Dr. Andrew Kwiringira

MBChB, MPH (MUK), Advanced-FETP
Email: pnabunya@musph.ac.ug
Telephone: +256775997741

Host Site: AIDS Control Program

Host Mentor:

ABOUT THE FELLOW

Andrew Kwiringira holds a Bachelor in Medicine and Bachelor Surgery, a Master of Public Health and a certificate in Implementation science. Andrew has extensive experience in conducting complex analyses of epidemiological, healthcare data and preparing related reports. Instrumental in supervising the design and administration of surveys to collect and report epidemiological, healthcare data; overseeing the development, maintenance, and quality of major epidemiological and healthcare databases. Thorough knowledge of the basic principles and methods of epidemiology; sound understanding of biostatistics as applied to epidemiology. Expertise in working with District Health Teams and community health workers in the implementation of health projects.

  Achievements at the Host Site

• Produced and published malaria weekly bulletin
• Led a survey of mosquito net ownership and utilization in 14 districts following a national mass distribution campaign
• Conducted an evaluation of effect of seasonal malaria chemoprevention on malaria incidence among children under five years in Kotido and Moroto District
• Developed capacity of District Health Teams (DHTs) in:

• • Analyzing surveillance data and developing visualizations to improve malaria data use.
  • Establishing the Malaria Epidemic Early Detection System (MEDS) in epidemic-prone districts
• Developed and delivered oral public health communications
• Conducted malaria risk communication activities

Fellowship program specific achievements

1. Led an investigation of cutaneous anthrax outbreak linked with handling dead animals, Madi- Okollo District, Uganda, January– February 2022
2. Led a quality improvement project to improve Management of Patients with Suspected Seizures Presenting at Hospital Emergency Departments in Uganda, 2021
3. Led an assessment of Uganda Public Health Fellowship Program’s Contributions to the US President’s Malaria Initiative Targets and the Ministry of Health Malaria Control Strategy, 2015 – 2022
4. Led a survey of prevalence of hypertension and risk factors in island districts of Lake Victoria in Uganda
5. Led an evaluation of effectiveness of a group-based education and monitoring program, delivered by health workers to improve control of hypertension in island districts of lave Victoria, Uganda 2022
6. Led an investigation of adherence to an HIV testing program protocol of testing all prisoners at entry, interim and at exit in prison health facilities in Uganda, 2022
7. Led a survey of mosquito net ownership and utilization in 14 districts following a national mass distribution campaign
8. Conducted an evaluation of effect of seasonal malaria chemoprevention on malaria incidence among children under five years in Kotido and Moroto District
9. Participated in the following outbreak investigations:

• • A malaria outbreak in Iganga District facilitated by agricultural activities and residing near water logged areas, December 2021- February 2021
  • An outbreak of Black Water Fever among children in Districts of Bugisu, Bukedi, and Busoga Regions in Eastern Uganda, January 2019 – July 2021
  • Assessment of performance of laboratory services during the COVID-19 response in Uganda, October-December, 2021
  • Assessment of preparedness of border districts to respond to plague-West Nile Region, Uganda- August, 2021
  • Readiness of Health Facilities to Manage COVID-19 in Uganda, June 2021

Conference presentations

• Oral presentation on a survey of mosquito net ownership and utilization in 14 districts following a national mass distribution campaign in the National Field Epidemiology Conference, Kampala, 2021
• Oral presentation evaluation of effectiveness of a group-based education and monitoring program, delivered by health workers to improve control of hypertension in island districts of Lake Victoria, Uganda in the National Field Epidemiology Conference, Kampala, 2022
• Oral presentation on evaluation of effect of seasonal malaria chemoprevention on malaria incidence among children under five years in Kotido and Moroto District in the global TEPHINET conference in Panama, 2022

Written communication

Manuscripts

• Ownership and Use of Long-lasting Insecticidal Nets Three Months after a Mass Distribution Campaign in Uganda, 2021
• Uganda Public Health Fellowship Program’s Contributions to the US President’s Malaria Initiative Targets and the Ministry of Health Malaria Control Strategy, 2015 – 2022
• Effectiveness of a Group-based Education and Monitoring Program Delivered by Community Health Workers to Improve Control of High Blood Pressure in Island Districts of Lake Victoria, Uganda, 2022
• Effect of Seasonal Malaria Chemoprevention on Incidence of Malaria Among Children Under Five Years in Kotido and Moroto Districts, Uganda, 2021: Time Series Analysis

Other publications

1. Ownership and Use of Long-lasting Insecticidal Nets Three Months after a Mass Distribution Campaign in Uganda, 2021: Epibulletin article published in the National Institute of Public Health quarterly bulletin
2. Effect of Seasonal Malaria Chemoprevention on Incidence of Malaria Among Children Under Five Years in Kotido and Moroto Districts, Uganda, 2021: Time Series Analysis: Epibulletin article in the National Institute of Public Health quarterly bulletin
3. Effectiveness of a Group-based Education and Monitoring Program Delivered by Community Health Workers to Improve Control of High Blood Pressure in Island Districts of Lake Victoria, Uganda, 2022: Epibulletin article in the National Institute of Public Health quarterly bulletin

Summary of Epidemiological Study: 

 Title: Effect of Seasonal Malaria Chemoprevention on Incidence of Malaria Among Children Under FiveYears in Kotido and Moroto Districts, Uganda, 2021: Time Series Analysis

1. Andrew Kwiringira1, Benon Kwesiga1,2, Richard Migisha1,2, Lilian Bulage1,2, Daniel Kadobera1,2, Damian Rutaazana3, Julie R. Harris4, Alex R. Ario1,2, Julius Ssempiira4
2. 1Uganda Public Health Fellowship Program, Kampala, Uganda
3. 2Uganda National Institute of Public Health, Kampala, Uganda
4. 3National Malaria Control Division, Ministry of Health, Kampala, Uganda
5. 4US Centers for Disease Control and Prevention, Kampala, Uganda

Background: Seasonal malaria chemoprevention (SMC) refers to monthly administration of full treatment courses of antimalarial medicine to children <5 years during high malaria transmission seasons. SMC has demonstrated effectiveness in Sahel and sub-Sahel countries in Africa. However, it was not implemented in Uganda until April 2021, when the country began SMC in the highly malaria-endemic Kotido and Moroto Districts. We assessed the effect of SMC on malaria incidence among children <5 years of age in Kotido and Moroto Districts.

Methods: We conducted an interrupted time-series analysis using monthly national health data from the Uganda Ministry of Health District Health Information System 2. We extracted monthly data for outpatient (uncomplicated) malaria among children <5 years, for the 52 months before SMC implementation (Jan 2017- Apr 2021), and 8 months during SMC implementation (May-Dec 2021). We computed monthly incidence per 1,000 children <5 years. We evaluated the incidence of uncomplicated malaria among children <5 years before and during SMC implementation.

Results: In Kotido District, malaria incidence was 693/1,000 during SMC implementation period, compared to an expected 1,216/1,000 if SMC had not been implemented. The mean monthly malaria incidence was 87/1,000, compared to an expected mean of 152/1,000 if SMC had not been implemented. This represents a statistically significant mean monthly change of -65.4 [95% CI=-104.6, -26.2] malaria cases/1,000 during SMC implementation, or a 43.0% decline. In Moroto District, malaria incidence was 713/1,000 during SMC implementation period, compared to an expected 905/1,000 if SMC had not been implemented. The mean monthly malaria incidence was 89/1,000, compared to an expected 113/1,000 if SMC had not been deployed. This represents a statistically significant mean monthly change of -24.0 [95% CI=-41.1, -6.8] malaria cases/1,000 during SMC implementation, or a 21.2% decline.

Conclusion: Implementation of SMC substantially reduced incidence of uncomplicated malaria among children <5 years in Moroto and Kotido Districts. Scaling up SMC in other districts with high malaria transmission could reduce malaria on a large scale across Uganda.

Keywords: Malaria, High Malaria Transmission, Seasonal Malaria Chemoprevention, Uganda

Key lessons learnt during the fellowship

During the fellowship, I learnt and developed the following skill sets:

• • Data analysis skills
  • Designing an epidemiological study
  • Evaluating a surveillance system
  • Presentation skills
  • Outbreak investigation
  • Writing skills
  • Networking skills

Next Steps

I hope to further my career in the field of Epidemiology or surveillance