Outbreak Research
Throughout the years, I've participated in several research projects as a member of the Outbreak Research Team at ITM.
Here are some highlights!
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Bartonella quintana infection in Brussels, Belgium
2024-2025
Research Summary
Background
Our prior epidemiological research documented a significant increase in scabies incidence across Belgium from 2000-2023, with annual increases of 15% observed in primary care settings from 2011-2023. This trend was consistently observed across multiple data sources and disproportionately affected young adults aged 15-24 years and urban populations.
Check the recent publication here
We were also interviewed in the Flemish science magazine EOS, see Dutch article here
Current Investigation
I am co-principal investigator, alongside Dr. Soledad Colombe, on a mixed-methods study conducted by the Institute of Tropical Medicine in partnership with Sciensano and the Flemish Department of Care. The research is being conducted across five major cities in Flanders: Antwerp, Ghent, Bruges, Leuven, and Hasselt.
Research Objectives
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Quantify scabies presentations to outpatient care in Flanders
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Assess rates of treatment failure and re-infection
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Identify risk factors associated with treatment failure and re-infection
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Characterize diagnostic pathways and delays
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Examine patient health-seeking behaviors and treatment access barriers
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Evaluate healthcare provider practices and management challenges
Methodology
The investigation employs a mixed-methods design over 18 months, utilizing a sentinel network of healthcare facilities including infectious disease clinics, emergency departments, general practices, dermatology services, and community outreach programs.
Data collection comprises:
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Qualitative interviews with approximately patients with scabies and healthcare providers
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Quantitative surveys administered to healthcare practitioners (baseline and monthly)
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Case report forms for detailed patient tracking
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Anonymous online patient surveys
Multilingual data collection (Dutch, English, French, Arabic, Dari, Pashto)
Significance
This research builds upon our established epidemiological foundation to examine the mechanisms underlying the documented increase in scabies incidence. The findings will inform evidence-based interventions to improve diagnostic accuracy, treatment efficacy, and public health response strategies, ultimately reducing disease burden on patients, healthcare systems, and communities in Belgium and potentially other European countries experiencing similar epidemiological trends.
2022-2025
Rift Valley Fever in Rwanda
Research Summary
Background
Rift Valley fever (RVF) is an emerging zoonotic mosquito-borne disease affecting humans and livestock across East Africa. Rwanda has experienced recurring outbreaks since 2012, with the 2022 outbreak representing the largest to date—1,339 confirmed animal cases across all provinces. Our research examines RVF control through three interconnected dimensions: outbreak response effectiveness, farmer engagement, and climate change impacts.
Check our first publication here
Current Research Program
As a collaborator, I conduct integrated research examining RVF prevention and control in Rwanda and neighboring East African countries through multidisciplinary approaches combining epidemiological analysis, systematic reviews, and One Health implementation research.
Research Objectives
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Evaluate Rwanda's One Health response to the 2022 RVF outbreak and cross-sectoral coordination mechanisms
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Analyze farmer engagement barriers and facilitators in RVF control across East Africa
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Assess climate change impacts on livestock management and disease risk
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Examine gender dynamics and socio-cultural factors affecting community participation
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Investigate climate-driven changes in farmer practices and livestock movement patterns
Methodology
The investigation employs mixed methods including retrospective analysis of national surveillance data, systematic literature reviews (2007-2025), and scoping reviews covering Rwanda, Burundi, Tanzania, Uganda, DRC, and Kenya. Data sources include outbreak surveillance systems, peer-reviewed literature, and grey literature from agricultural and health sectors.
Key Findings
Rwanda's coordinated One Health response effectively contained the 2022 outbreak through multisectoral command posts and mass vaccination (87% cattle coverage). However, persistent barriers limit farmer engagement, including gender inequities (women comprise 56.6% of farmers but have limited access to services), centralized veterinary systems, and underutilized local knowledge. Climate change is driving significant adaptations in livestock management, with 60% of farmers in some regions unaware of climate information despite identifying climate change as their primary environmental concern.
Significance
This research demonstrates that effective RVF control requires integrated response systems, community-centered approaches, and climate-informed strategies. The findings inform zoonotic disease preparedness, One Health implementation, and climate adaptation policies across sub-Saharan Africa, particularly as climate change continues altering disease epidemiology and increasing outbreak frequency in the East African region.
2021-2025
Malaria in Burundi
Research Summary
Background
Malaria remains the leading cause of morbidity and mortality in Burundi, constituting a major public health problem with endemic-epidemic characteristics. Despite the implementation of multiple prevention strategies since 2000—including mass distribution of long-lasting insecticidal nets (LLINs), indoor residual spraying (IRS), intermittent preventive treatment during pregnancy (IPTp), and community case management—Burundi has experienced a significant increase in cases and mortality rates, contrasting with the general downward trend observed across much of Africa between 2000 and 2015. With annual incidences fluctuating between 470 and 815 cases per thousand inhabitants between 2017 and 2021, and reaching mortality rates of 32%, the country presents a complex epidemiological landscape requiring comprehensive investigation.
Current Investigation
With my collaborators, we developed a package of 5 different studies, conducted by the Institute of Tropical Medicine in partnership with Médecins Sans Frontières (MSF), the National Integrated Malaria Control Programme (PNILP), and regional health authorities.
One of them was a qualitative study that was conducted in the health districts of Kinyinya and Ryansoro in central and eastern Burundi, representing different epidemiological profiles—Kinyinya characterized by high endemicity (50.7% annual incidence) in low-altitude plains, and Ryansoro by meso-endemicity (15.19% annual incidence) in highland areas.
Research Objectives of the qualitative study
• Analyze community perceptions, attitudes, and practices regarding long-lasting insecticidal nets (LLINs) utilization
• Examine community responses and behaviors toward indoor residual spraying (IRS) interventions
• Assess knowledge, acceptance, and adherence patterns for intermittent preventive treatment during pregnancy (IPTp-SP)
• Investigate environmental management practices and larval breeding site control behaviors
• Identify barriers and facilitators influencing the adoption of malaria prevention measures
• Understand healthcare-seeking behaviors and treatment access patterns
• Evaluate the interaction between multiple simultaneous prevention interventions
Methods
The study engaged participants across varied socio-economic backgrounds, with farmers comprising 82% of individual interview participants and women representing 53% of individual interviews and 57% of focus group participants.
Significance
This research addresses a critical gap in understanding community-level factors that may explain the persistence of high malaria transmission despite extensive control efforts. By examining the intersection of multiple prevention strategies from the community perspective, the findings provide essential insights into implementation challenges, and socio-economic constraints that influence intervention effectiveness. The results inform evidence-based approaches to improve diagnostic accuracy, treatment efficacy, and prevention program design, ultimately contributing to reduced disease burden on patients, healthcare systems, and communities in Burundi and potentially other countries experiencing similar epidemiological challenges in malaria control.
2022-2024
Cholera outbreak in Cameroon
Research Summary
Check our publication here
Background
Cholera remains a significant public health challenge in Cameroon, with the country experiencing recurring outbreaks since 1991 and an increasing annual incidence. The largest outbreak occurred in 2011 with 23,152 reported cases and 843 deaths. Historically, northern regions have reported the highest case numbers, while the Southwest region contributed approximately 8% of the total national burden. However, the 2021-22 period marked a dramatic shift in this epidemiological pattern.
The 2021-22 Outbreak Investigation
In October 2021, a cholera outbreak was declared in Cameroon that disproportionately affected the Southwest region, with over 4,400 cases (68% of the national total) reported by March 2022. The outbreak coincided with an ongoing humanitarian crisis that had led to an influx of internally displaced persons (IDPs) in major cities including Limbe, Buea, and Tiko. Concurrently, Nigeria was experiencing an unprecedented cholera outbreak with over 112,000 cases, particularly affecting Cross River State which borders the Southwest region of Cameroon.
My Involvement
I served as a collaborator and co-author on the epidemiological investigation of this outbreak, contributing to the analysis and manuscript preparation alongside colleagues from the Institute of Tropical Medicine, University of Buea, and regional health authorities.
Research Methodology
The investigation employed a mixed-methods approach combining:
• Retrospective analysis of surveillance data (line list) from October 2021 to July 2022
• Descriptive outbreak analysis examining temporal, spatial, and demographic patterns
• Case-control study conducted in the three most affected health districts (Limbe, Buea, and Tiko)
• Risk factor assessment focusing on overcrowding, internally displaced status, water sources, and housing conditions
Data collection utilized validated questionnaires adapted for the Cameroonian context, with 207 recovered cholera cases and 206 neighborhood controls recruited for the case-control component.
Key Findings
The outbreak represented the largest cholera outbreak ever recorded in the Southwest region, with 6,023 cases and 93 deaths (case fatality rate 1.54%) between October 2021 and July 2022. The investigation revealed:
• Cross-border transmission: First cases originated from maritime communities along the Nigeria-Cameroon border, supporting evidence of cross-border spread
• Geographic progression: Cases initially concentrated in maritime health districts before spreading to mainland urban areas
• Demographic impact: Median age 27 years, with 54% male cases
• Urban concentration: Over 80% of cases occurred in three mainland health districts (Limbe, Buea, Tiko)
• Higher maritime mortality: Case fatality was significantly higher in maritime districts (3.39%) compared to mainland districts (1.5%)
• Overcrowding association: While not statistically significant, point estimates suggested a potential dose-response relationship between household size and cholera risk
Public Health Significance
This research documented the first reported cholera outbreak in the Southwest region likely attributable to cross-border transmission, representing a substantial departure from historical epidemiological patterns. The findings highlight the vulnerability of conflict-affected populations and the importance of cross-border surveillance systems. The outbreak response included oral cholera vaccine campaigns achieving ~94% coverage in maritime communities and ~98% in mainland areas.
Implications
The study underscores the critical need for enhanced cross-border surveillance and outbreak preparedness, particularly in humanitarian crisis settings. The research contributes to understanding cholera transmission dynamics in conflict-affected regions and informs evidence-based preparedness strategies for similar cross-border epidemic scenarios in Central and West Africa.
2020-2023
COVID-19 research among racialized/ethnic minorities in Antwerp (Belgium)
Research Summary
Background
Building on prior epidemiological work documenting health disparities among immigrant and ethnic minority populations, this research examined the differential impacts of COVID-19 and related control measures on racialized/ethnic minority communities in Antwerp, Belgium. The investigation was motivated by early reports suggesting certain communities were disproportionately affected by both the virus and pandemic control measures, while lacking disaggregated epidemiological data to understand these impacts systematically.
Investigation
I served as co-principal investigator, alongside Dr. Christiana Nöstlinger, on a mixed-methods rapid assessment conducted by the Institute of Tropical Medicine in partnership with local authorities. The research was conducted across multiple racialized/ethnic minority communities in Antwerp, including Sub-Saharan African migrant communities, North-African and Middle-Eastern communities, and Orthodox Jewish communities.
Research Objectives
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Assess information and prevention needs among racialized/ethnic minority communities during COVID-19
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Examine community responses and coping strategies to pandemic control measures
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Identify barriers to accessing accurate COVID-19 information and healthcare services
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Document community-based initiatives and resilience mechanisms
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Analyze the intersection of pre-existing social, economic, and migration-related vulnerabilities with pandemic impacts
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Evaluate the role of community leadership and religious authorities in pandemic response
Methodology
The investigation employed a participatory mixed-methods design utilizing community advisory boards and established community networks. Data collection was conducted between April 2020 and May 2021, spanning the first lockdown period through subsequent waves.
Data collection comprised:
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Key informant interviews with community leaders, health professionals, and social workers (N=49)
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In-depth interviews with community members (N=22)
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Online group discussions with community representatives (N=10)
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Community mapping exercises to identify stakeholders and response mechanisms
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Multilingual data collection (Dutch, English, French, Yiddish, Hebrew, and Arabic)
Significance
This research provided critical insights into how COVID-19 functioned as a "social disease," with impacts strongly intertwined with pre-existing socio-economic disadvantages, discrimination experiences, and structural vulnerabilities. The findings revealed both the challenges faced by racialized/ethnic minorities—including information barriers, economic precarity, and stigmatization—and their remarkable resilience through community-based responses. The research documented valuable examples of community-centered approaches to health emergencies, including rapid mobilization of existing networks, culturally adapted communication strategies, and innovative solutions to maintain social support during physical distancing requirements. These findings inform evidence-based recommendations for inclusive pandemic preparedness and response strategies that recognize community expertise and address structural inequities affecting minority populations in urban settings.
Check our publications here
