My Fellows wshi hip Achi hievem evements nts Benon n Kwesiga - PowerPoint PPT Presentation

Public Health Fellowship Program – Field Epidemiology Tra ck My Fellows wshi hip Achi hievem evements nts Benon n Kwesiga a MBChB, MPH PHFP Fellow Cohort t 2015

Host Site: MoH - Divi vision of Health Information  Mandate – To provide ide quality ity and timely ly health-relate lated d informatio ation n to all stakeho hold lders – To enable le performan ance based d decisio ion n making ng at all levels of the health h sector 2 My Fellow owshi hip Achi hievement nts

Public Health Surve veillance ce  Weekly ly analysis is of Integrate ated d Diseas ase Surveil illan lance and Respo ponse (IDSR) data – HMIS timeliness and completeness of District cts – Cases and deaths of prior ority IDSR diseases – Data cleaning  Descriptiv iptive analysis of Uganda’s eMTCT surveillance data a in DHIS2 (2012-2015) – Great improv ovement in eMTCT indica cator ors – Consistently low male involvement in eMTCT 3 My Fellow owshi hip Achi hievement nts

Response to Public c Health Emergenci cies  Led outbreak k responses – Communi nity ty - wide Cholera outbr break ak in Kasese – Organo nopho phosph phate ate poisoni ning ng after eating ng chapati in Tororo  Partici cipated in other outbreak k responses – Typhoid id in Kampal ala – Typhoid id verific icatio ation n in Rakai ai & Lyanto tonde nde – Cholera a – In Kasese and Sironk nko – Yellow fever in various us distric icts ts 4 My Fellow owshi hip Achi hievement nts

Epidemiologica cal study  VHT functio tional nality ty and adherenc nce to requirements nts of Communi nity ty Based d Surveil illa lanc nce (CBS) in Kasese – VHTs do not adequa uate tely ly follo low CBS guideli line nes – VHTs are not properly ly recruite ited, , traine ned or supervise ised – CBS improves when VHTs are properly ly suppo porte ted d by Development nt Partne ners  Findings were disseminated to Kasese DHT 5 My Fellow owshi hip Achi hievement nts

Scientific c Communica cation  Presente nted d at AFENET Conferenc nce in Abuja, a, 2016 – Organop ophos osphate poison oning after eating chapati  Presente nted d at JASH/Natio ational nal Field d Epidemio iolo logy Conferenc nces – Community-wide cholera outbreak, k, Kasese  3 3 article les in MoH UNIPH quarte terly ly Epibu bull lletin tin  Newspape paper artic icle le – Role of safe water provisio ision n in preventing ting diarrho hoeal al diseas ase outbreak aks 6 My Fellow owshi hip Achi hievement nts

Publications  Main n autho hor – A A Prolon onged, Community-Wide Cholera Outbreak k Assoc ociated with Drinki king Water Contaminated by Sewage in Kasese, Uganda, 2015  Co Co-autho uthor – Cholera Outbreak k Caused by Drinki king Contaminated Water from a Lakeshor ore Water-Col ollect ction on Site, Kasese – Case study - Cholera Outbreak k in a Fishing Village in Uganda – Typhoi oid outbreak k in Kampala 7 My Fellow owshi hip Achi hievement nts

Leadership and Management  Upon n being traine ned, d, I train ined d Distr tric ict t level health h workers in: – District ct Health Infor ormation on System 2 – IDSR  Ensur ured d routine tine and timely analy lysis is of weekly IDSR data a and train ined d other fellows  Traine ned Cohort t 2016 fellows on analysis of surveil illan lance data a  Traine ned health th workers on yellow fever surveil illan lance 8 My Fellow owshi hip Achi hievement nts

Public Health Fellowship Program – Field Epidemiology Tra ck Food Poisoni ning ng after er Eating ng Chapatti Contam aminat nated d with Orga gano nopho phosphat hate, Uganda anda, Octobe ber r 2015 Dr. Benon Kwesiga, MBChB, MPH Fellow ow, Cohor ort 2015

Location of affecte cted area – Mukuju Sub-Co County 10 Food Poi oisoni oning ng after eat ating ng chap hapat ati

Organophosphate Poisoning in Uganda  Common n occur urrenc nce  Cases are usuall lly suicidal idal/ho homic icid idal al  Easy access to organo nopho phospha phate tes from animal l drug shops ps  Uses – Pestici cides in most homes – Indoo oor Residual Spraying against mosquitoe oes – Agricu cultural farms 11 Food Poi oisoni oning ng after eat ating ng chap hapat ati

Initial alert 3 students reported dead in a few w hours Chapat atti  3 3 stude dents nts became severely ly ill and died after eating ng chapatti 1  Other peopl ple also fell ill on the same day  They had eaten n chapatt tti from the same food-sta tand nd 2 12 Food Poi oisoni oning ng after eat ating ng chap hapat ati

Objecti ctive ves  To ascertain tain the cause of illness and death  To guide contr trol & preventio tion n measures 13 Food Poi oisoni oning ng after eat ating ng chap hapat ati

Case definition  Suspecte ted d case – Onset of confusion, vomiting, excessive sweating in a resident of Mukuju from 24-30/October/2015  Probable able case – Onset of foaming of saliva or low blood pressure or loss of consciousness or constricted pupils  Confirmed d case – Any suspected/Probable case with confirmed toxicological or post-mortem results of organophosphate poisoning 14 Food Poi oisoni oning ng after eat ating ng chap hapat ati

Case finding  Medical al records ds reviewed  Conduc ucte ted d communi nity ty intervie iews among – Survivor ors – Health worke kers – School ol Administrator ors – Police Offic ficers 15 Food Poi oisoni oning ng after eat ating ng chap hapat ati

Clinica cal, , laboratory y and autopsy inve vestigations  Patient nt records ds - clinic ical l investig tigatio ation/ n/mana anagement nt – To aid in verifying the diagnos osis – To classify the cases  Autopsy results ts follo lowed d up with h Polic ice – To identify cause of death  Environm nmental tal sample les collecte ted & tested – To identify the implica cated chemica cal(s) in the chapatti 16 Food Poi oisoni oning ng after eat ating ng chap hapat ati

7 people were affecte cted Level of case Case definition count Suspected 7 Probable 5 Confirmed by 3 autopsy 17 Food Poi oisoni oning ng after eat ating ng chap hapat ati

Characte cteristics of cases (N=7) Age: Mean = 24 years (20-32) Characteristic Frequency % Sex Male 6/7 86 86 Female 1/7 14 14 Residing in Mukuju village 7/7 100 Hospitalised (admitted) 4/7 57 57 Case Fatality Rate 3/7 43 43 18 Food Poi oisoni oning ng after eat ating ng chap hapat ati

Clinica cal signs/sym ymptoms consistent with organophosphate poisoning (N=7) 10 8 7 7 6 Cases 4 4 3 3 3 3 2 0 Profuse Confusion Diarrhea Constricted Frothing of Low blood Vomitting sweating pupils saliva pressure blood Symptoms 19 Food Poi oisoni oning ng after eat ating ng chap hapat ati

Flow w of events 30 th th Oct 2015 4 studen ents ate chapattis 3 die within 24 & developed ed Refer erred red hours post to Tororo ro symptoms hospitalisation immediatel ely. Hospital Studen ent Studen ents 1 ate only Chapattis who ate e referre erred to part of sold with part of Mukuju HC chapatti no chapatti IV but problem ems recovered ered worsen ened ed 4 hours 12 13 14 15 16 17 18 19 20 21 22 23 24 hrs 20 Food Poi oisoni oning ng after eat ating ng chap hapat ati

Cases clustered around the chapatti vending point Mukuju Cases HC IV Mukuju Primary ≈2km Teacher’s Chapatti point 0.25 0.5 1.0km 21 Food Poi oisoni oning ng after eat ating ng chap hapat ati

Autopsy findings consistent with organophosphate poisoning  Gross gastroin inte testina tinal l infla lammatio ation n – Suggested ingestion on as primary route of expos osure – Stron ong organop ophos osphate smell in gut contents  Evidenc nce of multiple iple organ n failur lure 22 Food Poi oisoni oning ng after eat ating ng chap hapat ati

Samples of chap apatt atti and wheat flour contained organophosphate  Sample les of chapatt atti and flour ur collecte ted d  Sent to Ugand nda a Analytic tical al Lab ab  Testin ing confir irmed organo nopho phospha phate te contam tamin inatio ation 23 Food Poi oisoni oning ng after eat ating ng chap hapat ati

Further Police ce inquiry y reve vealed intentional contamination  Sometim times people le would ld bring ng their own flour ur to the vendor to make for them chapatti  One person n broug ught t flour ur laced d with h OP to make chapatis for a specif ific family ly (Domesti tic conflic icts ts)  C hapatti vendor unkno nowing ngly ly mixed up the chapatti  Poisone ned d chapatti ended up being eaten by random people le  Culprit t arreste ted d and currentl ntly in prison 24 Food Poi oisoni oning ng after eat ating ng chap hapat ati