My Fellowshi hip p Achievement nts Christine Kihembo, MBChB, MIPH - - PowerPoint PPT Presentation

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My Fellowshi hip p Achievement nts Christine Kihembo, MBChB, MIPH - - PowerPoint PPT Presentation

May 18, 2023 7 likes •363 views

Public Health Fellowship Program Field Epidemiology Tra ck My Fellowshi hip p Achievement nts Christine Kihembo, MBChB, MIPH Fellow, Cohort 2015 Host Site - Epidemiology y & Surve veillance ce Divi vision (ESD), MoH ESD

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Public Health Fellowship Program – Field Epidemiology Track

My Fellowshi hip p Achievement nts

Christine Kihembo, MBChB, MIPH Fellow, Cohort 2015

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Fellowship Achievements

Host Site - Epidemiology y & Surve veillance ce Divi vision (ESD), MoH

  • ESD Mandate

Robust, sustainable systems for forecasting, early detection, response to public health events and improve disease prevention & response through IDSR

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Fellowship Achievements

Response to Public c Health Emergence ces

  • Large Typhoid outbreak in Kampala

– Desk review on strategies to deal with Antibiotic Resistance (ABR) – ABR Patterns Study in Kampala.

  • Typhoid Verification in Central districts

– Use of Standard Case Definitions – Strengthening Laboratory Surveillance

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Fellowship Achievements

Outbreak k Investigations & Rapid Response

  • Podoconiosis, Neglected Tropical Disease in

Kamwenge

  • Cholera Outbreak in Mutufu, Sironko
  • Suspected Hereditary Spastic Paraplegia in Ibanda
  • Rapid Assessment Avian Flu in Kalangala
  • Malaria Upsurge in Northern Uganda, Measles in

Kiruhura , Carbamate poisoning in Kagadi

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Fellowship Achievements

Surve veillance ce System Analysis and Evaluation

  • National Typhoid Surveillance System Analysis

– Disaggregation of data – Typhoid thresholds review

  • Re-vitalised IDSR/IHR evaluation
  • 2016 yellow fever outbreak preparedness and

response evaluation.

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Fellowship Achievements

Leadership and management

  • National Taskforce , Rapid Response Team Member
  • Technical Assistance to Emergency Operation

Centre on Event Based Surveillance

  • TWGs:

– AMR Taskforce, – Hepatitis B, Podoconiosis

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Fellowship Achievements

Deve velopment and Revi view of National Policy cy Guidelines

  • Antibiotic Resistance Surveillance Plan
  • Multi-hazard Preparedness and Response Plan
  • Curricula & SOPs:

– VHFs case management, – Frontline FETP – Rapid Response Teams

  • 2017 Cholera Prevention and Control Guidelines
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Fellowship Achievements

Led generation of epidemiological info for public c health action

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Fellowship Achievements

Training on Epidemic c Preparedness and Response.

  • IDSR/IHR Training and Support Supervision in 3

districts

  • Establishment of Podoconiosis Training: care,

treatment and surveillance

  • National Rapid Response Teams Training
  • Frontline Training roll out and mentorship
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Fellowship Achievements

Scientific c Communica cation

  • Risk factors for

Podoconiosis: EIS, NFEC, CDC science series

  • Significant Intermediate

Ciprofloxacin Resistance: JASH

  • ABR patterns in Kampala
  • ABR of Salmonella species

from scepticaemic patients in Kampala

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Fellowship Achievements

Sci cientific c Communica cation

  • Uganda to rethink infant Hep B vaccination

schedule

  • Articles in NIPH epi-bulletin
  • Co-author: BMC public health

– Large Typhoid Outbreak in Kampala – Risk Factors for ART Non-suppression

  • Kihembo et al., Risk factors for Podoconiosis in

Kamwenge, AJTMH

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Public Health Fellowship Program – Field Epidemiology Track

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Public Health Fellowship Program – Field Epidemiology Track

Anti-bacterial Resistance Patterns and Trends among Scepticaemic Patients, Kampala 2010-2015

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ABR patterns in Kampala, 2010-2015

ABR strains health system and economy

  • Anti-bacterial resistance (ABR): organism not

responsive to anti-bacterial drug previously effective

  • ABR implications: Longer hospital stay, high

cost, more toxic agents, poorer patient

  • utcomes
  • ABR is a priority area on GHSA
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ABR patterns in Kampala, 2010-2015

Limited non-mycobacterial ABR info: Fragmented surveillance in Uganda

  • No national active surveillance for ABR
  • Bacterial infections:

– 20% of all hospital deaths – 25% of deaths among children <5years

  • Published ABR info is a decade old
  • ABR data from private sector not utilized
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ABR patterns in Kampala, 2010-2015

  • Describe bacterial (non-mycobacterial)

etiologies for blood sepsis in Kampala

  • Characterize ABR patterns among most

identified bacteria

Objectives

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ABR patterns in Kampala, 2010-2015

Data source

  • Reviewed all blood culture records: 9 labs

(Public and Private) in Kampala

  • ABR testing according to Clinical and

Laboratory Standards Institute (CLSI) standards

  • Standardized data abstraction form
  • Collected demographics, organism isolated
  • Data analyzed over 6 year period
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ABR patterns in Kampala, 2010-2015

Case definitions

  • Species resistant to a drug annually

– High ABR ≥50%; Moderate ABR 10-49%; Low ABR <10%

  • Multi-drug resistant (MDR) salmonella:

resistant to Cotrimoxazole (COTRIM), Chloramphenicol (CAF) and Ampicillin (AMP)

  • MRSA: Staph species resistant to Oxacillin or

Cefoxitin

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ABR patterns in Kampala, 2010-2015

2998 Positive Blood Cultures Abstracted

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ABR patterns in Kampala, 2010-2015

Staphyl yloco cocc ccus predominant gram positive ve

85.9 7.9 3.6 1.2 0.7 0.6 0.1

20 40 60 80 100 Staphylococcus Streptococcus Enterococcus Corynbacteria Bacillus Others Non specified

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ABR patterns in Kampala, 2010-2015

Staph aureus most predominant among Staph speci cies

70.7 11.2 5.3 4.8 3.5 2.5 1.1 1

10 20 30 40 50 60 70 80 Staph Aureus Coagulase negative Staph Staph epidermidis Staph haemolyticus Staph spp Staph hominis Others Staph saprophyticus

Frequency (%) Staphylococcus species

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ABR patterns in Kampala, 2010-2015

Children<5 and elderly y more affected by Staph infections

50 100 150 200 250 20 40 60 80 100

Incidence /100,000 Age ( years)

Incidence of Staph spp by Age-group

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ABR patterns in Kampala, 2010-2015

Salmonella predominant gram neg eg

28.4 20.6 12.7 12.5 6.1 4.8 4.3 3.1 2.97 3.04

5 10 15 20 25 30 Coliforms Salmonella Klebsiella

  • E. coli

Acinetobacter Pseudomonas Enterobacter Citrobacter Non Specified Others

Frequency (%) Gram Neg

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ABR patterns in Kampala, 2010-2015

Typhoidal speci cies predominant among Salmonella organism

51.4 35.2 5.3 4.5 2 1.2 0.4

10 20 30 40 50 60

Salmonella typhi Salmonella spp Salmonella paratyphi Salmonella D Salmonella enterica Salmonella B Salmonella choleraesuis

Frequency (%) Salmonella specie

Non- specified

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ABR patterns in Kampala, 2010-2015

Children 0-5, young adults and elderly more affected by Salmonella

3 6 9 12 15 18 20 40 60 80 100

Incidence /100,000 Age ( years)

Incidence of Salmonella spp by Age-group

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ABR patterns in Kampala, 2010-2015

Staph: Moderate to high ABR to common drugs

20 40 60 80 100 2010 2011 2012 2013 2014 2015 % Resistance Year

ERTH CAF COTRIM TETRA

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ABR patterns in Kampala, 2010-2015

Increasing trend of Methici cillin Resistant Staph

10 20 30 40 50 60 70 80 90 2010 2011 2012 2013 2014 2015

% Resistance Year

MRSA CEFTR OXA CIPR

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ABR patterns in Kampala, 2010-2015

Reduct ction in 1st line drug ABR for Salmonella

15 30 45 60 75 90 2010 2011 2012 2013 2014 2015

% Resistance Year

AMP CAF MDR COTRIM

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ABR patterns in Kampala, 2010-2015

Rapidly increasing intermediate resistance ce to Ciprofloxaci cin

10 20 30 40 50 2010 2011 2012 2013 2014 2015

Year % Resistance

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ABR patterns in Kampala, 2010-2015

Increasing Resistance ce to Ceftriaxo xone

5 10 15 20 25 2010 2011 2012 2013 2014 2015 X2 =6.5 p=0.01

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ABR patterns in Kampala, 2010-2015

No Ciprofloxa xaci cin, Ceftriaxo xone susce ceptibility testing in >20% Salmonella isolates

% Tested

Ciprofloxacin (Fluroquinolone) 78 Ceftriaxone (Cephalosporin) 79

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ABR patterns in Kampala, 2010-2015

Limitations and Strengths

Strength

  • Relatively large sample for ABR studies
  • Routine data collected from registered health

units Limitations

  • Incomplete and missing data
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ABR patterns in Kampala, 2010-2015

Concl clusion

  • Salmonella and Staphylococcus most

common cause of scepticaemia

  • High level Methicillin Resistant Staph
  • Rapid increase in ABR to Ciprofloxacin among

Salmonella spp.

  • Susceptibility to traditional first line antibiotics

for Salmonella has gradually returned

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ABR patterns in Kampala, 2010-2015

Reco commendations

  • Adherence to ABR testing standards
  • Rational use of antibiotics guided by ABR

patterns to address the changing ABR picture.

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Public Health Fellowship Program – Field Epidemiology Track

Acknowledgment

  • Mulago, Mengo, Rubaga,

Nsambya Hospitals, Nakasero, Ebenezer Makerere University Medical Microbiology Lab, LMK, ABI, UNHLS

  • PHFP Secretariat
  • Epidemiology & Surveillance

Division, MOH

  • CDC