Allen Eva Okullo

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

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

71,769, including

Investigating a cholera outbreak in Kaiso Fishing Village, Hoima District, Uganda, October 2015

21,059 in direct cost (

Cholera outbreak caused by drinking lakeshore water contaminated by feces washed down from a hill-side residential area: Kaiso Village, Uganda

19,225 for allowances and transportation,

A large and persistent outbreak of typhoid fever caused by consuming contaminated water and street-vended beverages: Kampala, Uganda, January - June 2015.

1,774 for medical equipment and supplies, and

Rapid reduction of malaria following introduction of vector control interventions in Tororo District, Uganda: a descriptive study

60 for utilities), and

Malaria incidence among children less than 5 years during and after cessation of indoor residual spraying in Northern Uganda

50,620 in indirect cost (74,484 person-hours of salary and other compensations for responders). Conversely, constructing a deep well to provide cleaner water would cost approximately

Factors associated with malaria parasitaemia among children under 5 years in Uganda: a secondary data analysis of the 2014 Malaria Indicator Survey dataset

2500. Essentially, the total cost incurred in this outbreak would have been enough to construct 28 (=71769/2500) deep wells; even the direct cost only would have been enough to construct 8 (=21059/2500) deep wells. One such deep well would have prevented this outbreak and averted future waterborne outbreaks. Conclusion : a simple prevention measure such as constructing deep wells for village residents can be substantially cost-effective for preventing waterborne diseases such as cholera. We recommend that the government should proactively implement prevention measures for waterborne outbreaks whenever possible, instead of passively responding to these outbreaks.

Cholera outbreak caused by drinking lake water contaminated with human faeces in Kaiso Village, Hoima District, Western Uganda, October 2015

Introduction : in 2012, Tororo was a high malaria endemic district in Uganda with community Plasmodium prevalence of 71%. The Ministry of Health introduced universal distribution of long lasting insecticide-treated nets (LLINs) in 2013 and indoor residual spraying (IRS) in 2014 to control malaria in the district. We assessed malaria incidence, test positivity rates and outpatient department (OPD) attendance due to malaria before and after vector control interventions. Methods : this study was based on analysis of health management information system, secondary malaria surveillance data from 2,727,850 people who were assessed for malaria at OPD in 61 health facilities from 2012-2015. We estimated monthly malaria incidence for the entire population and also separately for Results : in 2014 when LLINs were used alone, the annual mean monthly malaria incidence fell from 95 in 2013 to 76 cases per 1000 with no significant monthly reduction trend (OR = 0.99, 95% CI = 0.96-1.01, P=0.37). Among children Conclusion : malaria incidence in Tororo District declined rapidly following introduction of integrated vector control interventions. Universal distribution of LLINs alone was not associated with significant reduction in malaria incidence in the district.

The challenge of using intermittent preventive therapy with sulfadoxine/pyrimethamine among pregnant women in Uganda

Globally, even though improvements have been made to effective surveillance and response, communicable diseases such as cholera remain high priorities for national health programs, especially in Africa. High-quality surveillance information coupled with adequate laboratory facilities are effective in curbing outbreaks from such diseases, ultimately reducing morbidity and mortality. One way of building this capacity is through simulation of response to such health events. This case study based on a cholera outbreak investigated by FETP trainees in October 2015 in Uganda can be used to reinforce skills of frontline FETP trainees and other novice public health practitioners through a practical simulation approach. This activity should be completed in 2.5 hours.