The role of PHFP Field Epidemiology Fellows in the response to the COVID-19 pandemic in Uganda, 2020: Volume 5| Issue 2| April – June 2020

Summary of Epidemiological Study: 

 Title: Use of a Toll-free Call Center for COVID-19 Responseand Continuity of Essential Services duringLockdown, Greater Kampala, Uganda, 2020

1.Katana1,2*, A Ndyabakira1,2, D.N. Gonahasa1, R. Migisha1, G. Amanya1, A. Byaruhanga1, I. Chebrot2, C. Oundo2, D. Kadobera1, L.Bulage1, AR Ario1,3, DA Okello2, JR Harris4; 1Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda, 2Directorate of Public Health and Environment, Kampala Capital City Authority, Kampala Uganda, 3Uganda National Institute of Public Health, Ministry of Health, Kampala, Uganda, 4Division of Global Health Protection, US Centers f or Disease Control and Prevention, Kampala, Uganda

Background: Establishment of a call center during public health emergencies is essential in reducing unnecessary calls to emergency telephone systems and providing relevant information to the public. Following the introduction of COVID-19 in Uganda, a total lockdown was initiated on March 30 and lifted in stages through June 30, 2021. On March 25, a toll-free call center with two hotlines was set up at Kampala Capital City Authority to respond to public concerns about COVID-19 and the lockdown. Call-related data were entered into a database. We documented the set-up and use of the call center and key concerns raised by the public during COVID-19 lockdown.

Methods: We abstracted data on incoming calls between March 25-June 30, 2020 from the database. We summarized the call data into categories and conducted descriptive analysis of the public concerns raised during the different phases of the lockdown.

Results: Of the 10,167 calls made, 6,578 (65%) were about health services access, 786 (8%) about social services access, and 1,375 (14%) about COVID-19 concerns. Among the 6,578 calls about access to health services, 2,152 (33%) were requests for ambulances for non-COVID emergencies, 1,155 (18%) were about persons stranded at health facilities, and 1,004 (15%) were about mothers in labor. Among the 786 calls about social services, 405 (52%) were requests for food and relief items and 158 (20%) were about price hikes for basic goods. Fifty-three percent of the 1,375 calls about COVID-19 response were seeking COVID-19 disease-related information and 360 (26%) were reporting COVID-19 suspected cases. There were no calls about COVID-19 emergencies.

Conclusion:The toll-free call center was used by the public during the COVID-19 response. Calls indicated gaps in health and social services associated with the lockdown. Continuity of essential services amidst an epidemic-related lockdown should be planned accordingly. Key words: call center, hotline, Uganda, COVID-19

Key lessons learnt during the fellowship

• Appreciated the approaches and diverse comparison that exists in research conducted between urban and rural populations, public health interventions, and programs
• Through my attachment at KCCA, I have appreciated key urban health epidemiology concepts including exposures or interventions that affect urban dwellers such as noise pollution, waste management, smoking and tobacco control, risk communication, among others.
• Improved communication skills; conducted training for surveillance teams in Kampala
• Public health bulletin writing
• Community engagement
• Networking
• Presentation skills and public speaking; presented abstracts at both local and international conferences
• Built interpersonal skills, team building, proactiveness, and networking
• Improved skills in design and coordination of studies
• Grants writing skills and approaches

Next Steps

• To continue training and learning with a focus on epidemiological analyses, statistical methodology, research methods, and clinical epidemiology
• To share and teach the acquired skills from this fellowship program to other public health

Pictorial