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

A community-wide cholera outbreak caused by drinking unsafe water: Kasese District, Western Uganda, February ­July 2015

Introduction: Kasese District is prone to cholera outbreaks and this was its third outbreak in 15 years. In May 2015, Kasese District reported a cholera outbreak that had lasted 3 months and caused >100 infections. A team from Ministry of Health set out to support the local response team in identifying the mode of transmission and informing control measures.Methods: we defined a suspected case as onset of acute watery diarrhoea from 1st February 2015 onward; a confirmed case was a suspect case with Vibrio cholerae cultured from a stool sample. We reviewed medical records for case finding and conducted a case-control study to compare the exposures of 49 confirmed cases with those of 201 asymptomatic controls, matched by village and age group. We conducted environmental assessments and tested water samples for faecal contamination.Results: we identified 183 suspected cases including 61 confirmed cases (serotype inaba) and 2 deaths from February to July. The outbreak occurred in 80 villages and affected all age groups; the highest attack rate occurred in persons aged 5-14 years (4.1/10,000). Stratified epidemic curves showed that the outbreak started in Bwera Sub-county bordering the Democratic Republic of Congo, and spread eastward. 94% (46/49) of cases compared with 75% (152/201) of controls drank water without boiling or treatment (ORM-H = 5.9; 95%CI = 1.6-22). The main water sources, public piped water (consumed by 39% of cases and 38% of controls) and stream water (consumed by 29% of cases and 24% controls), both had high levels of E. coli, a marker of faecal contamination. Environmental assessment revealed evidence of open defaecation along the streams. No food items were significantly associated with illness.Conclusion: drinking unsafe water contaminated by feces caused this outbreak. We recommended rigorous disposal of patients' feces, chlorination of piped water, and drinking boiled or treated water. The outbreak stopped 6 weeks after initiating implementation of these control measures

Factors affecting virological non-suppression amongst HIV-positive patients on antiretroviral therapy: Uganda, August 2014 - July 2015

Introduction: virological suppression is a critical indicator for HIV treatment success and reduction in HIV transmission risk. However, despite the increasing number of people on antiretroviral therapy (ART), there is limited information about non-suppression and its determinants among HIV-positive (HIV+) individuals enrolled in care in many resource-limited settings. This study estimated the virological non-suppression rates amongst HIV+ patients who had been on ART for at least 6 months and the factors associated with non-suppression. Methods: a descriptive cross-sectional study was conducted using routinely collected data from viral load testing samples from 100,678 HIV+ patients enrolled in HIV care across the country between August 2014 and July 2015. Viral load testing was conducted at the Central Public Health Laboratories in Kampala, Uganda. We extracted data on socio-demographic, clinical and viral load testing results. We defined virological non-suppression as having ≥ 1000 copies of viral RNA/ml of blood for plasma or ≥ 5000 copies of viral RNA/ml of blood for dry blood spots. We used logistic regression to identify factors associated with virological non-suppression. Results: majority of the patients (68%) were females. The overall non-suppression rate was 11%. Second-time testers had a higher non-suppression rate than first-time testers (50% vs. 10%, OR = 7.0, 95%CI = 6.2-7.9); and children aged < 5 years (29%, OR = 5.3, 95%CI = 4.8-6.0) and adolescents aged 15-19 (27%, OR = 4.1, 95%CI = 3.7-4.5) had higher non-suppression rates than persons of other age groups. Non-suppression rates were also higher among suspected treatment failures (29%, OR = 4.0, 95%CI = 3.7-4.4), patients with reported adherence levels < 85% (35%, OR = 3.4, 95%CI = 3.0-3.9), and patients with active TB (20%, OR = 2.0, 95%CI = 1.5-2.3) than those without these conditions. Breastfeeding (6%, OR = 0.61, 95%CI = 0.54-0.69) and pregnant women (8%, OR = 0.77, 95%CI = 0.65-0.91) had lower non-suppression rates than non-breastfeeding and non-pregnant women (10%). Conclusion: virological non-suppression was associated with second time testers, young age, poor adherence, and TB co-infection. To maximize the benefits of the expanded ART, we recommend close follow-up and intensified targeted adherence support for second time testers, children and adolescents. Adherence to standard guidelines for managing TB/HIV co-infections should be emphasized by all ART clinics