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Alex NdyabakirA, MPHFellow Cohort 2020 Host Site: Kampala Capital City Authority
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ABOUT THE FELLOWAlex Ndyabakira is a medical doctor with postgraduate diploma in project planning and management from Uganda Management Institute and Master of Public Health degree from Makerere University. Before joining the field epidemiology training program, he worked as a project coordinator at Infectious Diseases Research Collaboration where he designed and coordinated implementation of several community trials. He has published about use of incentives to promote health behaviours, HIV care and malaria. During the fellowship, Alex was hosted at the Kampala Capital City Authority where he led the city COVID-19 response, air quality management and mentored staff in scientific writing through initiation of the KCCA public health bulletin. Several achievements were attained at the host site for the COVID-19 response and air quality management: Achievements at the Host SiteCOVID-19 Response
Air QUALITY Management
Fellowship program specific achievements
Summary of Epidemiological Study:Title: COVID-19 outbreak at a quarantine prison, Central Uganda, September 2020 Background: During September-October 2020, an outbreak of COVID-19 occurred at Masaka Ssaza, a COVID-19 quarantine prison (holding center for newly-sentenced persons before transit to their host prison) in Central Uganda. We investigated to identify factors associated with introduction and spread of infection in Masaka Ssaza prison. Methods: We defined a case as PCR-confirmed SARS-CoV-2 infection in a prisoner/staff at Masaka Ssaza prison during September-October 2020. A control was defined as a prisoner or staff at Masaka Ssaza with a negative test during the same timeframe. We reviewed prison medical records to identify case-patients and interviewed prison staff to understand possible avenues of introduction of infection and opportunities for spread. We conducted a case-control study interviewing prisoners and staff to determine factors associated with spread of the infection. Logistic regression was used to assess factors associated with infection. Results: The index case was Inmate A, a 33-year-old male who entered the prison on September 16, 2020. On September 23, Inmate A learned that a colleague with whom he had close contact before imprisonment had died of COVID-19. He immediately reported this to prison authorities, prompting mass RT-PCR testing of all 254 prisoners at the prison on September 30, revealing three cases, including Inmate A. Additional follow-up testing of 251 prisoners confirmed 98 cases on October 15. On October 29, testing of 153 prisoners confirmed one case. The overall attack rate was 40/100. Ward-specific prisoner density ranged from 0.3-2.1 prisoners/m2 and prisoners were observed to congest at ward entrances and at mealtimes. Face mask ownership among case-patients was 35%. Using a face mask all the time was protective (aOR= 0.03: 95% CI 0.01-0.09). Residing in Ward 6 was associated with increased odds of infection (aOR=7.4; 95% CI 1.6-3.4). Conclusion: COVID-19 was likely introduced into Masaka Ssaza prison by an infected incoming prisoner. The outbreak may have been amplified by congestion in wards and at mealtimes and low use of preventive measures. Importantly, consistent use of face masks was protective. Unrestricted access to handwashing facilities, facemask use, and strict adherence to ‘do not enter another ward’ rules could mitigate risk of future outbreaks. Next StepsI have developed passion for urban health programing and in my new role as the supervisor medical services for the KCCA, I will continue implementing all the projects that are still ongoing despite the fellowship training termination. I will continue taking lead on air quality management as well as NCDs in the city, ensuring publication of the quarterly bulletin as well as mentoring the KCCA staff in scientific writing. As a visiting lecturer for air quality planning and Health at University of Wisconsin, USA, I will continue to foster collaborations with all partners in this sector. Key words: COVID-19, Quarantine prison, Uganda Pictorial
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