ABSTRACT
Introduction: on 18 August 2015, Kyegegwa District reported 8 deaths during a suspected measles outbreak. We investigated this cluster of deaths to verify the cause, identify risk factors, and inform public health interventions. Methods: we conducted active community case-finding to identify probable measles patients, defined as a Kyegegwa District resident with fever (> 39°C) and generalized rash during 1 February - 15 September, plus ⥠one of the following: coryza, conjunctivitis, and cough. A deceased measles case was defined as death to a probable measles patient. In a case-control study, we compared risk factors between 16 deceased measles cases and 48 probable measles patients who survived (i.e., controls), matched by age (± 4 years) and village of residence. Blood specimens from probable measles patients were tested for measles-specific IgM.Results: we identified 94 probable measles patients. Children aged < 5 years accounted for 68% (64/94) of probable measles patients and all 16 deaths (case fatality ratio = 25%, 16/64). In the case-control study, 63% (10/16) of deceased measles cases and 33% (16/48) of controls received no vitamin A supplementation during illness (ORM-H = 7.1; 95% CI = 1.3-37); 31% (5/16) of deceased measles cases and 2.1% (1/48) of controls were not treated according to guidelines (adjORML = 8; 95% CI = 80-8); 6.3% (1/16) of deceased measles cases and 46% (22/48) of controls were vaccinated against measles (adjORML = 0.0; 95% CI = 0.0-0.33). Of blood specimens collected from probable measles patients, 71% (10/14) were positive for measles-specific IgM.Conclusion: no vaccination, lack of vitamin A supplementation and inappropriate treatment increased risk for measles deaths. The one-dose measles vaccination currently in the national EPI schedule, although providing inadequate protection against infection, did protect against measles death. We recommended enhancing measles vaccination, providing universal vitamin A supplementation, and enforcing treatment guidelines
Subject(s)
Disease Outbreaks , Measles , UgandaABSTRACT
Introduction: there is limited data on HIV burden and access to services among adolescents/youths in fishing communities in Uganda.Kasensero fishing community has an HIV prevalence of 41.0% and incidence of 3.9 per 100 person years. We assessed the burden of HIV and uptake of services among adolescents in Kasensero.Methods: we analyzed data collected between 2013-2014 among youths aged 15-24 in the Rakai Community Cohort Study. Social demographic, behavioral and risk characteristics were collected and blood taken for HIV diagnosis using rapid and enzyme-immunoassay (EIA) tests. Adolescents' characteristics in Kasensero were compared with those in two neighboring communities 4 and 12 kilometers apart. HIV prevalence and uptake of services was compared between communities using Chi square. Data was analyzed using Stata version 12.Results: of the 789 youth interviewed 155 (19.7%) were HIV positive. HIV prevalence was higher among females than males 112/431(26.0%) vs 43/358(12.0%)) and was highest in Kasensero fishing community (25.1%) than neighboring communities (11.0% an -d 3.9%). HIV prevalence among females in Kasensero was 34.7% compared to 8.7% and 4.7% in the neighboring communities (P < 0.001). Youths in Kasensero were more likely to be married or separated, 81.5% compared to 75.2% and 52.0% for females, and 42.0% compared to 25.9% and 11.4% for males. HIV prevalence was highest among youths who were bar-workers (64.3%), do housework in own home (36.9%), and trading and vending (43.0%). Consistent condom use was practiced by only 3.4% of the youths (6.4% Male; 1.3% Female). Only 27.7% of HIV positive females and 7.0% of males were on ART, and 44.8% of non-Muslim males were circumcised.Conclusion: HIV burden among youths in fishing communities is high especially among females yet uptake of prevention and care services is poor despite availability. There is need to provide youth friendly services in these MARPs