Comparing static and outreach immunization strategies and associated factors in Uganda, Nov-Dec 2016

Introduction: the government of Uganda aims at reducing childhood morbidity through provision of immunization services. We compared the proportion of children 12-33 months reached using either static or outreach immunization strategies and factors affecting utilization of routine vaccination services in order to inform policy updates.Methods: we adopted the 2015 vaccination coverage cluster survey technique. The sample selection was based on a stratified three-stage sample design. Using the Fleiss formula, a sample of 50 enumeration areas was sufficient to generate immunization coverages at each region. A total of 200 enumeration areas were selected for the survey. Thirty households were selected per enumeration area. Epi-Info software was used to calculate weighted coverage estimates.Results: among the 2231 vaccinated children aged 12-23 months who participated in the survey, 68.1% received immunization services from a health unit and 10.6% from outreaches. The factors that affected utilization of routine vaccination services were; accessibility, where 78.2% resided within 5km from a health facility. 29.7% missed vaccination due to lack of vaccines at the health facility. Other reasons were lack of supplies at 39.2% and because the caretaker had other things to do, 26.4%. The survey showed 1.8% (40/2271) respondents had not vaccinated their children. Among these, 70% said they had not vaccinated their child because they were busy doing other things and 27.5% had not done so because of lack of motivation.Conclusion: almost 7 in 10 children aged 12-23 months access vaccination at health facilities. There is evidence of parental apathy as well as misconceptions about vaccination

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

Introduction: Uganda has the highest alcohol per capita consumption in Africa. Surveillance data was analysed to describe trends in alcohol abuse by gender, identify districts with most cases and describe trends of annual rates by region.Methods: data was from HMIS 108 (inpatient), HMIS 105 (outpatient) forms. Total number of cases was acquired by summing age-aggregated cases by gender in both reports. Rates of alcohol abuse were acquired by dividing annual total cases by annual regional projected population.Results: 57897 cases were reported between 2010 and 2014. Most were males 72% (1963). There is a steady increase in reported cases. All regions show increases in cases reported, the highest being central, western, northern then eastern. Kampala, Kabale, Arua, Gulu, Wakiso reported most cases. Higher numbers among males might be because of a higher genetic risk for disorders. Men are more likely to exhibit risk factors of disorders such as impulsivity making diagnosis simpler. Additionally, biological and social consequences among women may be deterrents to alcohol use. Increasing numbers of cases might be because of social acceptability of alcohol and aggressive advertising. Current legislation limiting alcohol use covers only manufacture and sale, is weak and poorly enforced. High numbers in central region might be due to higher numbers of health centers and population density. Actual numbers are likely to be higher as people with alcohol abuse rarely seek for help. Findings are subject to epidemiological weaknesses: healthcare access bias, referral filter bias, mis classification bias.Conclusion: there is urgent need to address the increasing problem of alcohol abuse especially in central region. The national alcohol control policy should be completed and passed to address issues such as alcohol advertising, taxation and sale of alcohol to minors to limit access. Interventions to address alcohol abuse should be gender specific

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

Introduction: cholera is a bacterial diarrheal disease caused by Vibrio cholerae. On 15 October 2015, a cholera outbreak involving dozens of cases and 2 deaths was reported in Kaiso, a lakeshore fishing village. The district health department responded by setting up a treatment center and sensitizing the community. Despite initial response, the outbreak persisted, prompting a detailed epidemiological investigation to identify the source and mode of transmission and recommend evidence-based interventions to stop the epidemic.Methods: we defined a suspected case as onset of acute watery diarrhoea in a Kaiso Village resident from 1st October 2015 onward; a confirmed case was a suspected case with Vibrio cholerae isolated from stool. We performed descriptive epidemiology to generate a hypothesis, and conducted a case-control study to compare exposure histories of 61 cases and 126 controls randomly selected among village residents (age ≥ 4 years in both groups). We conducted environmental assessment and obtained meteorological data from a local weather station.Results: 123 suspected cases (2 deaths) were line-listed at the village's cholera clinic. The initial 2 deceased cases had onset on 2nd and 10th October. Heavy rainfall occurred during 7­11th October, setting in a point-source outbreak which started on 12th and peaked on 13th October. Three water collection points (WCP) A, B and C were associated with the outbreak. 9.8% (6/61) of case-persons and 31% (39/126) of control-persons usually collected water from WCP A. In comparison, 21% (13/61) of case-persons and 37% (46/126) of control-persons usually collected water from WCP B (OR = 1.8, 95%CI: 0.64-5.3) and 69% (42/61) of case-persons and 33% (41/126) of control-persons from WCP C (OR = 6.7; 95%CI = 2.5-17). 100% (61/61) of case-persons and 93% (117/126) of control-persons never treated/boiled drinking water (OR = ∞, 95%CIFisher = 1.0-∞). A gully channel from a hillside open defecation area washed down feces to the lakeshore at WCP C.Conclusion: this outbreak was caused by drinking lakeshore water contaminated by feces washed down a gully from the village. We recommended water boiling and treatment, fixing the broken piped-water system, and constructing latrines. The outbreak was stopped by implementing treatment and boiling of drinking water at household level