Public Health Fellowship Program Field Epidemiology Track among Under 5 s: Epidemic districts of Northern Uganda, July 2012-June 2015 Allen Eva Okullo, MPH, BSc. Zoo/Psy PHFP-FET Cohort 2015
Malaria Burden in Uganda Malaria is endemic in 95% of Uganda Burden of malaria in Uganda is high with an estimated 16million cases in 2013 Children under 5yrs are at high risk 2
Malaria control interventions Indoor Residual Spraying(IRS) Reduces malaria transmission, malaria incidence Integrated Community Case Management (iccm) Anecdotally noted to reduce malaria incidence at health facilities Long Lasting Insecticide treated Nets (LLINs) Reduces incidence of malaria by 50% 3
Malaria control interventions Diagnosis and treatment with anti- malarials Behavioral Change Communication 4
Malaria epidemic confirmed in Northern Uganda in June 2015 5
Malaria control interventions in the epidemic districts Lamwo district- 100% coverage of iccm Other districts varying coverage 0%-60% All 10 districts had IRS the last ones ending in November 2014 Mass distribution of LLINs in all districts - June 2014 (67% coverage mid north region) Case management and behavioral change communication ongoing 6
Objective To assess relationship between malaria control interventions and malaria incidence among under 5yr olds 7
Analysis of data from DHIS2 Data on malaria incidence among under 5yr old children Data on malaria cases obtained from HMIS 105 in DHIS2 Denominator for incidence from 2002 population projections and 2014 census data 8
Graphs and Negative Binomial Regression used for analysis Incidence: New Under5 malaria cases X 1000 Total Under5 population Malaria incidence graphs with malaria control interventions Negative binomial regression used to show difference in incidence rate of malaria 9
Incidence per 1000 popn Malaria Incidence Chart with Confidence Intervals 70 60 50 40 30 20 10 0 Kole Oyam Lamwo Pader Kitgum Apac Agago Amuru Gulu Nwoya District 10
Malaria Incidence across 10 districts- July 2012 to June 2015 11
Malaria Incidence Rate Ratios with Lamwo as reference District IRR 95%CI Lamwo 1 - Kole 0.69 0.66-0.72 Oyam 0.81 0.78-0.85 Pader 1.0 1.0-1.1 Kitgum 1.2 1.2-1.3 Apac 1.3 1.3-1.4 Agago 1.4 1.4-1.5 Amuru 1.5 1.4-1.5 Gulu 2.0 1.9-2.0 Nwoya 2.6 2.5-2.7 12
Malaria Incidence per 1000 popn Jul Malaria Control and Incidence in Under 5 s, Lamwo district Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun 180 Case Mgt, LLINs in facilities and BCC 160 140 iccm 120 IRS IRS IRS IRS Ended 100 80 60 LLINs Mass Campaign Start of Epidemic 40 Rapid Reduction 20 0 2012 2013 2014 2015 Month/Year 13
Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Malaria Incidence per 1000 popn Malaria Control and Incidence in Under 5 s in Nwoya district 180 Case Mgt, LLINs in facilities and BCC 160 140 IRS IRS IRS iccm IRS Ended 120 100 Rapid reduction LLINs Mass Campaign 80 60 40 Start of Epidemic 20 0 2012 2013 2014 2015 Month/Year 14
Malaria Incidence per 1000 popn Jul Aug Malaria Control and Incidence in Under 5 s in Kole district Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun 180 160 Case Mgt, LLINs in facilities and BCC 140 120 100 80 IRS IRS IRS IRS LLINs Mass Campaign IRS Ended 60 40 20 Rapid reduction Start of Epidemic 0 2012 2013 2014 2015 Month/Year 15
Reporting rates might not have been consistent across districts Limitations Incidence formula assumes that all the under 5yr old cases were included in the study 16
Conclusion IRS, LLINs, BCC and Case Mgt in combination seem to reduce malaria incidence among under 5 yr olds IRS seems to rapidly reduce malaria incidence among the under 5yr olds 17
Recommendations Malaria control measures should be used in combination to reduce malaria incidence IRS should be implemented as a key measure for rapidly reducing malaria 18
Public Health Fellowship Program Field Epidemiology Track Acknowledgments Host institution- National Malaria Control Program, Ministry of Health Dr. Albert Peter Okui (RIP) Dr. Jimmy Opigo Dr. Myers Lugemwa Dr. Humphrey Wanzira The Public Health Fellowship Program Assoc. Prof. Joan Kalyango Dr. Bao-Ping Zhu Dr. Ario Alex PHFP Fellows