Stella Martha Migamba

BSN (MUST), MPH (MUK), Advanced Field Epidemiology Fellow (UNIPH)
Email: smigamba@musph.ac.ug, migambastella@gmail.com
Telephone: +256 774 662488/+256702 037708

Host Site: Reproductive and Infant Health Division, Ministry of Health

Host Mentor: Dr. Robert Mutumba

ABOUT THE FELLOW

Stella Martha Migamba is a field epidemiology fellow with special interest in Maternal and Child health, as well as disease emergency preparedness and response. She holds a Master of Public Health from Makerere University and a Bachelor of Science in Nursing from Mbarara University of Science and Technology. Before joining the fellowship programme, she worked with the Infectious Diseases Institute and University Research Co., LLC, USAID RHITES EC where she implemented projects in HIV and Maternal Child Health.

During the fellowship, she was attached to the Reproductive Health Department of the Ministry of health where she conducted mentorships, support supervisions, and contributed to writing of national reports, workplans, and guidelines. She has authored a number of documents that demonstrate advanced scientific writing skills, including bulletin articles, newspaper articles, manuscripts, and website articles which enhanced her writing skills. She is also a mentor and trainer with the FETP Intermediate Program, and a trainer with the FETP Frontline Program.

  Achievements at the Host Site

• Participated in creating the Reproductive and Infant health communication strategy, July 2021. Its aim was to provide partners with a roadmap of how to support advocacy for safe motherhood.
• Reviewed the MPDSR facility-based mentorship concept and terms of reference for the regional MPDSR mentorship, August 2021Participated in a National Training of Trainers in provision of medical-legal support to Sexual Gender Based Violence victims/ survivors and finalisation of a guide on medical forensic evidence management, 22-24 September 2021
• Participated in a joint ministerial dialogue by the Association of Obstetricians and Gynaecologists of Uganda (AOGU) on Sexual Reproductive Health and Rights with representatives of line ministries (MoH, MoES, and MoGLSD) to disccuss RH policies and desired data capture and utilization changes
• Participated in workplan harmonization meetings for the Reproductive and Infant Health Division of the Ministry of Health in July, 2021 aimed at streamlining the Division’s activities
• Participated in organization of the second National Safe Motherhood Conference, September-October 2022
• Part of the team that reviewed SEMA RH’s (Shaping Equitable Market Access for Reproductive Health) workplan and defined country priorities for implementation, September 2022

Fellowship program specific achievements

• Surveillance data analysis:

Conducted a descriptive analysis to determine the trends and spatial distribution of in-patient neonatal sepsis in Uganda from 2016 to 2020

• Quality improvement project:

Implemented a quality improvement project in Iganga Hospital to improve perinatal deaths notification and review (June to November 2022).

• HIV Project:

Conducted an HIV project to assess the effect of point-of-care (POC) early-infant diagnosis testing (EID) on HIV results turnaround time and linkage to antiretroviral therapy at 10 health facilities.

Epidemiological studies

• Did an epidemiological study to determine risk factors associated with deaths among hospitalized pregnant women with COVID-19 in Uganda, June 2020 to August 2021
• Protective factors against Ebola virus infection among high risk contacts during an outbreak in Mubende and Kassanda districts, Uganda, 2022

Outbreak investigations

• Team lead for the yellow fever break investigation in Wakiso, Masaka, Kasese and Buikwe Districts in March, 2022; presented investigation findings in Incident Management Team (IMT) and National Task Force (NTF) meetings

• Co-investigated:

• • Black water fever in Mbale, Soroti, and Jinja from 14 June to 6 July 2021
  • Cholera outbreak investigation in Nakivale Refugee Settlement in Isingiro district in November, 2021
  • Malaria in Iganga in March 2021
  • Ebola outbreak investigation in Mubende and Kassanda districts in October and November 2022

Other projects

• Conducted malaria normal channels training among district health team members in six districts of Bukedi Region, Eastern Uganda and disseminated malaria data quality assessments.
• Supervised the catch-up vaccination project under Africa Field Epidemiology Network (AFENET) in Nakasongola District,June to September, 2022.
• Facilitated workshops for FETP Frontline and currently trainer and mentor of the FETP Intermediate Program of UNIPH
• Participated in a grant writing workshop, 16- 20 August, 2021
• Participated in the Uganda scientific communications training, 30 August- 3 September, 2021
• Participated in a 4- weeks Public Health Bulletin Writing (PHBW) workshop from 31 January- 28 February, 2022
• Editor of UNIPH Quarterly Epidemiological bulletin, Volume 7/Issue 1/ January- March, 2022

Public Health evaluations

Participated in:

• Assessment of readiness of health facilities to manage the second wave of COVID-19
• Evaluation of the performance of laboratory services in the COVID-19 response in September 2021
• Evaluation of the implementation of Xpert MTB/RIF Ultra assay testing, September 2021
• Supervision of data collection for the integrated community case management endline survey from 31 October – 19 November, 2021
• Investigation of malaria deaths in eight selected districts, June 2022

Conference presentations

• Oral presentation: Trends and Spatial Distribution of Neonatal Sepsis, Uganda, 2016-2020, at the National Field Epidemiology Conference, Kampala, 2021
• Oral presentation: Trends and Spatial Distribution of Neonatal Sepsis, Uganda, 2016-2020, at the 16th Joint MAKCHS and 28th UNACOH Annual Scientific Health Conference, September 2022
• Oral presentation: Risk factors associated with deaths among hospitalized pregnant women with COVID-19 in Uganda, June 2020 to August 2021, at the National Field Epidemiology Conference, Kampala, 2022
• Poster presentation: Trends and Spatial Distribution of Neonatal Sepsis, Uganda, 2016-2020, at the second international Conference on Public Health in Africa (CPHIA) 2022 in Kigali, Rwanda, 13-15 December 2022
• Poster presentation: Risk factors associated with deaths among hospitalized pregnant women with COVID-19 in Uganda, June 2020 to August 2021, at the second international Conference on Public Health in Africa (CPHIA) 2022 in Kigali, Rwanda, 13-15 December 2022

Written Communication

Bulletin articles

• Trends and Spatial Distribution of Neonatal Sepsis, Uganda, 2016-2020: UNIPH Quarterly Epidemiological Bulletin, Volume 7, Issue 2, April- June 2022
• Risk factors associated with deaths among hospitalized pregnant women with COVID-19 in Uganda, June 2020 to August 2021: UNIPH, Volume 7, Issue 4, October- December 2022
• Rapid Antiretroviral Therapy initiation following roll out of Point-of-Care Early Infant Diagnosis Testing in Uganda, 2018-2021: UNIPH, Volume 7, Issue 4, October- December 2022

Newspaper articles

• “Hepatitis can’t wait: A call for elimination” published as letter of the day in The New Vision on Thursday 22 July, 2021. This article was written to commemorate world hepatitis day 928 July, 2021) and aimed at raising awareness about vaccination for hepatitis B.
• “Newborn infections: A preventable cause of neonatal deaths” was published in The New Vision on 1 June, 2021. The intention was to explain the importance of preventing newborn infections in the prevention of newborn deaths.

Website article

• “The role of field epidemiologists in ensuring resilient health systems” was published on TEPHINET’s website to commemorate World Field Epidemiology Day on 7ptember, 2022

Manuscripts

Lead author

• Trends and spatial distribution of neonatal sepsis, Uganda, 2016- 2020– under peer review
• Risk factors associated with deaths among hospitalized pregnant women with COVID-19 in Uganda, June 2020 to August 2021 –under peer review
• Rapid Antiretroviral Therapy initiation following roll out of Point-of-Care Early Infant Diagnosis Testing in Uganda, 2018-2021–undergoing review

Co-author

• Ownership and use of long-lasting insecticidal nets three months after a mass distribution campaign in Uganda, 2021- published in BMC Malaria Journal
• Trends and geospatial distribution of stillbirths in Uganda, 2014-2020- submitted to BMC Pregnancy and Childbirth journal
• Trends and distribution of birth asphyxia incidence in Uganda, 2017-2020- submitted to PLOS One journal
• Readiness of Health Facilities to Manage COVID-19 in Uganda, June 2021- submitted to BMC Health Services Research journal
• Black Water Fever among children in Districts of Bugisu, Bukedi, and Busoga Regions in Eastern Uganda, January 2019 – July 2021- under review
• Loss to Follow-up Among People Living with HIV on Tuberculosis Preventive Treatment at Four Regional Referral Hospitals, Uganda, 2019–2021- under review
• Malaria Outbreak facilitated by agricultural activities, residing near water logged areas and participating in late night campaign activities: Nabitende Subcounty, Iganga District, December 2020-February

Summary of Epidemiological Study: 

 Title: Risk factors associated with deaths among hospitalized pregnant women with COVID-19 in Uganda, June 2020 to August 2021

Authors: Stella M. Migamba1, Bruno Ssemwanga2, Allan Komakech1, Benon Kwesiga1, Daniel Kadobera1, Lilian Bulage1, Alex R. Ario1, Julie R.

Affiliations

1Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda

2Reproductive and Infant Health Department, Ministry of Health, Kampala, Uganda

3Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Kampala, Uganda

Background: Pregnant women are at higher risk than other COVID-19 patients for severe COVID-19 disease. Few studies have been done to understand risk factors for death among COVID-19- infected pregnant women in Africa. We investigated risk factors for death among hospitalized pregnant women with COVID-19 in Uganda.

Methods: We abstracted demographic and clinical characteristics from files of pregnant women admitted during any trimester with confirmed SARS-CoV-2 infection at eleven hospitals in Uganda. We conducted an unmatched case-control study among hospitalized pregnant women with COVID-19 during June 2020-August 2021; cases were those who died while controls were those who recovered and were discharged during the same period. We enrolled 33 cases and 109 controls. We analysed risk factors for death using multivariable logistic regression adjusted for age, trimester, parity and presence of comorbidities because these factors have previously been associated with COVID death or maternal death.

Results: Of 33 cases and 109 controls, 32 (97%) cases and 73 (67%) controls were hospitalised in 2021 (p=0.01). Thirty-two (97%) cases and 85 (78%) controls had COVID-19 symptoms at admission (p=0.04). Nineteen (58%) cases and nine (8%) controls had severe or critical COVID-19 disease at admission (p<0.001). The median length of hospitalisation for cases was 3 days (IQR: 1-6) while that for controls was 7 days (IQR: 4-11) (p<0.001). Odds of seeking care from another medical facility before admission were higher among cases than controls (ORunadjusted= 3.0, 95% CI: 1.1-7.9). Having severe disease at admission increased odds of death (ORadj= 16, 95% CI: 4.0-69), while admission for ≥ 6 days was protective (ORadj= 0.15, 95% CI: 0.03-0.81).

Conclusion: Pregnant women with COVID-19 who died had higher odds of being admitted with symptomatic, severe disease compared with those who survived. Earlier facilities cases visited could have delayed referral to the hospitals where they died few days after hospitalisation. Orienting facilities on referral of pregnant women with COVID-19 could improve their clinical outcomes.

Keywords: COVID-19, pregnant, hospitalized, death, risk factors, Uganda

Key lessons learnt during the fellowship

I gained and improved the following skills

• Grant writing
• Scientific communication using abstracts, manuscripts
• Public speaking
• Mentoring
• Data presentation / graphical data presentation
• Programming of data collection tools onto software
• Bulletin writing and editing skills
• Responding to disease outbreaks
• Designing, implementing and monitoring projects
• Mentorship
• Support supervision

Next Steps

In the next 3 months after graduation, I will lead a team to implement a project to improve perinatal death notification and review in 9 districts of Bunyoro Region. In addition, I will mentor health workers in various areas of maternal child health, and on the surveillance data analysis and use to improve health programs. Furthermore, I intend to continue training and mentoring frontline and intermediate field epidemiology training program fellows.

Pictorial