My Fellowship Achievements Mafig igir iri i Richar ards dson, - PowerPoint PPT Presentation

Public Health Fellowship Program – Field Epidemiology Tra ck My Fellowship Achievements Mafig igir iri i Richar ards dson, n, BSc Zoo/Che hem, , MSc IIDM Fellow, , cohort t 2015

Host site, Raka kai District ct  Mission – 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; – Risk factors for measles death 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

Epidemiologica cal study  Under five mortality and househol old sanitary practice ces in Kakuuto o County Raka kai District ct, April 1 st st , 2014-March ch 30 th th , , 2016 4 My Fellowship achievements

Public health surve veillance ce  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  Risk factors for measles death 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 ors for Measles Death h in Childre dren: n: Kyegegwa wa Distri trict, t, Weste tern rn Uganda da, Feb - Sept t 2015 Mafigir iri Richar ards dson, n, BSc Zoo/Chem, , MSc IIDM Fellow, , Cohort t 2015

Measles affecte ted d Distr tricts ts 14 Risk factors for measles death

Events ts leadi ding ng to investi tigati ation on Lab confirm rmati ation on of measles outb tbre reak ak 18 th Aug 2015 25 th Aug 28 th Aug 2015 Start t of investi tigati ation on Notificat ation on of suspected measles deat ath 15 Risk factors for measles death

Objecti tives  Identi ntify risk factor tors for meas asles death ath in Kyegegwa Distri trict t  Provide evidenc nce-bas ased control trol meas asure ures to prevent nt futu ture re measles deat aths hs 16 Risk factors for measles death

Case defini niti tion ons  Probab able case: Onset t of high fever r and genera ralized rash, h, plus us ≥1 of the following: conjunctivitis, coryza , or cough  Measles death: th: Death th of probab able meas asles case 17 Risk factors for measles death

Active case finding  Searche hed for cases with th the help of VHTs  Reviewed medical al record ords  Analysed data a in the DHIS S 2 18 Risk factors for measles death

DHIS 2  An electroni nic Mo MoH nat ational al heal alth h info format ation system  Used for; – integrat ated data a manage nagement nt and anal alysis, – heal alth h program am moni nitoring ng and eval alua uation, n, – facility registry func nctions ns, etc.  Data a from heal alth h units is captur ured using ng HMIS S tools  Anal alysis of data a done ne periodical ally at nationa nal level for reporting ng and determinat ation n of diseas ase trend nds and alerts 19 Risk factors for measles death

Case count nt from active case findi ding ng  94 persons ons with h prob obab able meas asles diag agnos osis 64 <5 years rs 30 ≥5 years rs  16 deaths hs, all were re <5 years rs 20 Risk factors for measles death

Acti tive communi nity case findi ding ng yielde ded d more deaths hs than DHIS2 Data a sour urce Measles Deaths hs CFR cases DHIS2 S2 85 85 1 1. 1.2 Active 94 94 16 16 17 17 Communi unity ty surveillanc ance 21 Risk factors for measles death

Locati tion n of cases 22 Risk factors for measles death

Case-con ontr trol ol study dy  Cases: 16 childre ren (<5) 5) who o had measles and died  Contr trol ols: 48 childre ren n (<5) who o had measles and surv rvived  Matche hed by age and villag age 23 Risk factors for measles death

ors Potent ntial al risk factor  Vaccina nati tion on stat atus us  Vitamin n A supplement nt  Inappro ropri riate te treat atment nt  Nutri riti tion on sta tatus tus 24 Risk factors for measles death

Facto tors rs assoc ociat ated d with th measl asles death %of Cases %of Contr trol ols Va Variab ables (n=16) (n=48) 8) OR (95% CI) Tr Treatme tment t at home 63 63 6 33(6.8-159 59) No vaccinat nation 94 94 54 54 12(1. 1.6-104 04) No Vit A supp. 56 56 35 35 2.3(0. 0.74-7.4) Malnut utri riti tion on 38 38 25 25 2.5(0. 0.67 67-9. 9.1) 25 Risk factors for measles death

Conclusi usion ons  Non-vaccinati nation n was assoc ociate ated with th measles death th  Management nt of measles pati tients nts at home was associat ated with th death  More measles deaths ths occurr urred in communi unity ty than n repor orte ted in the National nal surv rveillanc ance syste tem 26 Risk factors for measles death

Recom ommenda ndati tion ons  Enhanc ncement nt of measles vaccinati nation on amon ong childre ren n <5 years rs  Measles patients ts shou ould be manag aged at health th facilities for better r treatm atment nt outcom ome  Streng ngthe thening ng communi nity ty compone onent nt of HMIS for more re complete te reporti rting ng 27 Risk factors for measles death

Ackno nowl wledg dgement nt  Ministr try of Health th  US Centers rs for Diseas ase Contr ntrol ol and Preventi ntion on  Makere rere re School ool of Public Health th  Kyegegwa Distr trict t Health th Team  Public Health th Fellow owshi hip Progra ram  Rakai ai Health h Scienc nces Program ram 28 Risk factors for measles death

Facto tors rs prote tecti tive against nst measles death th % of % of Cases Va Variab ables Contr trol ols ORM-H (95% CI) (n=16) (n=48) 8) Va Vaccinati ation on for 6.3 46 46 0.0 (0.0-0. 0.33 33) measles Vit A supplement nt 37 37 67 67 0.14 14 (0.03 037-0. 0.77 77) during illne ness Approp opri riate te 25 25 98 98 0.0 (0.0-0. 0.12 12) treatm tment nt Malnut utri riti tion on 38 38 25 25 2.5 (0.67 67-9. 9.1) 1) 29 Risk factors for measles death

Assessment nt for malnutrition  Used prox oxy pictur tures to parents nts of deceas ased childre ren – Severely malnour ourishe hed – Moderat rately malnour ourishe hed – Normal child 30 Risk factors for measles death