Alex Riolexus Ario

A prolonged, community-wide cholera outbreak associated with drinking water contaminated by sewage in Kasese District, western Uganda

BackgroundIn May 2015, a cholera outbreak that had lasted 3 months and infected over 100 people was reported in Kasese District, Uganda, where multiple cholera outbreaks had occurred previously. We conducted an investigation to identify the mode of transmission to guide control measures.MethodsWe defined a suspected case as onset of acute watery diarrhoea from 1 February 2015 onwards in a Kasese resident. A confirmed case was a suspected case with Vibrio cholerae O1 El Tor, serotype Inaba cultured from a stool sample. We reviewed medical records to find cases. We conducted a case-control study to compare exposures among confirmed case-persons and asymptomatic controls, matched by village and age-group. We conducted environmental assessments. We tested water samples from the most affected area for total coliforms using the Most Probable Number (MPN) method.ResultsWe identified 183 suspected cases including 61 confirmed cases of Vibrio cholerae 01; serotype Inaba, with onset between February and July 2015. 2 case-persons died of cholera. The outbreak occurred in 80 villages and affected all age groups; the highest attack rate occurred in the 5–14 year age group (4.1/10,000). The outbreak started in Bwera Sub-County bordering the Democratic Republic of Congo and spread eastward through sustained community transmission. The first case-persons were involved in cross-border trading. The case-control study, which involved 49 confirmed cases and 201 controls, showed that 94% (46/49) of case-persons compared with 79% (160/201) of control-persons drank water without boiling or treatment (ORM-H=4.8, 95% CI: 1.3–18). Water collected from the two main sources, i.e., public pipes (consumed by 39% of case-persons and 38% of control-persons) or streams (consumed by 29% of case-persons and 24% control-persons) had high coliform counts, a marker of faecal contamination. Environmental assessment revealed evidence of open defecation along the streams. No food items were significantly associated with illness.ConclusionsThis prolonged, community-wide cholera outbreak was associated with drinking water contaminated by faecal matter and cross-border trading. We recommended rigorous disposal of patients’ faeces, chlorination of piped water, and boiling or treatment of drinking water. The outbreak stopped 6 weeks after these recommendations were implemented.

Risk Factors for Podoconiosis: Kamwenge District, Western Uganda, September 2015

AbstractPodoconiosis, a noninfectious elephantiasis, is a disabling neglected tropical disease. In August 2015, an elephantiasis case-cluster was reported in Kamwenge District, western Uganda. We investigated to identify the diseases nature and risk factors. We defined a suspected podoconiosis case as onset in a Kamwenge resident of bilateral asymmetrical lower limb swelling lasting ≥ 1 month, plus ≥ 1 of the following associated symptoms: skin itching, burning sensation, plantar edema, lymph ooze, prominent skin markings, rigid toes, or mossy papillomata. A probable case was a suspected case with negative microfilaria antigen immunochromatographic card test (ruling out filarial elephantiasis). We conducted active case-finding. In a case-control investigation, we tested the hypothesis that the disease was caused by prolonged foot skin exposure to irritant soils, using 40 probable case-persons and 80 asymptomatic village control-persons, individually matched by age and sex. We collected soil samples to characterize irritants. We identified 52 suspected (including 40 probable) cases with onset from 1980 to 2015. Prevalence rates increased with age; annual incidence (by reported onset of disease) was stable over time at 2.9/100,000. We found that 93% (37/40) of cases and 68% (54/80) of controls never wore shoes at work (Mantel-Haenszel odds ratio [ORMH] = 7.7; 95% [confidence interval] CI = 2.0-30); 80% (32/40) of cases and 49% (39/80) of controls never wore shoes at home (ORMH = 5.2; 95% CI = 1.8-15); and 70% (27/39) of cases and 44% (35/79) of controls washed feet at day end (versus immediately after work) (OR = 11; 95% CI = 2.1-56). Soil samples were characterized as rich black-red volcanic clays. In conclusion, this reported elephantiasis is podoconiosis associated with prolonged foot exposure to volcanic soil. We recommended foot hygiene and universal use of protective shoes.

Trends of alcohol abuse using surveillance data from the Health Management Information System (HMIS) of Uganda

Uganda has the highest alcohol per capita consumption in Africa. Surveillance data was analyzed to describe trends in alcohol abuse by gender, identify districts with most cases and describe trends of annual rates by region.

Effect of vector control on malaria incidence in Tororo: a case for focusing surveillance to sub-county levels

Tororo is one of the highest malaria transmission districts in Uganda. Universal distribution of LLINs in 2013 and IRS in 2014 were introduced to control malaria transmission in the district, but their effect on the disease incidence is not known and the district has no documented malaria epidemic detection thresholds. The objectives of the analysis were to describe malaria trend, assess the effect of vector control interventions and to establish a district malaria surveillance thresholds for Tororo district. A descriptive analysis of aggregate surveillance data from 2013 to 2015 from DHIS2. Data were analyzed in Microsoft excel to make weekly, monthly and annual trend graphs of malaria incidence. The number of malaria cases reported included both the laboratory and clinically diagnosed. The percentage of malaria cases in Out Patient Department per year, malaria laboratory test positivity rates and incidence by sub-county were determined. We set the district malaria surveillance threshold using the five week moving mean. Universal distribution of LLINs in 2013 reduced malaria incidence in 2014 by 10%, but did not change the high endemic transmission. A combination of IRS and LLINs caused a greater reduction in malaria incidence from 59/1000 in April 2014 to 28/1000 in April 2015 and reduced the high transmission. Malaria incidence reduction by sub-county was not uniform and needs specific thresholds. Malaria incidence in Tororo has been reducing since introduction of vector control interventions. Malaria incidence varied by sub-county. Heterogeneity of malaria transmission needs sub-county specific surveillance thresholds for early detection of epidemics.

The first reported human Rift Valley Fever outbreak in Uganda, 2016

Introduction : on 8 March 2016, the Ministry of Health received a report of a suspected case of viral hemorrhagic fever (VHF) in Kabale Regional Referral Hospital. By 15th March, there were two laboratory confirmed cases of Rift Valley Fever (RVF). We conducted the investigation to assess the scope of the outbreak, identify its source and risk factors in order to inform public health interventions for controlling the outbreak. Methods : a suspected case was defined as acute onset of fever (> 37.5°C), negative malaria test, and at least two of the following three symptoms: Headache, Muscle or joint pain and any gastroenteritis symptom (nausea, vomiting, abdominal pain, and diarrhea). A Probable Case was any person meeting the suspect case definition with deranged liver functions tests plus at least one of the following; bleeding symptoms, such as: bleeding from the nose, vomiting blood, coughing out blood (without history of TB), blood in stool, blood in urine; sudden change in vision, jaundice, any unexplained death. A confirmed case was a suspected or probable case that is laboratory confirmed by detection of RVF nucleic acid by reverse-transcriptase polymerase chain reaction (RT-PCR) or demonstration of serum IgM or IgG antibodies by ELISA. We found cases by going to the affected communities and health facilities in the catchment areas where the confirmed cases came from. Results : the investigation revealed 2 confirmed cases. In-depth interviews revealed that the symptom onset for the primary case was February 13th while onset date for the secondary case was February 18th. A review of the records in the health centers in the vicinity of the area where the primary case originated also did not reveal any increase in febrile illnesses. Prior to symptom onset of the primary case, one farmer reported 3 successive goat abortions every month from October 2015 to December 2015. In February 2015, one farmer also reported 3 cow abortions within the same week. Conclusion : There appears to be an outbreak among the livestock however there is no increase in febrile illnesses in the community. Health education should be done in the community to promote use of mosquito nets and protection of abattoir workers. The ministry of Agriculture, Animal Industries and Fisheries (MAAIF) should work with the Ministry of Health to assess the existence of the virus among the animals and mosquitoes. MAAIF should also ensure enforcement of the laws prohibiting the sale and consumption of sick or dead animals. All animals in the area should be vaccinated against RVF and health workers should be sensitized to consider RVF as a differential diagnosis in non-malaria febrile illness.

Diarrheal diseases and household sanitary practices in Kakuuto County, Rakai District, Uganda, 2016

Introduction : limited data about population attributable fraction (PAF) due to the household sanitary practices associated with diarrheal diseases among children U5. This study assessed household sanitary practices associated with diarrheal diseases among U5 and suggested suitable interventions to direct policy to enhance decline in burden of diarrheal diseases among children U5 year in Kakuuto County. Method : we conducted a community based case-control study in a ratio of 1:5 case and controls. Cases were mothers or guardians with an under-five child who had diarrheal disease and controls were mothers or guardians with a child under five years who did not develop diarrhoeal disease between April 1, 2014 and March 31, 2016 in Kakuuto County. Controls were randomly picked from the neighboring households which had a child Results : majority 89% of households had a latrine. The proportion of cases that washed hands after visiting latrine was 46% compared to 43.1% of controls; 52% of cases used soap to wash compared to 61% of controls. 28% of cases compared to 18% of controls spent between 30 minutes and one hour to fetching water. Factors that were significantly associated with diarrheal diseases among children U5 were: no latrine in a household aOR=48 (95% CI, 2.9-309); never wash hands after visiting latrine aOR=24 (95% CI, 1.4-405); sweeping of compound once in a week, aOR= 5.3 (95% CI, 1.03-27) or twice a week, aOR= 3.8 (95% CI, 1.03-14); and spending 30 minutes to one hour fetching water from water source, aOR= 6 (95%CI, 1.1-31). PAF due to sanitary practices in Kakuuto County were, 36.2% of all cases among children U5 were attributable to irregular wash of hands after visiting latrine, 33.4% were attributable to taking between 30 and 60 minutes fetching water, 26% was attributable to never wash hands after visiting latrine, 18.2% was attributable to irregular sweeping of the compound and least 7.8% was attributable to lack of latrine in household. Conclusion : diarrheal diseases among children Under-five years of age in Kakuuto County are caused by not washing hand after visiting latrine, spending a lot of time fetching water, and lack of latrine in households.

The cost of responding to a waterborne cholera outbreak in a village in Uganda compared to a simple hypothetical intervention, 2016

Introduction : in September 2015, a cholera outbreak occurred in a village in Hoima District, western Uganda. The Ministry of Health assembled a rapid response team, with support by CDC, UNICEF and WHO, to investigate the outbreak, establish the Kaiso Cholera Treatment Center (KCTC), and implement control measures. The team identified 120 cholera cases (with 5 deaths) and determined that drinking contaminated water from the lakeshore caused this outbreak. We sought to determine the cost of investigating and controlling this outbreak, and compare it to a would-be simple preventive measure, constructing deep wells to provide cleaner water. Methods : we collected cost data, including personnel and material costs at KCTC, health facilities, Hoima District Health Office, Uganda Public Health Fellowship Program, UNICEF, CDC, and WHO. We defined direct cost of responding to this outbreak as expenditure on medications, medical equipment and supplies, utilities, and allowances and transport for responders; indirect cost included salary and other compensations for responders. We did not include difficult-to-measure costs such as vehicle depreciation, building maintenance, and loss of productivity to case-persons due to illness and deaths. The cost of constructing deep wells was quoted by a U.S.-based NGO. Results : the total cost incurred in investigating and controlling this outbreak was

Rapid evaluation of the disease surveillance system in the Rhino Camp Refugee Settlement, Uganda: a case for early warning systems in emergency settings, 2016

71,769, including

Malaria in Tororo district after four rounds of indoor residual spraying: need to test and treat to prevent resurgence, Uganda, 2016

21,059 in direct cost (

Sensitivity and positive predictive value of the measles surveillance system in Uganda, 2012-2015

19,225 for allowances and transportation,