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

Prevalence of Cervical Cancer Screening Among Women in Fishing Communities of Entebbe Municipality, Wakiso District. A Cross-sectional study.

Background: Cervical cancer disease in Uganda remains the leading causes of deaths among cancer patients, responsible for about 4,607 deaths annually. Despite the numerous modern treatment options and prevention strategies, cervical cancer screening prevalence remains undefined especially in the fishing communities and yet women living in fishing communities are core interest groups for cervical cancer due to their relatively higher risk of HIV and HPV infections. Methodology: A cross-sectional study employing a quantitative approach was performed, purposive sampling following a household survey was conducted. Structured interviews and questionnaires were administered to collect data from June 2021 to August 2021. Data were analyzed in SPSS version 25 using the log-binomial model. Results: prevalence of cervical cancer screening among women in fishing communities of Entebbe municipality, Wakiso district remains as low as 23.2%, mainly unsatisfactory among the married women (aPR = 0.232 [0.13 - 0.43], p < 0.001) and, Catholics (aPR = 0.050 [0.01 - 0.18], p < 0.001).  At the same time, higher cervical cancer screening prevalence was observed among employed women (aPR= 2.81 [1.48 - 5.33], p = 0.002), those who had prior recommendation from healthcare workers (aPR = 1.25 [0.09 - 0.65], p = 0.004), and those who perceived that cervical cancer is a curse from God (cPR = 2.800 [CI = 1.798 - 4.36], P = 0.000). Conclusion:  Cervical cancer screening is low among women in fishing communities of Entebbe municipality; only 2 in every 10 women have ever been screened for cervical cancer in their lifetime, while less than 1 in 10 had to follow-up of screening. Recommendation: Behavior change communication preferably using the intrapersonal channel on issues related to cervical cancer screening should be adopted in the fishing communities urgently if we are to elevate the uptake of this secondary prevention measure for cervical cancer

INTRAPERSONAL FACTORS ASSOCIATED WITH CERVICAL CANCER SCREENING AMONG WOMEN IN FISHING COMMUNITIES OF ENTEBBE MUNICIPALITY, WAKISO DISTRICT. A CROSS-SECTIONAL STUDY.

Background The chances of developing cervical cancer in Uganda continue to rise especially in the fishing communities due to the relatively higher prevalence of inter-related personal risk factors. This study aimed to examine the Intrapersonal Factors Associated with Cervical Cancer Screening Among Women in Fishing Communities of Entebbe Municipality, Wakiso District. Methodology A descriptive cross-sectional survey study was conducted among women in the fishing communities of Entebbe-Municipality Wakiso district in Central Uganda and utilized quantitative methods of data collection. Data were collected using a structured questionnaire with multiple-response questions. Data were analyzed using SPSS version 25, univariate, bivariate, and multivariate analysis were performed at 5% level significance. Results Of the 293 respondents that were interviewed, only 23.2% of women had ever been screened for cervical cancer. More than three-quarters of them knew that cervical cancer is not curable 234(79.9%). 150(51.2%) women mentioned that the age at the start of screening for cervical cancer in Uganda is 18 years and had 46% less prevalence of cervical cancer screening (cPR = 0.54 [0.33 - 0.90], p = 0.020). Among the perception attributes Cervical cancer screening prevalence was twice as high among women who agreed that cervical cancer is a curse from God (cPR = 2.43 [CI = 1.49 - 3.97], P = 0.000) compared to those who disagreed. Conclusion The intrapersonal factors associated with cervical cancer screening among women in the fishing communities of Entebbe municipality were mainly; marital status, employment status, knowledge of age at the start of the screening, and perceptions of the relevance of screening. Recommendation Communication and education should focus on awareness creation about the fact that even in a marriage where not much risky sexual behavior may be present, the risk of HPV infection remains apparent, for instance from sexually transmitted infections within the couple

Viruses associated with measles-like illnesses in Uganda

Objectives: In this study, we investigated the causes of measles-like illnesses (MLI) in the Uganda national surveillance programme in order to inform diagnostic assay selection and vaccination strategies. Methods: We used metagenomic next-generation sequencing (M-NGS) on the Illumina platform to identify viruses associated with MLI (defined as fever and rash in the presence of either cough, coryza or conjunctivitis) in patient samples that had tested IgM negative for measles between 2010 and 2019. Results: Viral genomes were identified in 87/271 (32%) of samples, of which 44/271 (16%) contained 12 known viral pathogens. Expected viruses included rubella, human parvovirus B19, Epstein Barr virus, human herpesvirus 6B, human cytomegalovirus, varicella zoster virus and measles virus (detected within the seronegative window-period of infection) and the blood-borne hepatitis B virus. We also detected Saffold virus, human parvovirus type 4, the human adenovirus C2 and vaccine-associated poliovirus type 1. Conclusions: The study highlights the presence of undiagnosed viruses causing MLI in Uganda, including vaccine-preventable illnesses. NGS can be used to monitor common viral infections at a population level, especially in regions where such infections are prevalent, including low and middle income countries to guide vaccination policy and optimize diagnostic assays

Two decades of regional trends in vaccination completion and coverage among children aged 12-23 months : an analysis of the Uganda Demographic Health Survey data from 1995 to 2016

BACKGROUND: Childhood vaccination is an important public health intervention but there is limited information on coverage, trends, and determinants of vaccination completion in Uganda at the regional level. We examined trends in regional vaccination coverage and established the determinants of vaccination completion among children aged 12-23 months in Uganda. METHODS: We analyzed data from the women’s questionnaire for the 1995-2016 Uganda Demographic Health Survey (UDHS). Vaccine completion was defined as having received a dose of Bacillus-Calmette Guerin (BCG) vaccine; three doses of diphtheria, pertussis, and tetanus (DPT) vaccine; three doses of oral polio vaccine (OPV) (excluding OPV given at birth); and one dose of measles vaccine. We performed Chi-square tests to compare vaccination completion by socio-demographic factors stratified by 10 sub-regions: Eastern, East Central, Central 1, Central 2, Kampala, Karamoja, North, Western, West Nile, and Southwest. We performed logistic regression analysis for each of the regions to identify factors associated with vaccination completion at 5% level of statistical significance. RESULTS: Overall vaccination completion was 48.6% (95%CI, 47.2, 50.1) and ranged from 17.3% in Central 1 to 65.9% in Southwest. Vaccination completion rates declined significantly by 10.4% (95% confidence interval (CI), − 16.1, − 4.6) between 1995 and 2000, and increased significantly by 10.0% (95% CI, 4.6, 15.4) between 2000 and 2006, and by 5.4% (95% CI, 0.2, 10.6) between 2006 and 2011. Maternal education (secondary or higher level), receipt of tetanus toxoid (TT) during pregnancy, and possession of a child health card were associated with vaccination completion across all the sub-regions. Other factors like place of residence, religious affiliation, household wealth, maternal age, childbirth order, size of child at birth, and place of delivery were associated with vaccination completion but differed between the 10 sub-regions. CONCLUSION: Besides considerable regional variations, the vaccination completion rate among children aged 12-23 months in Uganda remains suboptimal despite the availability of vaccines. Maternal education, receipt of TT, and possession of a child health card are associated with a higher likelihood of vaccination completion among children aged 12-23 months in all the regions of Uganda. Interventions to improve the utilization of vaccination services in Uganda should consider these factors

Factors contributing to measles transmission during an outbreak in Kamwenge District, Western Uganda, April to August 2015

This article discusses in April 2015, Kamwenge District, western Uganda reported a measles outbreak. We investigated the outbreak to identify potential exposures that facilitated measles transmission, assess vaccine effectiveness (VE) and vaccination coverage (VC), and recommend prevention and control measures.Background: In April 2015, Kamwenge District, western Uganda reported a measles outbreak. We investigated the outbreak to identify potential exposures that facilitated measles transmission, assess vaccine effectiveness (VE) and vaccination coverage (VC), and recommend prevention and control measures. Methods: For this investigation, a probable case was defined as onset of fever and generalized maculopapular rash, plus ≥1 of the following symptoms: Coryza, conjunctivitis, or cough. A confirmed case was defined as a probable case plus identification of measles-specific IgM in serum. For case-finding, we reviewed patients’ medical records and conducted in-home patient examination. In a case-control study, we compared exposures of case-patients Nand controls matched by age and village of residence. For children aged 9 m-5y, we estimated VC using the percent of children among the controls who had been vaccinated against measles, and calculated VE using the formula, VE = 1 - ORM-H, where ORM-H was the Mantel-Haenszel odds ratio associated with having a measles vaccination history. Results: We identified 213 probable cases with onset between April and August, 2015. Of 23 blood specimens collected, 78% were positive for measles-specific IgM. Measles attack rate was highest in the youngest age-group, 0-5y (13/10,000), and decreased as age increased. The epidemic curve indicated sustained propagation in the community. Of the 50 case-patients and 200 controls, 42% of case-patients and 12% of controls visited health centers during their likely exposure period (ORM-H = 6.1; 95% CI = 2.7–14). Among children aged 9 m-5y, VE was estimated at 70% (95% CI: 24–88%), and VC at 75% (95% CI: 67–83%). Excessive crowding was observed at all health centers; no patient triage-system existed. Conclusions: The spread of measles during this outbreak was facilitated by patient mixing at crowded health centers, suboptimal VE and inadequate VC. We recommended emergency immunization campaign targeting children <5y in the affected sub-counties, as well as triaging and isolation of febrile or rash patients visiting health centers

Enhancing Workforce Capacity to Improve Vaccination Data Quality, Uganda

In Uganda, vaccine dose administration data are often not available or are of insufficient quality to optimally plan, monitor, and evaluate program performance. A collaboration of partners aimed to address these key issues by deploying data improvement teams (DITs) to improve data collection, management, analysis, and use in district health offices and health facilities. During November 2014–September 2016, DITs visited all districts and 89% of health facilities in Uganda. DITs identified gaps in awareness and processes, assessed accuracy of data, and provided on-the-job training to strengthen systems and improve healthcare workers’ knowledge and skills in data quality. Inaccurate data were observed primarily at the health facility level. Improvements in data management and collection practices were observed, although routine follow-up and accountability will be needed to sustain change. The DIT strategy offers a useful approach to enhancing the quality of health data

Use of surveys to evaluate an integrated oral cholera vaccine campaign in response to a cholera outbreak in Hoima district, Uganda

Objectives To evaluate the quality and coverage of the campaign to distribute oral cholera vaccine (OCV) during a cholera outbreak in Hoima, Uganda to guide future campaigns of cholera vaccine.Design Survey of communities targeted for vaccination to determine vaccine coverage rates and perceptions of the vaccination campaign, and a separate survey of vaccine staff who carried out the campaign.Setting Hoima district, Uganda.Participants Representative clusters of households residing in the communities targeted for vaccination and staff members who conducted the vaccine campaign.Results Among 209 households (1274 individuals) included in the coverage survey, 1193 (94%; 95% CI 92% to 95%) reported receiving at least one OCV dose and 998 (78%; 95% CI 76% to 81%) reported receiving two doses. Among vaccinated individuals, minor complaints were reported by 71 persons (5.6%). Individuals with ‘some’ education (primary school or above) were more knowledgeable regarding the required OCV doses compared with non-educated (p=0.03). Factors negatively associated with campaign implementation included community sensitisation time, staff payment and problems with field transport. Although the campaign was carried out quickly, the outbreak was over before the campaign started. Most staff involved in the campaign (93%) were knowledgeable about cholera control; however, 29% did not clearly understand how to detect and manage adverse events following immunisation.Conclusion The campaign achieved high OCV coverage, but the surveys provided insights for improvement. To achieve high vaccine coverage, more effort is needed for community sensitisation, and additional resources for staff transportation and timely payment for campaign staff is required. Pretest and post-test assessment of staff training can identify and address knowledge and skill gaps

Rubella virus genotype 2B endemicity and related utility of serum-based molecular characterization in Uganda

Abstract There are 13 globally recognized rubella virus genotypes of which only 2 (1E and 2B) have been detected recently. The largest percentage of all reported rubella virus sequences come from China and Japan with Africa reporting limited data. In a bid to address the lack of rubella genotype data in Uganda and the World Health Organization Africa region, we sought to characterize rubella viruses retrospectively using sera collected from suspected measles patients that turned out rubella IgM positive. Seven sequences belonging to genotype 2B sub-lineage 2B-L2c were obtained. These sequences clustered with other genotype 2B sequences previously reported from Uganda. None of the other genotypes (1E and 1G) reported from Uganda in the earlier years were detected. In addition, none of the sequences were obtained after the introduction of the measles-rubella containing vaccine. The above highlight the need for continuous rubella virological surveillance to confirm interruption of endemic rubella genotype circulation