My Fellowship Achievements

Public Health Fellowship Program Field Epidemiology Track My Fellowship Achievements David W. Oguttu, BBLT, Mzoo/PAR Fellow, Cohort 2015

Mandate Host Site: Tororo District Health Office Coordination, planning, supervision, monitoring and evaluation of health service delivery in the district 2 My Fellowship achievements

Public Health Surveillance Analysis of Tororo malaria surveillance data 2012-2015 Malaria surveillance thresholds using HMIS data Trained DHT on use of surveillance data to detect public health threats Malaria vector Bionomics & susceptibility studies Change of vector biting behavior in IRS districts Malaria vector resistance to pyrethroids 3 My Fellowship achievements

Response to Public Health Emergency Led 2 outbreak investigations Cholera outbreak in Kaiso Hoima, Oct. 2015 Acute viral Hepatitis; Napak District Coinvestigated 4 other outbreaks: Typhoid outbreak in Kampala Typhoid outbreak verification, Nebbi and Moyo Malaria outbreak in Northern Uganda Cholera outbreak in Namayingo District April 2016 Responded & verified 5 outbreak rumors in Tororo 4 My Fellowship achievements

Epidemiological study Community malaria prevalence after 4 rounds of IRS in Tororo District Assessment of the effect of active testing and treatment on community malaria prevalence 5 My Fellowship achievements

Scientific Communication 4 oral presentation at National conferences JASHC & NFEC Poster Presentation at IMED conference, Austria 2016 Abstract for oral presentation : Typhoid conference, Kampala April 2017 6 My Fellowship achievements

Scientific communication Manuscript: Cholera outbreak caused by drinking lake water contaminated by human feces: Kaiso Village, Uganda, October 2015 : submitted to JIDP Articles in MoH Epidemiological Bulletin News paper articles in The New Vision Coauthor; Kampala Typhoid outbreak paper 7 My Fellowship achievements

Leadership and management Coordinated Integration of Hepatitis B screening in antenatal care and immunization of New borns (BASIIN) Pilot Led epidemic preparedness to prevent cholera in Tororo in 2016 National Rapid Response Team member 8 My Fellowship achievements

Leadership and management 9 My Fellowship achievements

Public Health Fellowship Program Field Epidemiology Track Malaria in Tororo District after Four Rounds of Indoor Residual Spraying : Need to Test and Treat to Prevent Resurgence David W. Oguttu, BBLT, Mzoo/PAR Fellow, Cohort 2015

Tororo District 11

Tororo: high malaria transmission district A. gambiae A. funestus Anopheles biting density 149/person/night Rate of infective bites Community malaria prevalence 2012 48% 2/person/night 12

Initial control strategies Prompt case management at health facilities LLINs to pregnant mothers Intermitent preventive therapy in pregnancy (IPTp) 13

Intensified vector control interventions Universal coverage with Long Lasting Insecticide Treated Nets (LLINs) in 2013 IRS in December 2014-4 rounds of 6 monthly IRS done - IRS to end in June 2017 14

Objectives Assess change in indoor biting malaria vector density Determine community malaria prevalence in Tororo District Describe relationship between indoor resting Anopheles and malaria magnitude in the district 15

Data collection Reviewed HMIS data to estimate incidence, test positivity rate Randomly selected one asymptomatic child and adult from a household Tested 960 under 5 children and 980 adults for malaria in 20 village communities Interviewed 980 adults in 20 villages 16

Ongoing entomological studies Pyrethrum spray catch in 12 houses in sentinel village before and during IRS Entomological surveillance data 2014-2016 Malaria vector bionomics studies 2015-2016 17

Indoor vectors controlled, malaria persists Incidence 75 60 IRS 1 IRS 2 IRS 3 IRS 4 375 300 Indoor Anopheles density 45 225 30 15 150 75 0 Oct Jan Jun Jan Jun Oct 2014 2015 2016 Month 0 18

Test positivity rates indicate ongoing transmission IRS 1 IRS 2 IRS 3 IRS 4 19

Asymptomatic community malaria prevalence persists at moderate endemicity Age group Number tested RDT positive Prevalence % < 5 years 979 206 21 18 years 984 68 7.0 Overall 1963 274 14 20

Vector bionomics and community exposure Vectors bite outdoors early after sunset 62% of people stay outdoors up to 9:00 pm 95% get mosquito bites outdoors before covering under a bed net 21

Malaria persists below baseline, a potential to upsurge IRS 4 Action Alert cases 2016 Baseline 22

Conclusions IRS has successfully controlled indoor feeding Anopheles and malaria to moderate endemicity Malaria parasite prevalence still persist at moderate endemic level after 4 rounds of IRS Malaria incidence rises in presence of indoor feeding vectors 23

Public health implication Moderate prevalence of Plasmodium in the population, a reservoir of malaria parasites for vectors to transmit when IRS is halted There is potential for malaria resurgence if the vector population rebuilds after halting IRS 24

Recommendations Test and treat malaria at community level to minimize the source of Plasmodium transmission Sustainability measures to keep malaria vector population low after IRS is halted 25

Public Health Fellowship Program Field Epidemiology Track Acknowledgment MOH US CDC Abt Associates Malaria Control Partners PHFP secretariat MakSPH Mentors Tororo DHT Dr. Bao-Ping Zhu