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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. Int J Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Nakiire L, Mwanja H, Pillai SK, Gasanani J, Ntungire D, Nsabiyumva S, Mafigiri R, Muneza N, Ward SE, Daffe Z, Ahabwe PB, Kyazze S, Ojwang J, Homsy J, Mclntyre E, Lamorde M, Walwema R, Makumbi I, Muruta A, Merrill RD. Population Movement Patterns Among the Democratic Republic of the Congo, Rwanda, and Uganda During an Outbreak of Ebola Virus Disease: Results from Community Engagement in Two Districts - Uganda, March 2019. MMWR Morb Mortal Wkly Rep 2020; 69:10-13. [PMID: 31917781 PMCID: PMC6973344 DOI: 10.15585/mmwr.mm6901a3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kabwama SN, Mafigiri R, Balinandi S, Kagirita A, Riolexus AA, Zhu BP. Risk factors for hematemesis in Hoima and Buliisa Districts, Western Uganda, September-October 2015. Pan Afr Med J 2017; 28:215. [PMID: 29610653 PMCID: PMC5878846 DOI: 10.11604/pamj.2017.28.215.12395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 10/28/2017] [Indexed: 12/12/2022] Open
Abstract
Introduction On 17 September 2015, Buliisa District Health Office reported multiple deaths due to haemorrhage to the Uganda Ministry of Health. We conducted an investigation to verify the existence of an outbreak and to identify the disease nature, mode of transmission and risk factors. Methods We defined a suspected case as onset of hematemesis between 1 June 2015 and 15 October 2015 in a resident of Hoima, Buliisa or neighbouring districts. We identified cases by reviewing medical records and actively searching in the community. We interviewed case-patients and health-care workers and performed descriptive epidemiology to generate hypotheses on possible exposures. In a case-control study we compared exposures between 21 cases and 81 controls, matched by age (± 10 years), sex and village of residence. We collected 22 biological specimens from 19 case-patients to test for Viral Haemorrhagic Fevers (VHF). We analysed the data using the Mantel-Haenszel method to account for the matched study design. Results We identified 56 cases with onset from June to October (attack rate 15/100,000 in Buliisa District and 5.2/100,000 in Hoima District). The age-specific attack rate was highest in persons aged 31-60 years (15/100,000 in Hoima and 47/100,000 in Buliisa); no persons below 15 years of age had the illness. In the case-control study, 42% (5/12) of cases vs. 0.0% (0/77) of controls had liver disease (ORM-H = ∞; 95%CI = 3.7-∞); 71% (10/14) of cases vs. 35% (28/81) of controls had ulcer disease (ORM-H = 13; 95% CI = 1.6-98); 27% (3/11) of cases vs. 14% (11/81) of controls used indomethacin prior to disease onset (ORM-H = 6.0; 95% CI = 1.0-36). None of the blood samples were positive for any of the VHFs. Conclusion This reported cluster of hematemesis illness was due to predisposing conditions and use of Non-Steroidal Anti-inflammatory Drugs (NSAID). Health education should be conducted on the danger of NSAIDs misuse, especially in persons with pre-disposing conditions.
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Affiliation(s)
- Steven Ndugwa Kabwama
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Richardson Mafigiri
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | | | - Atek Kagirita
- Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
| | - Alex Ario Riolexus
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Bao-Ping Zhu
- US Centers for Disease Control and Prevention, Kampala, Uganda
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Kabwama SN, Bulage L, Nsubuga F, Pande G, Oguttu DW, Mafigiri R, Kihembo C, Kwesiga B, Masiira B, Okullo AE, Kajumbula H, Matovu JK, Makumbi I, Wetaka M, Kasozi S, Kyazze S, Dahlke M, Hughes P, Sendagala JN, Musenero M, Nabukenya I, Hill VR, Mintz E, Routh J, Gómez G, Bicknese A, Zhu BP. Correction to: A large and persistent outbreak of typhoid fever caused by consuming contaminated water and street-vended beverages: Kampala, Uganda, January - June 2015. BMC Public Health 2017; 17:823. [PMID: 29047373 PMCID: PMC5648495 DOI: 10.1186/s12889-017-4801-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 11/20/2022] Open
Affiliation(s)
- Steven Ndugwa Kabwama
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda.
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Fred Nsubuga
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Gerald Pande
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - David Were Oguttu
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Richardson Mafigiri
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Christine Kihembo
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Ben Masiira
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Allen Eva Okullo
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Henry Kajumbula
- Makerere University College of Health Science Microbiology Laboratory, Kampala, Uganda
| | | | - Issa Makumbi
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Milton Wetaka
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Sam Kasozi
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Simon Kyazze
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Melissa Dahlke
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | | | | | - Monica Musenero
- Epidemiology and Surveillance Division, Ministry of Health, Kampala, Uganda
| | | | - Vincent R Hill
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eric Mintz
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Janell Routh
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gerardo Gómez
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amelia Bicknese
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bao-Ping Zhu
- US Centers for Disease Control and Prevention, Atlanta, GA, USA.,US Centers for Disease Control and Prevention, Kampala, Uganda
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Mafigiri R, Nsubuga F, Ario AR. Risk factors for measles death: Kyegegwa District, western Uganda, February-September, 2015. BMC Infect Dis 2017; 17:462. [PMID: 28673250 PMCID: PMC5496348 DOI: 10.1186/s12879-017-2558-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 06/19/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND On 18 August 2015, Kyegegwa District reported eight deaths during a measles outbreak to the Uganda Ministry of Health (MoH). We investigated this death cluster to verify the cause, identify risk factors, and inform public health interventions. METHODS We defined a probable measles case as onset of fever and generalised rash in a Kyegegwa District resident from 1 February - 15 September 2015, plus ≥1 of the following: coryza, conjunctivitis, and cough. A confirmed measles case was a probable case with measles-specific IgM positivity. A measles death was a death of a probable or confirmed case-person. We conducted an active case-finding to identify measles patients who survived or died. In a case-control study, we compared risk factors between 16 measles patients who died (cases) and 48 who survived (controls), matched by age (±4 years) and village of residence. RESULTS We identified 94 probable measles cases, 10 (11%) were confirmed by positive measles-specific IgM. Of the 64 probable measles patients aged <5 years, 16 died (case-fatality rate = 25%). In the case-control study, no history of vaccination against measles was found in 94% (15/16) among the case-persons (i.e., measles patients who died) and 54% (26/48) among the controls (i.e., measles patients who survived) (ORM-H = 12; 95% CI = 1.6-104), while 56% (9/16) of case-persons and 67% (17/48) of controls (ORM-H = 2.3; 95% CI =0.74-7.4) did not receive vitamin A supplementation during illness. 63% (10/16) among the case-persons and 6.3% (3/48) of the controls (ORM-H = 33; 95% CI = 6.8-159) were not treated for measles illness at a health facility (a proxy for more appropriate treatment), while 38% (6/16) of the case-persons and 25% (12/48) of the controls (ORM-H = 2.5; 95% CI = 0.67-9.1) were malnourished. CONCLUSION Lack of vaccination and no treatment in a health facility increased the risk for measles deaths. The one-dose measles vaccination currently in the national vaccination schedule had a protective effect against measles death. We recommended enhancing measles vaccination and adherence to measles treatment guidelines.
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Affiliation(s)
- Richardson Mafigiri
- Uganda Public Health Fellowship Program - Field Epidemiology Track, Kampala, Uganda. .,Uganda Public Health Fellowship Program, Ministry of Health, P.O. Box 7272, Kampala, Uganda.
| | - Fred Nsubuga
- Uganda Public Health Fellowship Program - Field Epidemiology Track, Kampala, Uganda
| | - Alex Riolexus Ario
- Uganda Public Health Fellowship Program - Field Epidemiology Track, Kampala, Uganda
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Mafigiri R, Matovu JKB, Makumbi FE, Ndyanabo A, Nabukalu D, Sakor M, Kigozi G, Nalugoda F, Wanyenze RK. HIV prevalence and uptake of HIV/AIDS services among youths (15-24 Years) in fishing and neighboring communities of Kasensero, Rakai District, South Western Uganda. BMC Public Health 2017; 17:251. [PMID: 28288604 PMCID: PMC5348807 DOI: 10.1186/s12889-017-4166-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although fishing communities have a significantly higher HIV prevalence than the general population, there is paucity of data on the burden of HIV and service utilization, particularly among the youth. We assessed the HIV prevalence and utilization of HIV prevention and treatment services among youth in Kasensero fishing community and the neighboring communities. METHOD Data were derived from the Rakai Community Cohort Study (RCCS) surveys conducted between 2013 and 2014. The RCCS is a population-based household survey that collects data annually from individuals aged 15-49 years, resident in 48 communities in Rakai and neighboring districts in Uganda. For this analysis, socio-demographic, behavioral and HIV-related data were obtained for 792 individuals aged 15-24 years. We used logistic regression to conduct bivariate and multivariable analysis to determine the factors that are independently associated with HIV-positive status and their corresponding 95% confidence intervals. Data were analyzed using STATA version 13. RESULTS Overall HIV prevalence was 19.7% (n = 155); higher in Kasensero (n = 141; 25.1%) and Gwanda (n = 8; 11%) than in Kyebe (n = 6; 3.9%), p < 0.001 and among females (n = 112; 26.0%) than males (n = 43; 12.0%), p < 0.001. Uptake of HIV testing was high in both HIV-positive (n = 136; 89.5%) and HIV-negative youth (n = 435; 92%). Consistent condom use was virtually non-existent in HIV-positive youth (n = 1; 0.6%) compared to HIV-negative youth (n = 20; 4.2%). Only 22.4% (n = 34) of the HIV-positive youth were receiving antiretroviral therapy (ART) in 2013-2014; higher in the HIV-positive females (n = 31; 28.4%) than HIV-positive males (n = 03; 6.7%). Slightly more than half of males (n = 134; 53.8%) reported that they were circumcised; the proportion of circumcised youth was higher among HIV-negative males (n = 122; 58%) than HIV-positive males (n = 12; 27.9%). Factors significantly associated with HIV-positive status included living in Kasensero landing site (adjusted Odds Ratio [aOR] = 5.0; 95%CI: 2.22-13.01) and reporting one (aOR = 5.0; 95%CI: 1.33-15.80) or 2+ sexual partners in the past 12 months (aOR = 11.0; 95% CI; 3.04-36.72). CONCLUSION The prevalence of HIV is high especially among young females and in landing site communities than in the peripheral communities. Uptake of HIV prevention and treatment services is very low. There is an urgent need for youth-friendly services in these communities.
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Affiliation(s)
- Richardson Mafigiri
- Public Health Fellowship Program (PHFP) – Field Epidemiology Track, Ministry of Health-Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Joseph K. B. Matovu
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fredrick Edward Makumbi
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Rakai Health Sciences Program, Kampala, Uganda
| | | | | | - Moses Sakor
- Rakai Health Sciences Program, Kampala, Uganda
| | | | | | - Rhoda K. Wanyenze
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
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Kabwama SN, Bulage L, Nsubuga F, Pande G, Oguttu DW, Mafigiri R, Kihembo C, Kwesiga B, Masiira B, Okullo AE, Kajumbula H, Matovu JKB, Makumbi I, Wetaka M, Kasozi S, Kyazze S, Dahlke M, Hughes P, Sendagala JN, Musenero M, Nabukenya I, Hill VR, Mintz E, Routh J, Gómez G, Bicknese A, Zhu BP. A large and persistent outbreak of typhoid fever caused by consuming contaminated water and street-vended beverages: Kampala, Uganda, January - June 2015. BMC Public Health 2017; 17:23. [PMID: 28056940 PMCID: PMC5216563 DOI: 10.1186/s12889-016-4002-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 12/23/2016] [Indexed: 11/15/2022] Open
Abstract
Background On 6 February 2015, Kampala city authorities alerted the Ugandan Ministry of Health of a “strange disease” that killed one person and sickened dozens. We conducted an epidemiologic investigation to identify the nature of the disease, mode of transmission, and risk factors to inform timely and effective control measures. Methods We defined a suspected case as onset of fever (≥37.5 °C) for more than 3 days with abdominal pain, headache, negative malaria test or failed anti-malaria treatment, and at least 2 of the following: diarrhea, nausea or vomiting, constipation, fatigue. A probable case was defined as a suspected case with a positive TUBEX® TF test. A confirmed case had blood culture yielding Salmonella Typhi. We conducted a case-control study to compare exposures of 33 suspected case-patients and 78 controls, and tested water and juice samples. Results From 17 February–12 June, we identified 10,230 suspected, 1038 probable, and 51 confirmed cases. Approximately 22.58% (7/31) of case-patients and 2.56% (2/78) of controls drank water sold in small plastic bags (ORM-H = 8.90; 95%CI = 1.60–49.00); 54.54% (18/33) of case-patients and 19.23% (15/78) of controls consumed locally-made drinks (ORM-H = 4.60; 95%CI: 1.90–11.00). All isolates were susceptible to ciprofloxacin and ceftriaxone. Water and juice samples exhibited evidence of fecal contamination. Conclusion Contaminated water and street-vended beverages were likely vehicles of this outbreak. At our recommendation authorities closed unsafe water sources and supplied safe water to affected areas. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-4002-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Steven Ndugwa Kabwama
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda.
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Fred Nsubuga
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Gerald Pande
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - David Were Oguttu
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Richardson Mafigiri
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Christine Kihembo
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Ben Masiira
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Allen Eva Okullo
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Henry Kajumbula
- Makerere University College of Health Science Microbiology Laboratory, Kampala, Uganda
| | | | - Issa Makumbi
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Milton Wetaka
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Sam Kasozi
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Simon Kyazze
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Melissa Dahlke
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | | | | | - Monica Musenero
- Epidemiology and Surveillance Division, Ministry of Health, Kampala, Uganda
| | | | - Vincent R Hill
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric Mintz
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janell Routh
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gerardo Gómez
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amelia Bicknese
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bao-Ping Zhu
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,US Centers for Disease Control and Prevention, Kampala, Uganda
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