ABSTRACT
During August 2007-February 2008, the novel Bundibugyo ebolavirus species was identified during an outbreak of Ebola viral hemorrhagic fever in Bundibugyo district, western Uganda. To characterize the outbreak as a requisite for determining response, we instituted a case-series investigation. We identified 192 suspected cases, of which 42 (22%) were laboratory positive for the novel species; 74 (38%) were probable, and 77 (40%) were negative. Laboratory confirmation lagged behind outbreak verification by 3 months. Bundibugyo ebolavirus was less fatal (case-fatality rate 34%) than Ebola viruses that had caused previous outbreaks in the region, and most transmission was associated with handling of dead persons without appropriate protection (adjusted odds ratio 3.83, 95% confidence interval 1.78-8.23). Our study highlights the need for maintaining a high index of suspicion for viral hemorrhagic fevers among healthcare workers, building local capacity for laboratory confirmation of viral hemorrhagic fevers, and institutionalizing standard precautions.
Subject(s)
Ebolavirus/isolation & purification , Hemorrhagic Fever, Ebola/virology , Adolescent , Adult , Aged , Child , Child, Preschool , Disease Outbreaks , Female , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fever, Ebola/etiology , Humans , Infant , Infant, Newborn , Male , Middle Aged , Risk Factors , Time Factors , Uganda/epidemiologyABSTRACT
Combining the delivery of multiple health interventions has the potential to minimize costs and expand intervention coverage. Integration of mass drug administration is therefore being encouraged for delivery of preventive chemotherapy (PCT) to control onchocerciasis, lymphatic filariasis, schistosomiasis, soil-transmitted helminthiasis, and trachoma in sub-Saharan Africa, as there is considerable geographical overlap of these neglected tropical diseases (NTDs). With only a handful of countries having embarked on integrated NTD control, experience on how to develop and implement an efficient integrated programme is limited. Historically, national and global programmes were focused on the control of only one disease, usually through a comprehensive approach that involved several interventions including PCT. Overcoming the resulting disease-specific structures and thinking, and ensuring that the integrated programme is embedded within the existing health structures, pose considerable challenges to policy makers and implementers wishing to embark on integrated NTD control. By sharing experiences from Uganda, Tanzania, Southern Sudan, and Mozambique, this symposium article aims to outlines key challenges and solutions to assist countries in establishing efficient integrated NTD programmes.
Subject(s)
Antibiotic Prophylaxis , Communicable Disease Control/organization & administration , Program Development , Africa South of the Sahara , Communicable Disease Control/methods , Communicable Diseases/drug therapy , Humans , Tropical MedicineABSTRACT
OBJECTIVE: To determine the prevalence and causes of disabling hearing loss in adults and children in Uganda. STUDY DESIGN: Cross-sectional survey of ear disease and hearing impairment. SETTING: A random cluster sample design of the population from the Masindi district of Uganda following the World Health Organization (WHO) guidelines, using a modified version of the WHO Ear Disease Survey Protocol. MAIN OUTCOME MEASURE: The prevalence of disabling hearing impairment using the WHO definitions (excluding 0.5 kHz owing to high background noise levels). RESULTS: In the study, 6041 participants were enrolled and underwent audiometric evaluation and an ear examination. The prevalence of disabling hearing impairment was 11.7% in adults and 10.2% in children. A further 2.3% of children in whom thresholds could not be measured were deemed to have significant hearing loss based on screening questions and/or sound-field stimuli. Correctable causes such as dry perforations, cerumen impaction, and chronic suppurative otitis media resulted in disabling hearing loss in 17% of adult subjects and 41% of children. Preventable hearing loss, such as meningitis and noise-induced hearing loss, was present in a further significant percentage of subjects. CONCLUSIONS: Ear disease and hearing impairment were found to be important health problems in the Ugandan population. Preventable ear disease is a major cause of hearing loss in the population. It is hoped that the findings of this study will draw attention to the problem in Uganda and will lead to proper allocation of resources for the prevention and treatment of hearing loss and ear disease.
Subject(s)
Ear Diseases/epidemiology , Hearing Loss/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Cluster Analysis , Cross-Sectional Studies , Ear Diseases/diagnosis , Ear Diseases/prevention & control , Female , Health Surveys , Hearing Loss/diagnosis , Hearing Loss/prevention & control , Humans , Infant , Male , Middle Aged , Prevalence , Risk Factors , Uganda/epidemiology , Young AdultABSTRACT
Schistosomiasis caused by infection with Schistosoma mansoni is a serious public health burden in 38 of the 56 districts of Uganda. This article reviews the initial experience of the national control programme. Launched in 2003, this started with a pilot phase with the main aim of utilizing the experience to formulate feasible and appropriate methods of drug delivery. Overall, 432,746 people were treated and coverage was 91.4% in schools and 64.7% in communities. The issues raised by independent evaluators included that most communities did not participate in the selection of community drug distributors (CDD) and that teachers and CDDs needed refresher training mainly on health education and the management of side effects. As a way forward, it is suggested that the Ministry of Health should integrate deworming into the existing health infrastructure so that every time a child is reached for any health service, the child is also de-wormed.
