Jane Frances Zalwango

B. Pharm (MUK), MSc CEB (MUK), & Advanced Field Epidemiology Fellow (UPHFP)
Email: jzalwango@musph.ac.ug/zalwangojf@uniph.go.ug
Telephone: +256779199389 / +256751036007

Host Site: Ministry of Health, National Malaria Control Division (NMCD)

Host Mentor: Dr. Gerald Rukundo

ABOUT THE FELLOW

Jane Frances Zalwango is a pharmacist passionate about understanding population disease dynamics and improving population safety, with a special focus on maternal and child health. She holds a Masters of Science in Clinical Epidemiology and Biostatistics and now the field epidemiology training program. Throughout this journey, she has made significant contributions to improving population safety through response to outbreaks, surveillance activities, and impactful research initiatives. Before the fellowship, she worked with the World Health Organization as an epidemiologist during the COVID-19 response.

During the fellowship program, Jane was attached to the National Malaria Control Division (NMCD), Uganda Ministry of Health whose mandate is to provide quality assured services for malaria prevention and treatment to all people In Uganda. While at NMCD, she monitored and evaluated malaria indicators and led the editing of the weekly malaria bulletin.

As a fellow, Jane led and participated in a number of outbreaks and projects including the 2022 Sudan Virus disease outbreak, evaluating surveillance systems, conducting operational research for program improvements, conducting root cause analyses, and implementing quality improvement projects among others. From this experience, she has improved her skills in outbreak detection and response, scientific writing, grant writing and management, and oral presentation. Aditionally, she has developed leadership skills over the last two years.

Routine surveillance data analysis sharpened her skills in using electronic data collection tools such as ODK and Kobo Collect, statistical software such as STATA, EpiInfo, and QGIS.

  Achievements at the Host Site

• Led the writing and dissemination of the weekly malaria bulletin which informs the Ministry of Health and its partners about the country’s malaria situation and guides the necessary response.
• Consultant on the Presidential Malaria Initiative Uganda Malaria Reduction Activity (PUMRA) under USAID during the baseline assessment in northern Uganda a key activity to improve the malaria response in high burdened districts.
• Won a TEPHINET grant to pilot a study focusing on understanding the etiopathogenesis of Blackwater fever-a complication of severe malaria that is increasingly reported in Uganda.
• As part of the malaria vaccine introduction secretariat, I participated in the drafting the strategic plan for malaria vaccine introduction that was the basis for the GAVI vaccine introduction grant application. This was approved in April 2023 and the vaccine is due for introduction in 2024.
• Trained health workers on drawing malaria normal channels for disease surveillance.
• I conducted numerous studies whose findings have contributed to improving service delivery within the division.
• ‘Analysis of trends of stockouts of malaria diagnosis and treatment commodities, 2017-2022.’
• A quality improvement project to improve artesunate management in Namutumba District that reduced periods of stockouts of the drug and improved severe case management.
• Participated in conducting malaria death audits at facilities.
• Participated in the review and development of a score card system for key malaria indicators, as well as routine data analysis to generate quarterly indicator score cards for key malaria indicators for monitoring.
• Participated in the preparation and execution of the national malaria day colloquiums in 2022 and 2023.

Fellowship program specific achievements

• Led one outbreak investigation: Crimean Congo Hemorrhagic Fever outbreak in Rakai District.
  • Participated in other outbreak responses and public health emergencies

• • 2022 Sudan Virus disease outbreak in Mubende.
  • Blackwater fever outbreak in Kakumiro District.
  • Malaria outbreak in Namutumba District.
  • COVID-19 outbreak in Nyakabande Transit centre
  • Rapid health assessment in Kisoro District following a refugee influx.

• Trained and mentored two cohorts of FETP-Frontline.
• Conducted a descriptive analysis of surveillance data on “Trends and spatial distribution of stockouts of malaria diagnosis and treatment commodities in public health facilities in Uganda, 2017– 2022”.
• Conducted an epidemiological study on factors associated with adherence to seasonal malaria chemoprevention in Moroto District, Uganda, 2023
• Conducted a study on understanding the gaps in surveillance that led to the delayed detection of Sudan Virus disease outbreak.
• Wrote 4 manuscripts as a lead author 3 of which are under peer-review in reputable journals and 1 under internal peer-review. I co-authored more than 10 manuscripts several of which are under peer review in journals.
• Presented my work at 6 conferences (3 national and 3 international) including:

• • 8th African Field Epidemiology Network conference in Mombasa.
  • 3rd international conference on Public health in Africa held in Lusaka.
  • 2023 Crimean Congo Hemorrhagic Fever Africa conference in Cape Town.
  • 8th and 9th NFEC Conferences in Kampala.
  • 17th JASHC conference in Entebbe.
• Published 2 articles in the UNIPH quarterly bulletin and was an editor of volume 7, issue 4 of the Uganda National Institute of Public health bulletin
• Wrote and published one newspaper article title “Antibiotic resistance: Is COVID-19 pandemic fueling this ‘silent epidemic’?

Summary of Epidemiological Study: 

 Title: Understanding the delay in identifying Ebola Virus Disease: gaps in integrated disease surveillance and response and community based surveillance to detect viral hemorrhagic fever outbreaks in Uganda, September 2022

Background: Early detection of outbreaks requires robust surveillance and reporting at both community and health facility levels. Uganda implements Integrated Disease Surveillance and Response (IDSR) for priority diseases and uses the national District Health Information System (DHIS2) for reporting. However, investigations after the first case in the 2022 Uganda Sudan virus outbreak was confirmed on September 20, 2022 revealed many community deaths among persons with Ebola-like symptoms as far back as July. Most had sought care at private facilities. We explored possible gaps in surveillance that may have resulted in late detection of the Sudan virus disease (SVD) outbreak in Uganda.

Methods: Using a standardized tool, we evaluated core surveillance capacities at public and private health facilities at the hospital level and below in three sub-counties reporting the earliest SVD cases in the outbreak. Key informant interviews (KIIs) were conducted with 12 purposively-selected participants from the district local government. Focus group discussions (FGDs) were conducted with community members from six villages where early probable SVD cases were identified. KIIs and FGDs focused on experiences with SVD and Viral Hemorrhagic Fever (VHF) surveillance in the district. Thematic data analysis was used for qualitative data.

Results: Forty-six (85%) of 54 health facilities surveyed were privately-owned, among which 42 (91%) did not report to DHIS2 and 39 (85%) had no health worker trained on IDSR; both metrics were 100% in the eight public facilities. Weak community-based surveillance, poor private facility engagement, low suspicion index for VHF among health workers, inability of facilities to analyze and utilize surveillance data, lack of knowledge about to whom to report, funding constraints for surveillance activities, lack of IDSR training, and lack of all-cause mortality surveillance were identified as gaps potentially contributing to delayed outbreak detection.

Conclusion: Both systemic and knowledge-related gaps in IDSR surveillance in SVD-affected districts contributed to the delayed detection of the 2022 Uganda SVD outbreak. Targeted interventions to address these gaps in both public and private facilities across Uganda could help avert similar situations in the future.

Key lessons learnt during the fellowship

• Leadership and team management skills
• Outbreak investigation and institution of effective control measures.
• Best practice approaches to public health emergencies.
• Scientific writing and communication skills: abstracts, manuscripts, newspaper articles, editing of bulletins.
• Data management, analysis (using Epi info, STATA, QGIS) and interpretation.
• Oral presentation skills: dissemination of findings, scientific conferences (national and international), colloquiums.
• Designing and implementing of projects.
• Networking and lobbying
• Community engagement
• Capacity building

Next Steps

I hope to further my career as an epidemiologist within an organization that provides a conducive environment for improving my skills and enhancing my overall contribution to the Global Health Security Agenda, ultimately contributing to population safety. I am excited to put my newly acquired skills and expertise to work in contributing to Uganda’s health security objectives. Along with this, I will continue to support the program’s other tiers in order to strengthen Uganda’s workforce capacity.

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