My Fellows wship Achieve vements David W. Oguttu tu, , BBLT, - - PowerPoint PPT Presentation

Public Health Fellowship Program – Field Epidemiology Track

My Fellows wship Achieve vements

David W. Oguttu tu, , BBLT, Mzoo/PAR Fellow, , Cohort t 2015

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My Fellowship achievements

Host Site: Tororo District ct Health Office ce

• Mandate

– Coordin dinatio ation, n, plann nnin ing, , supervisio ision, n, monito torin ing and evaluatio ation n of health h service delivery in the distr tric ict

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My Fellowship achievements

Public Health Surve veillance ce

• Analysis of Tororo malaria

ia surveil illan lance data 2012-2015 2015

• Malar

aria ia surveil illanc ance thresho holds lds using HMIS data

• Traine

ned DHT on use of surveil illan ance data to detect t public ic health h threats ts

• Malar

aria ia vector Bionomic ics & suscept ptibil ibility ity studie dies

– Change of vector

• r biting behavior
• r in IRS district

cts – Malaria vector

• r resistance

ce to pyrethroi

• ids

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My Fellowship achievements

• Led 2 outbreak investigations

– Cholera outbreak in Kaiso Hoima, Oct. 2015 – Acute viral Hepatitis; Napak District

• Coinvestigated 4 other outbreaks:

– Typhoi

• id outbreak

k in Kampala – Typhoi

• id outbreak

k verifica cation

• n, Nebbi and Moyo

– Malaria outbreak k in Northern Uganda – Cholera outbreak in Namayingo District April 2016

• Respon
• nded & verified 5 outbreak

k rumor

• rs in Toror
• ro

Response to Public c Health Emergency cy

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My Fellowship achievements

Epidemiologica cal study

• Communi

nity ty malaria ia prevale lenc nce after 4 rounds nds of IRS in Tororo Distr tric ict

• Assessment

nt of the effect t of activ ive testin ing and treatm tment nt on commun unity ity malaria ia prevale lence

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My Fellowship achievements

Scientific c Communica cation

• 4 oral presentation at National conference

ces JASHC C & NFEC EC

• Poster Presentation at IMED conference

ce, Austria 2016

• Abstract

ct for oral presentation : Typhoid conference ce, Kampala April 2017

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My Fellowship achievements

Scientific c communica cation

• Manuscr

cript: Cholera outbreak

k caused by drinki king lake water contaminated by human feces: s: Kaiso Village, , Uganda, , October 2015 : submitt tted d to JIDP

• Articl

cles in MoH Epidemiologica cal Bulletin

• News

ws paper articl cles in The New w Vision

• Coauthor; Kampal

ala a Typhoid d outbre reak ak paper

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My Fellowship achievements

Leadership and management

• Coordina

dinate ted d Integratio ation n of Hepatitis titis B screeni ning ng in antenatal natal care and immuni nizatio ation n of New borns ns (BASIIN) Pilot

• Led epidemic

ic prepar aredne ness to prevent t cholera a in Tororo in 2016

• Natio

ional al Rapid d Response nse Team member

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My Fellowship achievements

Leadership and management

Public Health Fellowship Program – Field Epidemiology Track

Malaria in Tororo District ct after Four Rounds of Indoor Residual Sprayi ying : Need to Test and Treat to Preve vent Resurgence ce

David W. Oguttu, tu, BBLT, Mzoo/PAR Fellow, , Cohort t 2015

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Malaria in Tororo after 4 rounds of IRS

Tororo District ct

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Malaria in Tororo after 4 rounds of IRS

Tororo: high malaria transmission district

• A. gambiae
• A. funestus

Anopheles biting density 149/person/night Rate of infective bites 2/person/night Community malaria prevalence 2012 48%

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Malaria in Tororo after 4 rounds of IRS

Initial control strategies

• Prompt

pt case management nt at health th facili litie ties

• LLINs to pregnant

ant mothers

• Intermite

itent t preventiv tive therapy py in pregnan nancy (IPTp) p)

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Malaria in Tororo after 4 rounds of IRS

Intensified vecto ctor control interve ventions

• Universal

al coverag age with Long Lastin ing Insectic ticide ide Treate ted d Nets (LLINs Ns) in 2013

• IRS in December 2014
• 4 rounds

ds of 6 month thly ly IRS done

• IRS to end in June 2017

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Malaria in Tororo after 4 rounds of IRS

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

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Malaria in Tororo after 4 rounds of IRS

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

• Intervie

iewed d 980 adults ts in 20 villag ages

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Malaria in Tororo after 4 rounds of IRS

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

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Malaria in Tororo after 4 rounds of IRS

Indoor vectors controlled, malaria persists

75 150 225 300 375 15 30 45 60 75

Oct Jan Jun Jan Jun Oct 2014 2015 2016 Month

IRS 2 IRS 3 IRS 4

IRS 1

Indoor Anopheles density

Incidence

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Malaria in Tororo after 4 rounds of IRS

Test positivi vity y rates indica cate

• ngoing transmission

IRS 1 IRS 2 IRS 3 IRS 4

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Malaria in Tororo after 4 rounds of IRS

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

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Malaria in Tororo after 4 rounds of IRS

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

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Malaria in Tororo after 4 rounds of IRS

Malaria persists below w baseline, a potential to upsurge

IRS 4

Action Alert Baseline

cases 2016

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Malaria in Tororo after 4 rounds of IRS

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

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Malaria in Tororo after 4 rounds of IRS

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

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Malaria in Tororo after 4 rounds of IRS

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

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