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Risk Factors for Measles Death Among Children in Kyegegwa District – Measles Outbreak in Kyegegwa District

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Risk Factors for Measles Death Among Children in Kyegegwa District – Measles Outbreak in Kyegegwa District Public Health Fellowship Program – Field Epidemiology Track My Fellowship Achievements Mafigiri Richardson, BSc Zoo/Chem, MSc IIDM Fellow, cohort 2015 Host site, Rakai District . 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 Epidemiological study . Under five mortality and household sanitary practices in Kakuuto County Rakai District, April 1st, 2014-March 30th, 2016 4 My Fellowship achievements Public health surveillance . 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, 1st 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 1st draft of fellowship logo-currently being used 12 My Fellowship achievements Public Health Fellowship Program – Field Epidemiology Track Risk Factors for Measles Death in Children: Kyegegwa District, Western Uganda, Feb - Sept 2015 Mafigiri Richardson, BSc Zoo/Chem, MSc IIDM Fellow, Cohort 2015 Measles affected Districts 14 Risk factors for measles death Events leading to investigation Lab confirmation of measles outbreak 18th Aug 2015 25th Aug 28th Aug 2015 Start of investigation Notification of suspected measles death 15 Risk factors for measles death Objectives . Identify risk factors for measles death in Kyegegwa District . Provide evidence-based control measures to prevent future measles deaths 16 Risk factors for measles death Case definitions . Probable case: Onset of high fever and generalized rash, plus ≥1 of the following: conjunctivitis, coryza, or cough . Measles death: Death of probable measles case 17 Risk factors for measles death Active case finding . Searched for cases with the help of VHTs . Reviewed medical records . Analysed data in the DHIS 2 18 Risk factors for measles death DHIS 2 . An electronic MoH national health information system . Used for; – integrated data management and analysis, – health program monitoring and evaluation, – facility registry functions, etc. Data from health units is captured using HMIS tools . Analysis of data done periodically at national level for reporting and determination of disease trends and alerts 19 Risk factors for measles death Case count from active case finding . 94 persons with probable measles diagnosis 64 <5 years 30 ≥5 years . 16 deaths, all were <5 years 20 Risk factors for measles death Active community case finding yielded more deaths than DHIS2 Data source Measles Deaths CFR cases DHIS2 85 1 1.2 Active Community 94 16 17 surveillance 21 Risk factors for measles death Location of cases 22 Risk factors for measles death Case-control study . Cases: 16 children (<5) who had measles and died . Controls: 48 children (<5) who had measles and survived . Matched by age and village 23 Risk factors for measles death Potential risk factors . Vaccination status . Vitamin A supplement . Inappropriate treatment . Nutrition status 24 Risk factors for measles death Factors associated with measles death %of Cases %of Controls Variables (n=16) (n=48) OR (95% CI) Treatment at home 63 6 33(6.8-159) No vaccination 94 54 12(1.6-104) No Vit A supp. 56 35 2.3(0.74-7.4) Malnutrition 38 25 2.5(0.67-9.1) 25 Risk factors for measles death Conclusions . Non-vaccination was associated with measles death . Management of measles patients at home was associated with death . More measles deaths occurred in community than reported in the National surveillance system 26 Risk factors for measles death Recommendations . Enhancement of measles vaccination among children <5 years . Measles patients should be managed at health facilities for better treatment outcome . Strengthening community component of HMIS for more complete reporting 27 Risk factors for measles death Acknowledgement . Ministry of Health . US Centers for Disease Control and Prevention . Makerere School of Public Health . Kyegegwa District Health Team . Public Health Fellowship Program . Rakai Health Sciences Program 28 Risk factors for measles death Factors protective against measles death % of % of Cases Variables Controls (n=16) ORM-H (95% CI) (n=48) Vaccination for 6.3 46 0.0 (0.0-0.33) measles Vit A supplement 37 67 0.14 (0.037-0.77) during illness Appropriate 25 98 0.0 (0.0-0.12) treatment Malnutrition 38 25 2.5 (0.67-9.1) 29 Risk factors for measles death Assessment for malnutrition . Used proxy pictures to parents of deceased children – Severely malnourished – Moderately malnourished – Normal child 30 Risk factors for measles death .
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