My Fellowship Achievements Allen Eva Okullo, MPH, BSc. Zoo/Psy - PowerPoint PPT Presentation

Public Health Fellowship Program – Field Epidemiology Tra ck My Fellowship Achievements Allen Eva Okullo, MPH, BSc. Zoo/Psy Fellow, Cohort 2015

Host Site: National Malaria Control Program  Mandate: Direct and guide the day to day implementation of the National Malaria Control strategy  Vision: A malaria free Uganda  Mission: Provide quality assured services for malaria prevention and treatment to all people in Uganda 2 My Fellowship Achievements

Response to Public Health Emergency  Led an epidemiological investigation on a suspected guinea worm outbreak  Co-investigator in 5 epidemiological outbreaks: • Typhoid • Malaria • Acute Viral Hepatitis • Cholera 3 My Fellowship Achievements

Epidemiological Studies  Factors associated with malaria illness in three districts of Northern Uganda, 2015  Assessment of risk factors for the malaria outbreak, Uganda 2016 4 My Fellowship Achievements

Public Health Surveillance  Malaria incidence among <5yr olds in relation to malaria control interventions  Led analysis of malaria indicators to inform programming and bulletin writing  Mapped burden of malaria at sub county level by week in epidemic districts, 2015 5 My Fellowship Achievements

Public Health Surveillance  Analysis of sub county data to estimate malaria incidence for all the sub counties in Uganda, 2015  Analysis on trends of malaria incidence in N. Uganda after provision of ACTs to communities by PMI/USAID  Enhanced Yellow Fever Surveillance in Masaka & Mbarara Districts 6 My Fellowship Achievements

Scientific Communication  Lead Editor - Uganda National Malaria Quarterly Bulletin  Oral presentation on development of an epidemic prediction tool at IMED2016, Austria  Poster presentation on comparative cost analysis for cholera outbreak response at IMED2016 7 My Fellowship Achievements

Scientific Communication  3 oral presentations at JASH & National Field Epidemiology Conference – Malaria Incidence vis a vis control interventions – Cholera comparative cost analysis  Sub-editor - Ministry of Health Quarterly Epidemiological bulletin 8 My Fellowship Achievements

Scientific Communication  Published 2 articles in the MoH Quarterly Epidemiological bulletin  Co-author in two publications : – The challenge of using both long lasting insecticide bed nets and intermittent preventive therapy among pregnant women in Uganda – A large typhoid outbreak in Kampala 2015 9 My Fellowship Achievements

Scientific Communication  Authored 2 Newspaper articles on the malaria epidemic  Submitted a manuscript to the Malaria Journal titled, ‘Malaria incidence among children less than five years during and after cessation of Indoor Residual Spraying in Northern Uganda’ 10 My Fellowship Achievements

Leadership and management  Led analysis of data to estimate malaria incidence which informed the decision for LLIN provision – 10.4 million LLINs donated by Against Malaria Foundation (AMF) based on this evidence – Baseline for all future studies on effectiveness of mass distribution of LLINs in Uganda 11 My Fellowship Achievements

Leadership and management  Made a pitch at the IMED2016 Hackathon that led to devt ‘Puddle Predict’ -a malaria epidemic prediction tool 12 My Fellowship Achievements

Leadership and management  Got second runner up prize at Hackathon IMED2016 pre- conference event for ‘Puddle Predict’  Led team-Puddle Predict that won the ProMED follow-up award for best progress among all projects developed at IMED2016  Coordinating the development of malaria epidemic prediction tool 13 My Fellowship Achievements

Leadership and management  An active team player in the development of the first ever Uganda Malaria portal  Coordinated micro planning activities in 24 districts for LLIN mass campaign in Uganda  Led response to the malaria epidemic as an Incident Mgt Team member of the NTF 14 My Fellowship Achievements

Leadership and management  Trained Fellows on map making using QGIS for epidemic investigations and health programming  Made multiple maps for NMCP, FETP fellows, & UPHFP secretariat  Quantified Anti malarial medicines with NMCP for response to malaria epidemic 15 My Fellowship Achievements

Public Health Fellowship Program – Field Epidemiology Tra ck The cost of responding to a waterborne cholera outbreak in a village in Uganda compared to a simple hypothetical intervention

Cholera Outbreak- Hoima district, Sept 2015  Cholera outbreak- Kaiso fishing village, Hoima  Rapid response team assembled by MoH, supported by WHO, CDC, and UNICEF to: – establish Kaiso Cholera Treatment Centre – investigate the outbreak – implement control measures  120 cholera cases (4 deaths) identified  Drinking contaminated water from lakeshore caused outbreak 17 My Fellowship Achievements

Limited information on cholera cost analyses  Repeated cholera outbreaks in Uganda  Cholera imposes substantial economic burden  Limited information on cost analyses for cholera outbreak response and control activities vis-a-vis preventive measures 18 My Fellowship Achievements

Objectives  To determine the cost of responding to and controlling the cholera outbreak  To compare the cost to a would-be simple preventive measure – constructing bore holes to provide cleaner water 19 My Fellowship Achievements

Collection of cost data  Cost data collected on: – Medical Equipment and Supplies used – Utilities – Personnel Costs – Person Hours  Cost data from KCTC, health facilities, Hoima District Health Office, UPHFP, UNICEF, CDC,and WHO  Cost of constructing a bore hole quoted by a U.S.- based NGO 20 My Fellowship Achievements

Definitions & Analysis  Direct cost- Expenditure on medications, medical equipment and supplies, utilities, allowances and transport for responders  Indirect cost - Salary and other compensations for responders  Not included- Vehicle depreciation, building maintenance, loss of productivity to case-persons due to illness and deaths 21 My Fellowship Achievements

Cost of Response & Control= $71,769 Cost Category Cost In UgShs Cost in USD Medical Equipment 5,942,675 1,774 &Supplies Utilities 200,000 60 Personnel Costs 64,403,935 19,225 Direct Costs 21,059 Person Hours 169,578,340 50,620 Indirect Costs 50,620 Overall Total 240,124,950 71,679 22 My Fellowship Achievements

Cost of response was 24 times cost of constructing a bore hole Cost Category Cost In USD Control costs: Bore hole costs Response & Control 71,769 71,769:3000=~24 Direct Costs 21,059 21,059:3000=~7 Indirect Costs 50,620 50,620:3000=~17 Construction of a Bore 3000 Hole 23 My Fellowship Achievements

Summary of results  Constructing a bore hole to provide cleaner water would cost approximately $3000  Total cost incurred in response ~24 (=71769/3000) bore holes - Even the direct cost only ~7 (=21059/3000) bore holes  Five such bore holes would have prevented this outbreak and averted future waterborne outbreaks 24 My Fellowship Achievements

Conclusion  A simple prevention measure such as constructing bore holes for village residents can be substantially cost-effective for preventing waterborne diseases such as cholera 25 My Fellowship Achievements

Recommendation  Governments should proactively implement prevention measures for waterborne outbreaks whenever possible, instead of passively responding to these outbreaks 26 My Fellowship Achievements

Public Health Fellowship Program – Field Epidemiology Tra ck Acknowledgments  The Uganda Public Health Fellowship Program  National Malaria Control Program  Dr. Opigo Jimmy  Prof. Joan Kalyango  USAID/PMI  WHO  Malaria Implementing Partners  Dr. Bob Snow; Dr. Ambrose Talisuna; Dr. Albert Kilian