Public Health Fellowship Program Field Epidemiology Track My Fellowship Achievements Mafigiri Richardson, BSc Zoo/Chem, MSc IIDM Fellow, cohort 2015
Mission Host site, Rakai District To serve community through a transparent & coordinated delivery of service which focus on national, local priority and contribute to improvement in quality of life of people in Rakai District Mandate To provide health services through a decentralized system 2 My Fellowship achievements
Response to Public Health Emergencies Led outbreaks; among children in Kyegegwa district Measles outbreak in Kyegegwa district Participated in; Suspected food poisoning among primary school pupils, Namutumba Dist. A large typhoid outbreak in Kampala, 2015 Suspected bleeding disease, Hoima & Buliisa districts 3 My Fellowship achievements
Epidemiological study Under five mortality and household sanitary practices in Kakuuto County Rakai District, April 1 st, 2014-March 30 th, 2016 4 My Fellowship achievements
Public health surveillance Analysis of public health surveillance data on neonatal and perinatal mortality in Rakai District Typhoid verification in Lyantonde and Rakai districts 5 My Fellowship achievements
Scientific Communication HIV Prevalence among Youths & Services Uptake in Kasensero, 1 st NAHC & NFEC in children, Kyegegwa District, AFENET & NFEC Diarrheal diseases mortality in U5 & household sanitary practices in Kakuuto County, Rakai District-NFEC 6 My Fellowship achievements
Scientific Communication-Main Author HIV Prevalence and Uptake of HIV Services among Youth (15-24 Years) in Fishing and Neighboring Communities of Kasensero, Rakai District (BMC Public health) Risk Factors for Measles Death in Children: Kyegegwa District (BMC Infectious diseases) 7 My Fellowship achievements
Scientific Communication, Co-Author Suspected Bleeding Illness in Hoima and Surrounding Districts, 2016 (Plos One) Outbreak of Typhoid Fever in Kampala, 2015 (BMC Public Health) 8 My Fellowship achievements
Scientific Communication News paper article on burden of TB in Uganda-new vision Two articles in MoH quarterly epidemiology bulletin 9 My Fellowship achievements
Leadership and management Coordinated performance monitoring of HMIS reporting from health facilities in district. Coordinated quarterly surveillance reports for the district Trained records assistants on data management and report writing Coordinated designing IEC materials for health workers and HIV clients to have viral load testing 10 My Fellowship achievements
Leadership and management Designed measurement performance plan tool for key indicators for health surveillance system Did HIV service availability and mapping activity in 5 districts Mentored Frontline FETP health workers 11 My Fellowship achievements
Other Achievement Designed 1 st draft of fellowship logo-currently being used 12 My Fellowship achievements
Public Health Fellowship Program Field Epidemiology Track Risk Factors for Measles Death in Children: Kyegegwa District, Western Uganda, Feb - Sept 2015 Mafigiri Richardson, BSc Zoo/Chem, MSc IIDM Fellow, Cohort 2015
Measles affected Districts 14
Events leading to investigation Lab confirmation of measles outbreak 18 th Aug 2015 25 th Aug 28 th Aug 2015 Notification of suspected measles death Start of investigation 15
Objectives Identify risk factors for measles death in Kyegegwa District Provide evidence-based control measures to prevent future measles deaths 16
Case definitions Probable case: Onset of high fever and generalized rash, plus 1 of the following: conjunctivitis, coryza, or cough Measles death: Death of probable measles case 17
Active case finding Searched for cases with the help of VHTs Reviewed medical records Analysed data in the DHIS 2 18
DHIS 2 An electronic MoH national health information system Used for; integrated data management and analysis, health program monitoring and evaluation, facility registry functions, etc. Data from health units is captured using HMIS tools Analysis of data done periodically at national level for reporting and determination of disease trends and alerts 19
Case count from active case finding 94 persons with probable measles diagnosis 64 <5 years 30 5 years 16 deaths, all were <5 years 20
Active community case finding yielded more deaths than DHIS2 Data source Measles cases Deaths CFR DHIS2 85 1 1.2 Active Community surveillance 94 16 17 21
Location of cases 22
Case-control study Cases: 16 children (<5) who had measles and died Controls: 48 children (<5) who had measles and survived Matched by age and village 23
Potential risk factors Vaccination status Vitamin A supplement Inappropriate treatment Nutrition status 24
Factors associated with measles death %of Cases (n=16) %of Controls (n=48) Variables OR (95% CI) Treatment at home 63 6 33(6.8-159) No vaccination 94 54 12(1.6-104) No Vit A supp. 56 35 2.3(0.74-7.4) Malnutrition 38 25 2.5(0.67-9.1) 25
Non-vaccination was associated with measles death Conclusions Management of measles patients at home was associated with death More measles deaths occurred in community than reported in the National surveillance system 26
Recommendations Enhancement of measles vaccination among children <5 years Measles patients should be managed at health facilities for better treatment outcome Strengthening community component of HMIS for more complete reporting 27
Acknowledgement Ministry of Health US Centers for Disease Control and Prevention Makerere School of Public Health Kyegegwa District Health Team Public Health Fellowship Program Rakai Health Sciences Program 28
Factors protective against measles death Variables Vaccination for measles Vit A supplement during illness % of Cases (n=16) % of Controls (n=48) ORM-H (95% CI) 6.3 46 0.0 (0.0-0.33) 37 67 0.14 (0.037-0.77) Appropriate treatment 25 98 0.0 (0.0-0.12) Malnutrition 38 25 2.5 (0.67-9.1) 29
Assessment for malnutrition Used proxy pictures to parents of deceased children Severely malnourished Moderately malnourished Normal child 30