Patricia Thiwe

BEHS, MPH (MUK)
Email: pnabunya@musph.ac.ug
Telephone: pthiwe@musph.ac.ug

Host Site: National Malaria Control Division, Ministry of Health

Host Mentor: Dr. Damian Rutazaana Dr. Daniel Kyabayinze

ABOUT THE FELLOW

Patricia Thiwe holds a Bachelor of Environmental Health Science and Master of Public Health from Makerere University, School of Public Health. During her two years of the fellowship, she was hosted at the National Malaria Control Division (NMCD), Ministry of Health where she was part of the team that is charged with malaria prevention and control in Uganda. Patricia gained skills in Epidemiology including disease outbreak investigation, response to public health emergencies, design and implementation of operational research, data analysis, scientific writing, and communication among others Prior to joining the fellowship programme, Patricia worked as an Assistant District Health Officer- Environmental Health in Nebbi District where she oversaw environmental health services in the district.

Achievements at the Host Site

• Analyzed surveillance data on Trends and distribution of malaria in pregnancy in Uganda, 2015-2019. Our analysis showed a significant overall decline in the incidence of malaria in pregnancy between 2015 and 2019. It also showed that Acholi, Lango, Teso and Karamoja regions had the highest incidences of malaria in pregnancy throughout the five-year period.
• Developed and disseminated weekly malaria reports which highlights district malaria status and informs early intervention in case of any gaps.
• Participated in analyzing data for the malaria annual report 2020/2021
• Lead editor for three quarterly malaria bulletins that are usually dissemination to malaria stakeholders in the country. These bulletins highlight key malaria indicators in the country and is based on routinely collected data from health facilities through the DHIS2 platform.
• Implemented a quality improvement project on improving iCCM reporting and data quality in Zombo
• Participated in building capacity of district health teams in central region on malaria surveillance, particularly in monitoring detection of malaria outbreaks using normal channels and coordination of responses to detected outbreaks.
• Participated in data collection for an assessment on ITN ownership and utilization in Dokolo District,
• Participated in malaria mortality surveillance in Nebbi District.

Fellowship program specific achievements

• Lead Investigator on the following outbreak investigations:
• Epidemiological assessment of COVID-19 cluster among attendees of a farewell party at a church in Omoro District, Uganda, October 2020
• Characterization of COVID-19 cases among children in Lacor Hospital, June-Sept 2021
• Participated in the following outbreak investigations:
• Measles outbreak in Nakivale Refugee camp in Isingiro District in February 2020
• Malaria mortality in Nebbi District in May 2021
• Wrote a policy brief on Frequent Commodity Restocking by Village Health Teams to Improve Community Management of Childhood Malaria in Uganda
• Conducted an HIV study on Uptake of HIVST among male partners of women attending ANC in Kampala region, 2020.
• Analyzed surveillance data on Trends and distribution of malaria in pregnancy in Uganda, 2015-2019.
• Conducted an epidemiological study on Impact of Covid-19 on Utilization of Immunization Services in Mityana District.
• Editor of the UNIPH Epi Bulletin Volume 5, Issue 4

Conference Presentations

• Factors affecting COVID-19 district surveillance data reporting during the first phase of the pandemic, Uganda at 6th Field Epidemiology Conference in Kampala, September 2020.
• Investigation of a COVID-19 cluster among attendees of a farewell party at a church in Omoro District, Uganda, at 7th Field Epidemiology Conference in Kampala, October 2021 and 8th East African Health and scientific conference

Publications and manuscripts written

Manuscripts:

• Factors affecting COVID-19 district surveillance data reporting during the first phase of the pandemic, Uganda
• Investigation of a COVID-19 cluster among attendees of a farewell party at a church in Omoro District, Uganda

Newspaper articles

• The following articles were published in the New Vision
• Did you know that zero malaria starts with you?
• Handwashing: Clean hands save lives

Epi-bulletin articles in the National Institute of Public Health quarterly bulletin:

• Factors affecting COVID-19 district surveillance data reporting during the first phase of the pandemic, Uganda Investigation of a COVID-19 cluster among attendees of a farewell party at a church in Omoro District, Uganda

Summary of Epidemiological Study: 

 Title: Investigation of a COVID-19 cluster among attendees of a farewell party at a church, Omoro District, Uganda, 2020

Background: On 2 October 2020, a cluster of COVID-19 infections was reported in Omoro District, Northern Uganda. Despite government directives banning public gatherings, many infected persons had reportedly attended a farewell party at Church X on 5 September. We investigated to determine the source of infections, understand the outbreak magnitude, and identify risk factors for transmission.

Methods: We defined a case as a positive PCR for SARS-CoV-2 virus in a respiratory sample from an Omoro District resident, taken from 4 September to 5 October 2020. We developed a line list by reviewing records and interviewed the index case-patient, church farewell party attendees, and several community members to ascertain possible exposures. We conducted a retrospective cohort study among the 62 farewell party attendees.

Results: We identified 23 confirmed case-patients (74% male; median age 36 years) in Omoro District, including 12 in the Church X cluster. Illness onsets ranged from 23 August to 29 September. Fifteen (24%) farewell party attendees were infected. The index case, Mr. A, was a businessman active in Church X with onset on 23 August. Mr. A had no travel history but had multiple traveller clients. He attended the farewell party and multiple Church X services in August. In total, 17 (74%) case-patients had exposure to Mr. A. The second case-patient, Mr. B, had onset on 1 September. He was also active in Church X, frequently interacted with Mr. A, and attended the farewell party. All 23 cases had contact with Mr. A, Mr. B, or their contacts. Close contact with Mr. A (RR=2.4; 95% CI=1.1-5.8) or Mr. B (RR=2.6; 95% CI; 1.2-6.7) at the farewell party was associated with infection.

Conclusion: A social event at a church and lack of adherence to government directives provided an opportunity for spread of COVID-19. Improved adherence to national guidelines and government directives for COVID-19 and enforcement of adherence to standard operating procedures for COVID-19 could avert similar clusters in the future.

Key words: COVID-19, cluster, Church, Uganda

Key lessons learnt during the fellowship

• Outbreak detection, investigation, response and control
• Scientific writing (grant proposals, proposals/protocol writing, manuscripts, abstracts, policy briefs, Newspaper articles and bulletin articles)
• Data analysis using Epi info, STATA, QGIS, and interpretation of results
• Presentation and communication skills at both national and international levels
• Multitasking
• Public speaking
• Improved analytical skills (Deeper understanding of elements)
• Public speaking (with a lot of opportunity to present to different fora and researchers)

Next Steps

I am looking forward to further my career I field Epidemiology through service with the Ministry of Health and/or other organizations that will allow me leverage the knowledge, and skills obtained during this training.

Pictorial