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

Public Health Fellowship Program – Field Epidemiology Tra ck My Fellows wship Achieve vements David W. Oguttu tu, , BBLT, Mzoo/PAR Fellow, , Cohort t 2015

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 2 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 or biting behavior or in IRS district cts – Malaria vector or resistance ce to pyrethroi oids 3 My Fellowship achievements

Response to Public c Health Emergency cy  Led 2 outbreak investigations – Cholera outbreak in Kaiso Hoima, Oct. 2015 – Acute viral Hepatitis; Napak District  Coinvestigated 4 other outbreaks: – Typhoi oid outbreak k in Kampala – Typhoi oid outbreak k verifica cation on, Nebbi and Moyo – Malaria outbreak k in Northern Uganda – Cholera outbreak in Namayingo District April 2016  Respon onded & verified 5 outbreak k rumor ors in Toror oro 4 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 5 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 6 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 : s ubmitt 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 7 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 8 My Fellowship achievements

Leadership and management 9 My Fellowship achievements

Public Health Fellowship Program – Field Epidemiology Tra ck 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

Tororo District ct 11 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% 12 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) 13 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 14 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 15 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 16 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 17 Malaria in Tororo after 4 rounds of IRS

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

Test positivi vity y rates indica cate ongoing transmission IRS 2 IRS 1 IRS 3 IRS 4 19 Malaria in Tororo after 4 rounds of IRS

Asymptomatic community malaria prevalence persists at moderate endemicity Number RDT Age group tested positive Prevalence % < 5 years 979 206 21 ≥ 18 years 984 68 7.0 Overall 1963 274 14 20 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 21 Malaria in Tororo after 4 rounds of IRS

Malaria persists below w baseline, a potential to upsurge IRS 4 Action Alert Baseline cases 2016 22 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 23 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 24 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 25 Malaria in Tororo after 4 rounds of IRS

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