Dr. Rukundo B Gerald

MPH (Southern Medical University, Guangzhou, P.R China), MBChB (MUST), Field Epidemiology Fellow (UPHFP)
Tel:+256782432315/+256775130488
Email: rukundobg@yahoo.com

Host Site: National Malaria Control Division (NMCD)

Host Mentors: Dr. Damian Rutazaana, Dr. Daniel Kyabayinze and Dr. Denis Rubahika

ABOUT THE FELLOW

Dr. Gerald Rukundo joined the Uganda Public Health Fellowship in January 2018 and was hosted at the National Malaria Control Division (NMCD), Ministry of Health for a two year apprenticeship. While at the Malaria division, Gerald was part of the team that strives to control malaria in Uganda. Gerald has horned his skills in Epidemiology including disease outbreak investigation, response to public health emergency, evaluation of surveillance systems, design and implementation of operational research, data analysis, scientific writing and communication among others.
Prior to joining the Fellowship program, Gerald worked as a senior medical officer at Kisoro Hospital, Fort portal Regional Referral Hospital under a USAID funded project of Strengthening Uganda‟s Systems of Treating AIDS Nationally (SUSTAIN) and Marie stopes Uganda, an organization responsible for providing reproductive health services.
Dr. Gerald holds a Master of Science degree in Public Health from Southern Medical University, Guangzhou, People‟s Republic of China and Bachelor of Medicine and Bachelor of Surgery degree from Mbarara University of Science and Technology, Mbarara, Uganda.

  Achievements at the Host Site

Designed and published malaria quarterly bulletin issues

• Investigated malaria outbreak in Butambala District and made recommendations to the ministry to stop the outbreak
• Regularly analyzed malaria data from District Health Information System to inform the program
• Trained health workers in Karamoja and Busoga sub-regions on Malaria Normal Channel graphs
• Trained several health workers on Malaria in Pregnancy
• Participated in the Universal Campaign of mosquito net distribution
• Participated in mentorships and supervisions on Integrated community case management(ICCM)
• Participated in the Malaria Control Program Review
• Participated in Global fund grant writing

Fellowship program specific achievements

Led a malaria outbreak investigation in Butambala district

• Conducted an evaluation of community level malaria surveillance system under Integrated Community Case Management
• Conducted an Epidemiological study on factors associated with risk of malaria infection among pregnant women in Gulu City, Uganda
• Implemented a quality improvement project on Improving Uptake of Intermittent Preventive Therapy (IPT3) among Pregnant Women at Chahafi Health Centre IV, Kisoro District, Uganda, 2020
• Conducted a study on use of Viral load to identify advanced HIV disease

Participated in the following outbreak investigations;

• Leprosy outbreak investigation in Lira district
• Malaria outbreak investigation in Oyam district
• Cholera outbreak investigation in Kyaka II refugee settlement, Kyegegwa district
• Yellow fever outbreak investigation in Buliisa district
• Suspected COVID19 cases in Kazo district
• COVID19 infections among prisoners at Gulu main prison

Written abstracts accepted and presented at National Conferences. These include

• Malaria outbreak investigation in Butambala district, Uganda, February 2019 and Improving Uptake of Intermittent Preventive Therapy (IPT3) among Pregnant Women at Chahafi Health Centre IV, Kisoro District, Uganda, 2020

Manuscript on Malaria outbreak investigation in Butambala district, February 2019 is under review.

Written a policy brief on Improving Malaria Reporting by Village Health Teams under Integrated Community Case Management

I was the editor of the UNIPH Epi Bulletin Issue 3 Volume 4

Published a Newspaper article,” Everyone has a role to play in malaria control an prevention” in the New vision dated 2nd January 2020

Published three articles in the UNIPH Epi bulletin.

Summary of Epidemiological Study: 

 Title: Improving Uptake of Intermittent Preventive Therapy (IPT3) among Pregnant Women at Chahafi Health Centre IV, Kisoro District, Uganda -2020

Background: Pregnant women are among the most vulnerable populations for severe malaria infection. Preventing malaria during pregnancy can be achieved through intermittent preventive treatment (IPT) with sulfadoxine pyrimethamine (SP). The Uganda Ministry of Health recommends pregnant women take ≥3 doses of IPT at the beginning of the second trimester, targeting 80% receiving the third dose (IPT3) before delivery. However, 2019 data at Chahafi Health Centre IV (HCIV) in Western Uganda indicated that only 38% of pregnant women taking IPT2 subsequently took IPT3. We used quality improvement approaches to improve IPT3 uptake at Chahafi HCIV.

Methods: The quality improvement (QI) project spanned six months (March-August 2020), corresponding to three plan-do-study-act (PDSA) cycles. The root causes for low IPT3 uptake at Chahafi HCIV were identified using fishbone analysis, conducted with the antenatal clinic staff. These were subjected to a prioritization matrix by quality improvement committee based on ease of implementing remedial actions and perceived contribution to low uptake of IPT3; an interventional plan was developed to address the root causes with the highest priority scores. Interventions were implemented and longitudinal data collected from March-August 2020 and learning sessions were held with antenatal clinic staff at the end of every two-month PDSA cycle. Data were analyzed using Microsoft Excel 2010.

Results: Highly prioritized root causes of poor IPT3 uptake included poor documentation of IPT commencement on patients‟ cards and antenatal registers (failure to document previous IPT2 led to repeat IPT2 documentation), SP stock-outs, and missed appointments. Staff were trained on proper documentation, ensuring timely ordering of SP, and appointment reminders for pregnant women. Overall IPT3 uptake among pregnant women in their second trimester increased from 38% (32/84) during March 2020 to 93% (97/104) during August 2020.

Conclusion: QI approaches increased documented IPT3 uptake among pregnant women at Chahafi HCIV. Health programmers are encouraged to empower health facilities to contextualize their problems and apply QI approaches to improve health service delivery in the country.

Key Skills Lessons Learnt

Conducting outbreak investigations

• Analyzing surveillance data
• Evaluating surveillance systems
• Designing and implementing projects
• Communication and presentation at both national and international level
• Capacity building of health workers

Next Steps

• I hope to transfer the knowledge and skills acquired to other health workers especially in the field of surveillance.
• I hope to further my career in Epidemiology.