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Harris JR, Kadobera D, Kwesiga B, Kabwama SN, Bulage L, Kyobe HB, Kagirita AA, Mwebesa HG, Wanyenze RK, Nelson LJ, Boore AL, Ario AR. Improving the effectiveness of Field Epidemiology Training Programs: characteristics that facilitated effective response to the COVID-19 pandemic in Uganda. BMC Health Serv Res 2022; 22:1532. [PMID: 36526999 PMCID: PMC9756722 DOI: 10.1186/s12913-022-08781-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/10/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The global need for well-trained field epidemiologists has been underscored in the last decade in multiple pandemics, the most recent being COVID-19. Field Epidemiology Training Programs (FETPs) are in-service training programs that improve country capacities to respond to public health emergencies across different levels of the health system. Best practices for FETP implementation have been described previously. The Uganda Public Health Fellowship Program (PHFP), or Advanced-FETP in Uganda, is a two-year fellowship in field epidemiology funded by the U.S. Centers for Disease Control and situated in the Uganda National Institute of Public Health (UNIPH). We describe how specific attributes of the Uganda PHFP that are aligned with best practices enabled substantial contributions to the COVID-19 response in Uganda. METHODS We describe the PHFP in Uganda and review examples of how specific program characteristics facilitate integration with Ministry of Health needs and foster a strong response, using COVID-19 pandemic response activities as examples. We describe PHFP activities and outputs before and during the COVID-19 response and offer expert opinions about the impact of the program set-up on these outputs. RESULTS Unlike nearly all other Advanced FETPs in Africa, PHFP is delinked from an academic degree-granting program and enrolls only post-Master's-degree fellows. This enables full-time, uninterrupted commitment of academically-trained fellows to public health response. Uganda's PHFP has strong partner support in country, sufficient technical support from program staff, Ministry of Health (MoH), CDC, and partners, and full-time dedicated directorship from a well-respected MoH staff member. The PHFP is physically co-located inside the UNIPH with the emergency operations center (EOC), which provides a direct path for health alerts to be investigated by fellows. It has recognized value within the MoH, which integrates graduates into key MoH and partner positions. During February 2020-September 2021, PHFP fellows and graduates completed 67 major COVID-related projects. PHFP activities during the COVID-19 response were specifically requested by the MoH or by partners, or generated de novo by the program, and were supervised by all partners. CONCLUSION Specific attributes of the PHFP enable effective service to the Ministry of Health in Uganda. Among the most important is the enrollment of post-graduate fellows, which leads to a high level of utilization of the program fellows by the Ministry of Health to fulfill real-time needs. Strong leadership and sufficient technical support permitted meaningful program outputs during COVID-19 pandemic response. Ensuring the inclusion of similar characteristics when implementing FETPs elsewhere may allow them to achieve a high level of impact.
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Affiliation(s)
- Julie R. Harris
- grid.512457.0Centers for Disease Control and Prevention, Kampala, Uganda
| | - Daniel Kadobera
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda
| | - Benon Kwesiga
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda
| | - Steven N. Kabwama
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda
| | - Henry B. Kyobe
- grid.4991.50000 0004 1936 8948University of Oxford, Kellogg College, Oxford, UK ,grid.415705.2Ministry of Health, Kampala, Uganda
| | | | | | - Rhoda K. Wanyenze
- grid.11194.3c0000 0004 0620 0548College of Health Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Lisa J. Nelson
- grid.512457.0Centers for Disease Control and Prevention, Kampala, Uganda
| | - Amy L. Boore
- grid.512457.0Centers for Disease Control and Prevention, Kampala, Uganda
| | - Alex Riolexus Ario
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda ,grid.415705.2Ministry of Health, Kampala, Uganda
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Kayiwa J, Homsy J, Nelson LJ, Ocom F, Kasule JN, Wetaka MM, Kyazze S, Mwanje W, Kisakye A, Nabunya D, Nyirabakunzi M, Aliddeki DM, Ojwang J, Boore A, Kasozi S, Borchert J, Shoemaker T, Nabatanzi S, Dahlke M, Brown V, Downing R, Makumbi I. Establishing a Public Health Emergency Operations Center in an Outbreak-Prone Country: Lessons Learned in Uganda, January 2014 to December 2021. Health Secur 2022; 20:394-407. [PMID: 35984936 PMCID: PMC10985018 DOI: 10.1089/hs.2022.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Uganda is highly vulnerable to public health emergencies (PHEs) due to its geographic location next to the Congo Basin epidemic hot spot, placement within multiple epidemic belts, high population growth rates, and refugee influx. In view of this, Uganda's Ministry of Health established the Public Health Emergency Operations Center (PHEOC) in September 2013, as a central coordination unit for all PHEs in the country. Uganda followed the World Health Organization's framework to establish the PHEOC, including establishing a steering committee, acquiring legal authority, developing emergency response plans, and developing a concept of operations. The same framework governs the PHEOC's daily activities. Between January 2014 and December 2021, Uganda's PHEOC coordinated response to 271 PHEs, hosted 207 emergency coordination meetings, trained all core staff in public health emergency management principles, participated in 21 simulation exercises, coordinated Uganda's Global Health Security Agenda activities, established 6 subnational PHEOCs, and strengthened the capacity of 7 countries in public health emergency management. In this article, we discuss the following lessons learned: PHEOCs are key in PHE coordination and thus mitigate the associated adverse impacts; although the functions of a PHEOC may be legalized by the existence of a National Institute of Public Health, their establishment may precede formally securing the legal framework; staff may learn public health emergency management principles on the job; involvement of leaders and health partners is crucial to the success of a public health emergency management program; subnational PHEOCs are resourceful in mounting regional responses to PHEs; and service on the PHE Strategic Committee may be voluntary.
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Affiliation(s)
- Joshua Kayiwa
- Joshua Kayiwa, MSc, is a Plans Chief and Information Analyst, Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Jaco Homsy
- Jaco Homsy, MD, MPH, is an Associate Clinical Professor, Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco School of Medicine, San Francisco, CA
| | - Lisa J Nelson
- Lisa J. Nelson, MD, MPH, MSc, is a Medical Officer and Uganda Country Director, US Centers for Disease Control and Prevention (CDC) Country Office, Kampala, Uganda
| | - Felix Ocom
- Felix Ocom, MD, is Deputy Director, Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Juliet N Kasule
- Juliet N. Kasule, MSc, is an Early Warning Specialist, US Centers for Disease Control and Prevention (CDC) Country Office, Kampala, Uganda
| | - Milton M Wetaka
- Milton M. Wetaka is a Logistics Chief and Laboratory Specialist, Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Simon Kyazze
- Simon Kyazze, MSc, is an Operations Chief, Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Wilbrod Mwanje
- Wilbrod Mwanje, MPH, is an Epidemiologist, Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Anita Kisakye
- Anita Kisakye, MSc, is a Monitoring and Evaluation Specialist, Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Dorothy Nabunya
- Dorothy Nabunya is an Administrative Specialist, Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Margaret Nyirabakunzi
- Margaret Nyirabakunzi is an Administrative Assistant, Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Dativa Maria Aliddeki
- Dativa Maria Aliddeki, MSc, is an Epidemiologist, Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Joseph Ojwang
- Joseph Ojwang, MPH, is an Epidemiologist, US Centers for Disease Control and Prevention (CDC) Country Office, Kampala, Uganda
| | - Amy Boore
- Amy Boore, PhD, is Director, Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC) Country Office, Kampala, Uganda
| | - Sam Kasozi
- Sam Kasozi is a Systems Developer, Health Information Systems Program Uganda, Kampala, Uganda
| | - Jeff Borchert
- Jeff Borchert, MSc, is a Public Health Advisor, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), US CDC, Fort Collins, CO
| | - Trevor Shoemaker
- Trevor Shoemaker, PhD, is an Epidemiologist, Division of High-Consequence Pathogens and Pathology, NCEZIDUS CDC, Atlanta, GA
| | - Sandra Nabatanzi
- Sandra Nabatanzi, MSc, is an Epidemiologist, Monitoring and Evaluation Technical Support Program, Makerere University School of Public Health, Kampala, Uganda
| | - Melissa Dahlke
- Melissa Dahlke, MSc, is an Epidemiologist, Global Immunization Division, Center for Global Health, US CDC, Atlanta, GA
| | - Vance Brown
- Vance Brown, MA, is a Public Health Advisor, Division of Global Health Protection, NCEZID, US CDC, Atlanta, GA
| | - Robert Downing
- Robert Downing, PhD, is a Laboratory Specialist, Uganda Virus Research Institute, Ministry of Health, Entebbe, Uganda
| | - Issa Makumbi
- Issa Makumbi, MSc, is Director, Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
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Walekhwa AW, Musoke D, Nalugya A, Biribawa C, Nsereko G, Wafula ST, Nakazibwe B, Nantongo M, Odera DA, Chiara A, Boyce RM, Mulogo EM. Gaps in measles vaccination coverage in Kasese district, Western Uganda: results of a qualitative evaluation. BMC Infect Dis 2022; 22:589. [PMID: 35787247 PMCID: PMC9251590 DOI: 10.1186/s12879-022-07579-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Despite the availability of a highly effective vaccine, measles remains a substantial public health problem in many countries including Uganda. In this study, conducted between June–August 2020 following a local outbreak, we sought to explore the factors that could affect measles vaccination coverage in rural western Uganda. Methods We conducted a descriptive study using qualitative data collection approaches in the Kasese district. The research team utilized purposive sampling to identify and select participants from the public health sector and district government. We conducted key informant interviews (KII) and one focus group discussion (FGD). Responses were recorded using portable electronic devices with the FGD and KII guide installed. Interviews were conducted at the health centre and district headquarters. Data was coded and analysed using ATLAS.ti version 8 software through deductive thematic analysis to identify key themes. Results Barriers to measles vaccination identified in this study were premised around six themes including: (i) availability of supplies and stock management, (ii) health worker attitudes and workload, (iii) financing of vaccination outreach activities, (iv) effectiveness of duty rosters (i.e., health workers’ working schedules), (v) community beliefs, and (vi) accessibility of healthcare facilities. Respondents reported frequent vaccine supply disruptions, lack of resources to facilitate transportation of health workers to communities for outreach events, and health centre staffing that did not adequately support supplemental vaccination activities. Furthermore, community dependence on traditional medicine as a substitute for vaccines and long distances traveled by caregivers to reach a health facility were mentioned as barriers to vaccination uptake. Conclusions Health system barriers limiting vaccination uptake were primarily logistical in nature and reflect inadequate resourcing of immunization efforts. At the same time, local beliefs favouring traditional medicine remain a persistent cultural barrier. These findings suggest an urgent need for more efficient supply management practices and resourcing of immunization outreaches in order to achieve the Uganda Ministry of Health’s targets for childhood immunization and the prevention of disease outbreaks. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07579-w.
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Affiliation(s)
- Abel Wilson Walekhwa
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda. .,School of Public Health, College of Health Sciences, Makerere University, P.O. BOX 7072, Kampala, Uganda.
| | - David Musoke
- School of Public Health, College of Health Sciences, Makerere University, P.O. BOX 7072, Kampala, Uganda
| | - Aisha Nalugya
- School of Public Health, College of Health Sciences, Makerere University, P.O. BOX 7072, Kampala, Uganda
| | - Claire Biribawa
- School of Public Health, College of Health Sciences, Makerere University, P.O. BOX 7072, Kampala, Uganda.,Ministry of Health, Uganda, P.O BOX 7272, Kampala, Uganda
| | | | - Solomon Tsebeni Wafula
- School of Public Health, College of Health Sciences, Makerere University, P.O. BOX 7072, Kampala, Uganda
| | - Brenda Nakazibwe
- School of Public Health, College of Health Sciences, Makerere University, P.O. BOX 7072, Kampala, Uganda
| | - Mary Nantongo
- School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. BOX 7072, Kampala, Uganda
| | - Doreen Awino Odera
- Department of Public Health, North Dakota State University, Fargo, ND, 58102, USA
| | - Achangwa Chiara
- Department of Public Health and Hygiene, University of Buea, Cameroon, P.O. Box 63, Buea, Cameroon
| | - Ross Mathew Boyce
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda.,Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Edgar Mugema Mulogo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
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Song K, Lee JM, Lee EJ, Lee BR, Choi JY, Yun J, Lee SN, Jang MY, Kim HW, Kim HS, Moon SM, Kim YK. Control of a nosocomial measles outbreak among previously vaccinated adults in a population with high vaccine coverage: Korea, 2019. Eur J Clin Microbiol Infect Dis 2022; 41:455-466. [PMID: 34999974 DOI: 10.1007/s10096-021-04390-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/30/2021] [Indexed: 01/26/2023]
Abstract
We describe a measles outbreak among previously vaccinated healthcare workers (HCWs) and inpatients and the control measures implemented at a tertiary care hospital in 2019. Case-patients were laboratory-confirmed measles with throat swabs tested by quantitative polymerase chain reactions (PCR), during April-May 2019. Medical histories and documented immunization records were obtained. We compared attack rates (ARs) among HCWs by occupational subgroup and age and examined the outbreak-associated costs. The index case was not ascertained. Among 26 measles case-patients (22 HCWs, four inpatients) aged 18-28 years, 25 had previously received measles-mumps-rubella (MMR) vaccine (12/26, 46% (two doses); 13/26, 50% (one dose)), and 16 (62%) had positive results of measles IgG prior to measles diagnosis. ARs were higher among HCWs aged < 30 years (1.88%), especially in the subgroup under 25 years of age (2.22%). Control measures included work restrictions for seronegative HCWs (218/2320, 9.4%) in immunity verification, administration of the MMR vaccine (207 HCWs) or intravenous immunoglobulin (2 HCWs and 11 inpatients), enhanced health surveillance of HCWs, and mandatory assessment of patients with measles-like symptoms at the infectious diseases screening units. The hospital spent 90,417,132 Korean won (US $79,733) in response to the outbreak. Measles outbreaks can occur in healthcare settings despite high population immunity, highlighting the importance of stronger vaccination policies, particularly among young HCWs. Moreover, an effective outbreak response comprising immunization activities and enhanced surveillance of HCWs and patients to rapidly detect measles-like symptoms at a prodromal phase is essential to control nosocomial measles outbreaks.
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Affiliation(s)
- Kyunghyun Song
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Ju Mi Lee
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eun Ju Lee
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Bo Ram Lee
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ji Young Choi
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jihee Yun
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Se Na Lee
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Mi Young Jang
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Han Wool Kim
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea.,Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Han-Sung Kim
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea.,Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Song Mi Moon
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.,Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea.,Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Yong Kyun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea. .,Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea. .,Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
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Moon J, Ryu BH. Transmission risks of respiratory infectious diseases in various confined spaces: A meta-analysis for future pandemics. ENVIRONMENTAL RESEARCH 2021; 202:111679. [PMID: 34265349 PMCID: PMC8566017 DOI: 10.1016/j.envres.2021.111679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/14/2021] [Accepted: 06/30/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND If the different transmission risks of respiratory infectious diseases according to the type of confined space and associated factors could be discovered, this kind of information will be an important basis for devising future quarantine policies. However, no comprehensive systematic review or meta-analysis for this topic exists. OBJECTIVE The objective of this study is to analyze different transmission risks of respiratory infectious diseases according to the type of confined space. This information will be an important basis for devising future quarantine policies. METHODS A medical librarian searched MEDLINE, EMBASE, and the Cochrane Library (until December 01, 2020). RESULTS A total of 147 articles were included. The risk of transmission in all types of confined spaces was approximately 3 times higher than in open space (combined RR, 2.95 (95% CI 2.62-3.33)). Among them, school or workplace showed the highest transmission risk (combined RR, 3.94 (95% CI 3.16-4.90)). Notably, in the sub-analysis for SARS-CoV-2, residential space and airplane were the riskiest space (combined RR, 8.30 (95% CI 3.30-20.90) and 7.30 (95% CI 1.15-46.20), respectively). DISCUSSION Based on the equation of the total number of contacts, the order of transmission according to the type of confined space was calculated. The calculated order was similar to the observed order in this study. The transmission risks in confined spaces can be lowered by reducing each component of the aforementioned equation. However, as seen in the data for SARS-CoV-2, the closure of one type of confined space could increase the population density in another confined space. The authority of infection control should consider this paradox. Appropriate quarantine measures targeted for specific types of confined spaces with a higher risk of transmission, school or workplace for general pathogens, and residential space/airplane for SARS-CoV-2 can reduce the transmission of respiratory infectious diseases.
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Affiliation(s)
- Jinyoung Moon
- Department of Environmental Health Science, Graduate School of Public Health, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea; Department of Occupational and Environmental Medicine, Seoul Saint Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Byung-Han Ryu
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, 11, Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, 51472, Republic of Korea.
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Siya A, Mafigiri R, Migisha R, Kading RC. Uganda Mountain Community Health System-Perspectives and Capacities towards Emerging Infectious Disease Surveillance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8562. [PMID: 34444315 PMCID: PMC8394296 DOI: 10.3390/ijerph18168562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/05/2021] [Accepted: 08/11/2021] [Indexed: 11/22/2022]
Abstract
In mountain communities like Sebei, Uganda, which are highly vulnerable to emerging and re-emerging infectious diseases, community-based surveillance plays an important role in the monitoring of public health hazards. In this survey, we explored capacities of village health teams (VHTs) in Sebei communities of Mount Elgon in undertaking surveillance tasks for emerging and re-emerging infectious diseases in the context of a changing climate. We used participatory epidemiology techniques to elucidate VHTs' perceptions on climate change and public health and assessed their capacities to conduct surveillance for emerging and re-emerging infectious diseases. Overall, VHTs perceived climate change to be occurring with wider impacts on public health. However, they had inadequate capacities in collecting surveillance data. The VHTs lacked transport to navigate through their communities and had insufficient capacities in using mobile phones for sending alerts. They did not engage in reporting other hazards related to the environment, wildlife, and domestic livestock that would accelerate infectious disease outbreaks. Records were not maintained for disease surveillance activities and the abilities of VHTs to analyze data were also limited. However, VHTs had access to platforms that could enable them to disseminate public health information. The VHTs thus need to be retooled to conduct their work effectively and efficiently through equipping them with adequate logistics and knowledge on collecting, storing, analyzing, and relaying data, which will improve infectious disease response and mitigation efforts.
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Affiliation(s)
- Aggrey Siya
- Department of Environmental Management, Makerere University, Kampala P.O. Box 7062, Uganda
- EcoHealth180, Kween District, Kapchorwa P.O. Box 250, Uganda
| | - Richardson Mafigiri
- Global Health Department, Infectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, Uganda;
| | - Richard Migisha
- Department of Physiology, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda;
| | - Rebekah C. Kading
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523, USA;
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Walekhwa AW, Ntaro M, Kawungezi PC, Achangwa C, Muhindo R, Baguma E, Matte M, Migisha R, Reyes R, Thompson P, Boyce RM, Mulogo EM. Measles outbreak in Western Uganda: a case-control study. BMC Infect Dis 2021; 21:596. [PMID: 34157990 PMCID: PMC8220759 DOI: 10.1186/s12879-021-06213-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measles outbreaks are prevalent throughout sub-Saharan Africa despite the preventive measures like vaccination that target under five-year-old children and health systems strengthening efforts like prioritizing the supply chain for supplies. Measles immunization coverage for Kasese district and Bugoye HC III in 2018 was 72 and 69%, respectively. This coverage has been very low and always marked red in the Red categorization (below the national target/poor performing) on the national league table indicators. The aim of this study was to assess the scope of the 2018-2019 measles outbreak and the associated risk factors among children aged 0-60 months in Bugoye sub-county, Kasese district, western Uganda. METHODS We conducted a retrospective unmatched case-control study among children aged 0-60 months with measles (cases) who had either a clinical presentation or a laboratory confirmation (IgM positivity) presenting at Bugoye Health Centre III (BHC) or in the surrounding communities between December 2018 and October 2019.. Caregivers of the controls (whose children did not have measles) were selected at the time of data collection in July 2020. A modified CDC case investigation form was used in data collection. Quantitative data was collected and analyzed using Microsoft excel and STATA version 13. The children's immunization cards and health registers at BHC were reviewed to ascertain the immunization status of the children before the outbreak. RESULTS An extended measles outbreak occurred in Bugoye, Uganda occured between December 2018 and October 2019. All 34 facility-based measles cases were documented to have had maculopapular rash, conjunctivitis, and cough. Also, the majority had fever (97%), coryza (94.1%), lymphadenopathy (76.5%), arthralgias (73.5%) and Koplik Spots (91.2%) as documented in the clinical registers. Similar symptoms were reported among 36 community-based cases. Getting infected even after immunized, low measles vaccination coverage were identified as the principal risk factors for this outbreak. CONCLUSION Measles is still a significant problem. This study showed that this outbreak was associated with under-vaccination. Implementing a second routine dose of measles-rubella vaccine would not only increase the number of children with at least one dose but also boost the immunity of those who had the first dose.
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Affiliation(s)
- Abel Wilson Walekhwa
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda.
| | - Moses Ntaro
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Peter Chris Kawungezi
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Chiara Achangwa
- Department of Public Health and Hygiene, University of Buea, P.O. Box 63, Buea, Cameroon
| | - Rabbison Muhindo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Emmanuel Baguma
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Michael Matte
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Richard Migisha
- Department of Physiology, Faculty of Medicine, Mbarara University of Science & Technology, Mbarara, Uganda
| | - Raquel Reyes
- Department of Medicine, Division of Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Peyton Thompson
- Department of Pediatrics, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Ross M Boyce
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Edgar M Mulogo
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, P.O. BOX 1410, Mbarara, Uganda
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