Peter Omms Oumo

BSc. EHS (MUK), MPH (IHSU), Advanced Field
Email: poumo@musph.ac.ug, oumopeter4@gmail.com
Telephone: +256 782 533 926

Host Site: National Malaria Control Division

Host Mentor: Dr. Damian Rutazaana, Dr. Daniel Kyabayinze, Dr. Jimmy Opigo

ABOUT THE FELLOW

SP Peter Oumo is a field epidemiologist with a background in environmental health. I hold a Master of Public Health from International Health Sciences University (IHSU). During my tenure as a Public Health Fellow, I have been attached to the National Malaria Control Division (NMCD) of Ministry of Health where I have developed confidence in myself amidst challenges of the lockdown and learnt to work in a dynamic environment. No sooner had I reported to the host site that was the lockdown instituted. We have literally been known as the COVID-19 cohort.

  Achievements at the Host Site

• When I was placed at the host site shortly after the lockdown was instituted, I was hosted at the epidemiology department where I largely supported the publication of the weekly and quarterly bulletins at the National Malaria Control Division which are used as information sources and basis for decision making at national and sub-national levels for malaria response.
• I have also heavily been involved in supporting the routine weekly analysis of malaria surveillance to monitor upsurges of malaria cases through the construction of malaria normal channels using weekly reported DHIS 2 data which is eventually shared in the weekly malaria status of districts to NMCD and respective districts.
• For purposes of sustainability and wide coverage, I participated in supporting districts in Uganda to build capacity by training and mentoring district health teams to construct malaria normal channels as a surveillance tool to detect malaria outbreaks this was conducted in 6 districts in western Uganda, September 2020.
• Through constant analysis of DHIS2 surveillance data, I noticed that there are many deaths occurring due to malaria. I therefore took keen interest in conducting an analysis of trends and distribution of malaria deaths in Uganda using District Health Information System surveillance data between 2015 and 2019. The results of this analysis revealed that there was a significant increase of malaria deaths in 2016 although the malaria deaths generally declined over the years with the biggest decline being in 2018 after the net campaign. Children under 5 years were the most affected and had more deaths. The results of this analysis enabled me to identify and implement a Continuous Quality Improvement project in Iganga district.
• I then conducted a Quality Improvement (QI) project in Bugono Health Center IV in Iganga district 2021 with the aim of improving the identification and management of severe malaria among patients especially children to reduce malaria deaths. Results of the end line assessment indicated that malaria deaths had reduced from 11 deaths reported during 2020-2021 to 00 deaths at the time of assessment with basic interventions of mentoring and training facility teams in early detection of severe malaria.
• I was further intrigued to assess the risk factors associated with malaria deaths in 8 high death burden districts in Uganda, May 2021. This investigation found out that children under 5 years died more than their older counterparts of 5 years and above. Risk factors of malaria deaths included; anaemia, bleeding, hospitalisation, non-use of a mosquito net, convulsions and going into coma and non-receipt of antimalarial drugs after admission. Presence or co-morbidities such as cancer, sickle cell was a risk factor of malaria death.
• I was part of the Malaria Surveillance, Monitoring, Evaluation and Operational Research technical working group (SMEOR) which discussed Strategic
• Objectives and its activities during the finalisation of the Uganda Malaria Reduction and Elimination Strategic Plan 2021-2025. This is a national plan with the aim of reducing malaria morbidity and mortality. It is also now advocating for strategies which seek to eliminate malaria in parts of the
• While at the host site, I was also involved in several COVID-19 investigation activities and responses. I was involved in the investigation of COVID-19 deaths in Rubaga and Makindye division in Kampala 25th/02/2021-22nd/03/2021, because of continued rise of cases with over 300 cases reported with many deaths occurring all over the country without being investigated. Results of this investigation indicated that 71% of deaths were male and median age was 61 years (IQR: 50-71). Of the 126 deaths, 98 (78%) had an underlying medical condition. Cough 90 (71%) was the most common symptom at first presentation to a health facility. Most case-patients had severe disease 64 (51%) or were critically ill 54(43%).
• I conducted the Novel Oral Polio Vaccine (nOPV) regional trainings as the Central Supervisor for 11 districts in the Jinja region. This was in preparation for the forthcoming National Immunisation Days scheduled to take place in January 2022. The training took place on 11th and 12th November 2021. This saw all the district health teams in the region

Fellowship program specific achievements

• Evaluation of malaria deaths in Uganda using District Health Information System surveillance data, 2015-2019”, December 2020. This eventually led to my quality improvement project in Bugono HCIV as described earlier.
• Investigation of risk factors associated with malaria deaths in 08 high death burden districts in Uganda, May 2021. The 08 districts included: Agago, Apac, Iganga, Kakumirqo, Kikuube, Kitgum, Nebbi and
• I led the investigation of COVID-19 cases in Gulu and Lira regions, 2020. This was done following the upsurges of COVID-19 cases including the high numbers of truck drivers who were falling sick at the time, with also a big number of accumulated backlogs of un-investigated COVID-19 cases in the The purpose was to understand factors that exposed the cases to COVID-19 and provide appropriate public health interventions.
• While we investigated COVID-19 cases in Gulu district, a cluster of COVID-19 among prisoners of Amuru Central Prison with some staff was I led the eepidemiological investigation on the characterization of COVID-19 cluster amongst prisoners from Amuru Central Prison. The results indicated that 150 (100%) of the prisoners were investigated at Gulu Main prison. All 150 (100%) were male since it was a male prison, the mean age was 28 years. 149 (99%) were Ugandan and 1 (1%) South Sudanese. Most of the cases were arrested from Gulu 42 (28%), and Amuru 19 (15%). Most of the prisons case patients were symptomatic 108 (72%), the most common signs and symptoms were; Cough 39 (26%).
• I led the investigation to understand the Effects of COVID-19 on Gender-Based Violence during the Covid-19 lockdown: January 1 to July 30, 2020 in Uganda following the rising cases of GBV cases as reported by police sources. Results indicated the largest increase in reported GBV cases occurred among students and pupils, although incidence generally increased across all population groups during the first lockdown with women, adolescents and students experiencing the greatest burden. GBV associated with alcohol consumption increased We therefore recommended that awareness and prevention efforts to should focus on alcohol-associated GBV.

Co-investigator

• Measles outbreak investigation in Nakivale refugee camp, Isingiro district, 2020
• Part of the team that investigated the COVID-19 outbreak amongst a cluster of health workers in health facilities in Abim district, October 2020.
• I participated in the investigation of the Truck drivers under the “Trucker Protection Project” in Entebbe, Lira, Gulu and Arua RRHs amid increasing COVID-19 infections among Truck drivers in Uganda 18 May to 4th June 2020.
• Epidemiological case investigation on a confirmed COVID-19 case that was isolated in Masaka Regional Referral Hospital isolation unit, May 2020”
• Characterization of COVID-19 cases among children in Lacor Hospital, June-Sept 2021.

HIV Project

• I investigated the effects of COVID-19 on ART services utilisation among people living with HIV and AIDS in the Rwenzori Region, Mid-Western Uganda, 2021. We evaluated effects of the first COVID-19 lockdown on critical metrics of HIV program delivery (retention, viral load coverage, and viral load suppression). The results show that those active on ART were 2266 patients before the intervention period. At implementation of the intervention, incidence of those active on art dropped by 500 cases. results also show reductions in proportions of Viral Load Coverage Suppression.

Quality improvement project

• We implemented a Continuous Quality Improvement (CQI) project in Bugono Health Center IV in Iganga district with the aim of improving identification and management of severe malaria among patients to reduce on malaria deaths. Interviews with health facility staff indicated multiple challenges, including inability to test all clients due to inadequate reagents, malfunctioning microscopes and testing kits in the laboratory for diagnosis, few personnel in the laboratory to conduct testing, medicines and supplies stockouts, health worker absenteeism, and delays in referral due to a non-functional grounded ambulance. We conducted trainings, mentorships and Continuous Professional Development sessions. Results indicated a tremendous reduction in the deaths in Bugono Health Center IV from the 11 deaths that had been reported in the previous year to 0 deaths after the 5 months of implementation of the project.

Scientific WritingArticles in the MOH Epidemiological Bulletin

• A policy brief titled “Stopping malaria in its tracks: Empowering Uganda’s Village Health Teams to treat malaria in children under 5 at the community level”.
• Effects of COVID-19 on GBV during the COVID-19 lockdown: January 1 to July 30, 2020
• Trends and distribution of malaria deaths among the general population, Uganda 2015-2019

Newspaper articles

• Police officers should observe COVID-19 guidelines while on duty

Manuscripts Lead author

• Characterization of Gender-Based Violence During the COVID-19 Lockdown in Uganda, July 2020

Co-author

• “Trucker Protection Project” amid increasing COVID-19 infections among Truck drivers 18 May to 4th June 2020.
• Measles outbreak investigation in Nakivale, Isingiro district
• A cluster of COVID-19 among children in Lacor Hospital, Gulu district
• Investigation of COVID-19 deaths in Rubaga and Makindye division in Kampala 25th/02/2021-22nd/03/2021, because of continued rise of cases with over 300 cases reported with many deaths occurring all over the country without being
• The main purpose of this activity was therefore to investigate all confirmed deaths due to COVID-19 in Kampala district.

Conference presentations

• Oral presentation of Characterization of Gender-Based Violence During the Covid-19 Lockdown in Uganda, July 2020 at the 6th National Field Epidemiology Conference, November 2020.
• Oral presentation of Description of Malaria Deaths in Selected Districts in Uganda January 2020—May 2021 at the 7th National Field Epidemiology Conference, October 2021.
• Oral Presentation of Trends and Distribution of Malaria Deaths in Uganda 2015-2019 at the 20th Annual Scientific Conference Program, of Uganda Society for Health Scientists July 2020.

Summary of Epidemiological Study: 

 Title: Description of Malaria Deaths in Selected Districts in Uganda January 2020—May 2021Introduction

Background:In Uganda, malaria accounts for 30-50% of outpatient visits, 35% of hospital admissions, and 13% of hospital deaths. However, the characteristics of persons who die of malaria in Uganda are not well-described. We investigated the characteristics of malaria deaths in high-malaria-burden districts to inform programming for targeted interventions.

Methods:Cases were defined as death of a hospitalized person with a positive microscopy or rapid diagnostic test for malaria from 1 January 2020-30 May 2021. We used District Health Information System 2 malaria death data to identify districts with the highest case rates in Uganda during this period. We selected 8 high-burden districts from various areas of the country (Agago, Apac, Kitgum, Napak, Nebbi, Iganga, Kakumiro, and Kikuube) and visited all Health Centers (HC) III, HC IV, and general hospitals to abstract data on cases at the facilities. We abstracted data on age, sex, health facility name and level, district, diagnosis, date of admission, and date of death. Mortality rates (MR) were computed using deaths (cases) as numerators and district populations as denominators. We analyzed the data by demographic and geographic characteristics.

Results: Among 273 cases, 157 (58%) were male; median age was 5 years (IQR: 2-13). The overall MR was 11/100,000. Children <5 years had a higher MR than persons ≥5 years old (25.6 vs 7.1/100,000). Agago district had the highest mortality rate (35/100,000) followed by Nebbi District (20/100,000) and Napak district (18/100,000); all three are in the northern area of the country. Most malaria deaths occurred during June-August.

Conclusion: Children <5 years experienced malaria death rates four times higher than older age groups. The highest malaria death rates occurred in northern Ugandan districts. Malaria prevention measures and appropriate clinical management should be heightened amongst children <5 years in these districts.

Key lessons learnt during the fellowship

• Outbreak detection, investigation, response, and control
• Scientific and Public Health Bulleting writing of concepts, manuscripts, abstracts, policy briefs, bulletin articles and newspaper articles, the use of data for policy writing
• Editorial skills for scientific articles including the weekly, monthly, quarterly and epidemiological
• Data analysis using Epi info, STATA and QGIS.
• Leadership and management skills
• Designing and implementing Continuous Quality Improvement projects.
• Evaluation a surveillance system
• Communication skills including presentation, written and visualisation

Next Steps

With the skills Peter Oumo has acquired through the fellowship tenure, I hope to further my career in the field of epidemiology through service in an organisation that will provide me with the opportunity to serve and practice my epidemiology and other skills learnt along the fellowship.

Pictorial