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

. 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

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

My Fellowship achievements Epidemiological study

. Under five mortality and household sanitary practices in Kakuuto County Rakai District, April 1st, 2014-March 30th, 2016

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

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

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)

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)

My Fellowship achievements Scientific Communication

. News paper article on burden of TB in Uganda-new vision . Two articles in MoH quarterly epidemiology bulletin

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

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

My Fellowship achievements Other Achievement

. Designed 1st draft of fellowship logo-currently being used

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

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

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

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

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

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

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

Risk factors for measles death

Location of cases

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

Risk factors for measles death

Potential risk factors

. Vaccination status

. Vitamin A supplement

. Inappropriate treatment

. Nutrition status

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

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

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

Risk factors for measles death