Dr. Rek John

Dr. Rek John

MBChB (MUST), MSc Epidemiology (LSHTM), FETP Graduate
Email: jcedrek@gmail.com
Telephone: +256782387857

Host Site: National Malaria Elimination Division, Ministry of Health, Uganda

Host Mentor:1. Dr. Jimmy Opigo, Dr. Catherine Maiteki

ABOUT THE FELLOW

I hold a Bachelor’s Degree in Medicine and Surgery – Mbarara University of Science and Technology and a Master’s in Epidemiology – London School of Hygiene and Tropical Medicine, University of London. With the Advanced FETP, I am now a well-grounded epidemiologist. My passion lies in supporting malaria elimination efforts, through innovative surveillance, data-driven strategies, and epidemiological practices.

During the fellowship, I was attached to the National Malaria Control Division, now, the National Malaria Elimination Division (NMED). The NMED provides overall leadership for malaria control in Uganda. Through the in-service training at the NMED, I have attained great skills in leadership, outbreak investigation, and response including data analysis and interpretation, advocacy, multisectoral coordination, and engagement. Additionally, I

Achievements at the Host Site

Revitalized the production and dissemination of weekly surveillance reports.
Initiated production of the monthly malaria surveillance status update report.
Participated in the rapid assessment of the malaria situation in the country following the 2022 malaria outbreaks across the country.
Participated in the country’s malaria strategic plan mid-term review
Led the data analysis and preparation of presentations for the malaria expert review meeting.
Nominated to lead the development and presentation of malaria information products at the Ministry of Health Strategic Committee meetings.
Presented at several strategic committee meetings, providing updates on the malaria situation in the country.
Nominated to support the Incident Management System (IMS), with data analytics, surveillance, and epidemiology during the malaria outbreak response in 2023
Led a team to implement a rapid assessment of the malaria surveillance system – to support the IMT response to the outbreaks.
Led the development of the malaria epidemic response SOPs. The SOPs will be disseminated and rolled out to the rest of the country in Q1 of 2025.
Led a study to characterize severe malaria complications in patients admitted with malaria in the malaria epidemic districts, a demand from the Ministry of Health strategic committee meeting.
Participated in the Global Fund Grant Cycle 7 application process, and successfully wrote a concept note for sustenance of malaria sentinel surveillance sites across the country. This was funded
Participated in the national malaria commodity quantification activity
Participated in the antimalarial resistance strategy development activities
Contributed to the development of the Uganda Malaria Elimination Strategy
Contributed to the malaria surveillance system assessment efforts, to inform the next malaria strategic plan
Developed an outbreak detection online tool, using monthly data to complement the weekly data detection method
Developed materials for district-led malaria outbreak response. These were deployed in Serere, Kibuku, Butaleja, Bugiri, and Amolatar districts
Trained district leaders and malaria partners on malaria outbreak investigation, community parasite prevalence surveys and mortality surveillance in the context of malaria outbreaks
- Participated in a panel discussion at the MiM 8th Pan African Conference, April 2024, Kigali, Rwanda
- Nominated to attend four training activities: – Kigali, Rwanda: WHO Malaria Epidemiological Stratification workshop, December 2023. – Dakar, Senegal – Science of Defeating Malaria, Harvard University and University Cheikh Anta Diop of Dakar, June 2023.
– Pnong Peng, Cambodia: South to South Malaria Surveillance Practice Exchange, National Centre for Parasitology, Entomology and Malaria Control (CNM), March 2024.- New Orleans, USA – Malaria Molecular Surveillance, Imperial College, London, November 2024.

Fellowship program specific achievements

Led one outbreak investigation: Cholera outbreak in Namayingo District, June 2023.
Participated in three other outbreak investigations:

– Anthrax outbreak in Ibanda District, April 16 to 29, 2023

– Mpox outbreak in Mukono District, Kampala Metropolitan Area, October 30–November 9, 2024

– Mpox outbreak in Nakasongola District, Sept 30 to Oct 13, 2024

Analyzed surveillance data to describe Malaria in Kampala Capital City Authority between2020 and 2023
- Presented at two local conferences – The 9th and 10th Field Epidemiology conferences
- Published three newspaper articles – Death by Malaria: Understanding the disease path to fatality.
– Why you should care about health data reporting from your health service provider. – Malaria likes travelers even more. Take extra precautions.
- Published two articles in the NIHP bulletin – Cholera outbreak associated with drinking contaminated lake shore water, Namayingo District, Uganda July – August 2023.
– Increasing cases of Malaria in Kampala City, Uganda. Descriptive analysis of

surveillance data, Jan 2020 to Dec 2023.
- Conducted a Continous Quality Improvement study “Utilizing Quality Improvement to Improve Medical Certification of Cause of Death at Lira Regional Referral Hospital in Uganda”
- Conducted an HIV epidemiological study on the incidence and risk factors of Infant HIV infections in Kampala and Wakiso districts of Uganda, 2022 – 2023.
- Submitted a manuscript for publication to a peer-reviewed journal titled ‘Cholera outbreak associated with drinking contaminated lake shore water, Namayingo district, Uganda, July
August 2023.

Summary of Epidemiological Study:

Title: Multiple Complications in Patients Admitted with Severe Malaria in Epidemic Districts of Uganda, May to July 2023: An Epidemiological Study

Background: Severe malaria, manifesting as a dysfunction of one or more organs, is a fatal form of malaria and is one of the leading causes of morbidity and mortality in Uganda. Between 2021 and 2023, Uganda experienced malaria epidemics in over 50 districts, resulting in high admissions and reported deaths. This study aimed to characterize severe malaria manifestations in hospitalized patients from the malaria epidemic districts in Uganda.

Methods: We analyzed data from a line list of all patients hospitalized due to malaria in 27 high volume health facilities in 11 epidemic districts between May and July 2023. Patient demographics, clinical characteristics, pre-hospital treatments, severe malaria manifestation, and treatment outcomes were described as proportions. Using multivariable regression, we identified risk factors for multiple complications.

Results:

We line-listed 1,936 patients. The median age was 5 years (range 1-89), 54% (1,044) were <5 years old, and 51% (994) were females. The case fatality rate was 0.7% (14). Sickle cell anemia was the most common comorbidity in 77% (83/107) of patients with comorbidities. Most patients reported a fever (97%, 1,882), and 48% (924) had received pre-admission treatment for their symptoms. Unknown medicines accounted for the most pre-admission treatments received at 47% (550), in addition to oral paracetamol, 24% (281), and antimalarials 20% (236). Up to 75% (1443) of the patients had danger signs. 2,715 complications were reported80% (2,157) were in children <10 years, and 74% (2017) presented as ≥2 complications. The most common complications were low blood sugar, 22% (609), severe anemia, 19% (510), jaundice 12% (321), and blackwater fever 11% (306). Independent risk factors for multiple complications were age; <5 years [aOR=2.2, 95% CI=1.6-3.1] and 5≤15 [aOR=2.7, 95% CI=1.9-3.9]; having comorbidities [aOR=4.4, 95% CI=1.8-11]; and a danger sign of severe malaria at admission [aOR=10.1, 95% CI=7.6-13.5].

Conclusion: Multiple complications of malaria were common but mainly in children in the malaria epidemic settings. Younger age, comorbidities, and danger signs were predictors for multiple complications. Clinical teams must fully assess patients for all possible malaria complications for effective treatment.

Key lessons learnt during the fellowship

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

Outbreak Investigation and response
Evaluation of surveillance systems
Designing Quality Improvement Projects
Designing and implementing projects
Data management, analysis, and interpretation using EpiInfo and STATA
Creating, editing, visualizing, analyzing, and publication of geospatial data using QGIS
Scientific writing (for Abstracts Manuscripts, Policy Briefs, and short articles)
Presentation skills and dissemination of findings
Developing a policy brief
● Leadership, Teamwork, Multisectoral engagement, Community engagement, and lobbying skills

Next Steps

Following the fellowship, I am better placed to identify public health challenges, highlight them to relevant authorities, and lead change. I am therefore embarking on a change process to lead mentorship, surveillance, and research for malaria elimination in Uganda.