Good governance for sustainable WASH programming: lessons from two USAID-funded projects in Uganda

The USAID/Uganda Strengthening Decentralization for Sustainability (SDS) Program’s WASH component and the Northern Uganda Development of Enhanced Local Governance, Infrastructure, and Livelihoods (NUDEIL) Program brought innovative approaches to supplying WASH services and infrastructure through existing District Local Government systems in Southwestern and Northern Uganda respectively. The SDS Program’s WASH Component focused on increasing the flow of resources, both human and financial, into existing District programs. Increased numbers of trainers and informational resources for CLTS and hygiene education allowed Districts to increase their number of ODF communities. The NUDEIL program built infrastructure through the District Local Governments, all the way from planning to construction supervision. The program allowed war-affected Districts to build up their capacity for planning, procurement, engineering supervision, and training with technical guidance from the implementing partner to successfully complete a large number of water points, with trained hand pump mechanics and water user committees

Two decades of post-graduate training in Applied Public Health: The experience and challenges of the Uganda Public Health School Without Walls

The objective of this work is to describe the experience of the Uganda Public Health School Without Walls (PHSWOW) in training public health professionals at post-graduate level to offer leadership in planning, delivery of health services and research within a decentralized health system. As one of the constituents of the Makerere University College of Health Sciences, the Uganda PHSWOW has the vision of becoming a Centre of Excellence, providing leadership in public health and the mission of promoting the attainment of better health of the people in Uganda and beyond through public health training, research and community service. Key to the successes of the program are the 238 program graduates, most of whom have remained in-country to serve at district and national levels of service delivery. Collaborations have been established with government, private, non-governmental and international institutions leading to increased health service provision and research for the improvement of health status of populations and influence on public policy. There is still a lot to do in diversifying the skills mix of graduates and contributing to an ambitious increment from 0.4 to 4.7 public health professionals per 10,000 population; as is currently the case in high-middle income countries. Currently, the Uganda PHSWOW has exceeded the proposed output for FETPs of training 3 to 5 graduates per 1 million population suggested by some authors, however the output is still inadequate. More also needs to be done to promote a culture of publication in an effort to translate public health evidence into policy and practice

Application of the Ceditest FMDV type O and FMDV-NS enzyme-linked immunosorbent assays for detection of antibodies against Foot-and-mouth disease virus in selected livestock and wildlife species in Uganda

Diagnosis and control of Foot-and-mouth disease virus (FMDV) requires rapid and sensitive diagnostic tests. Two antibody enzyme-linked immunosorbent assay (ELISA) kits, Ceditest® FMDV-NS for the detection of antibodies against the nonstructural proteins of all FMDV serotypes and Ceditest® FMDV type O for the detection of antibodies against serotype O, were evaluated under African endemic conditions where the presence of multiple serotypes and the use of nonpurified vaccines complicate serological diagnosis. Serum samples from 218 African buffalo, 758 cattle, 304 goats, and 88 sheep were tested using both kits, and selected samples were tested not only in serotype-specific ELISAs for antibodies against primarily FMDV serotype O, but also against other serotypes. The FMDV-NS assay detected far more positive samples (93%) than the FMDV type O assay (30%) in buffalo (P < 0.05), with predominant antibodies against the South African Territories (SAT) serotypes, while the seroprevalence was generally comparable in cattle with antibodies against serotype O elicited by infection and/or vaccination. However, some districts had higher seroprevalence using the FMDV type O assay indicating vaccination without infection, while 1 cattle herd with antibodies against the SAT serotypes had far more positive samples (85%) using the FMDV-NS versus the FMDV type O (10%), consistent with the latter test\u27s lower sensitivity for antibodies against SAT serotypes. Based on the current investigation, the FMDV type O ELISA may be limited by the presence of SAT serotypes. The FMD NS assay worked well as a screening test for antibodies against all FMDV serotypes present in Uganda; however, as long as nonpurified vaccines are applied in the region, this test cannot be used to differentiate between vaccinated and infected animals

Phylogenetic analyses of the polyprotein coding sequences of serotype O foot-and-mouth disease viruses in East Africa: evidence for interserotypic recombination

BACKGROUND: Foot-and-mouth disease (FMD) is endemic in East Africa with the majority of the reported outbreaks attributed to serotype O virus. In this study, phylogenetic analyses of the polyprotein coding region of serotype O FMD viruses from Kenya and Uganda has been undertaken to infer evolutionary relationships and processes responsible for the generation and maintenance of diversity within this serotype. FMD virus RNA was obtained from six samples following virus isolation in cell culture and in one case by direct extraction from an oropharyngeal sample. Following RT-PCR, the single long open reading frame, encoding the polyprotein, was sequenced. RESULTS: Phylogenetic comparisons of the VP1 coding region showed that the recent East African viruses belong to one lineage within the EA-2 topotype while an older Kenyan strain, K/52/1992 is a representative of the topotype EA-1. Evolutionary relationships between the coding regions for the leader protease (L), the capsid region and almost the entire coding region are monophyletic except for the K/52/1992 which is distinct. Furthermore, phylogenetic relationships for the P2 and P3 regions suggest that the K/52/1992 is a probable recombinant between serotypes A and O. A bootscan analysis of K/52/1992 with East African FMD serotype A viruses (A21/KEN/1964 and A23/KEN/1965) and serotype O viral isolate (K/117/1999) revealed that the P2 region is probably derived from a serotype A strain while the P3 region appears to be a mosaic derived from both serotypes A and O. CONCLUSIONS: Sequences of the VP1 coding region from recent serotype O FMDVs from Kenya and Uganda are all representatives of a specific East African lineage (topotype EA-2), a probable indication that hardly any FMD introductions of this serotype have occurred from outside the region in the recent past. Furthermore, evidence for interserotypic recombination, within the non-structural protein coding regions, between FMDVs of serotypes A and O has been obtained. In addition to characterization using the VP1 coding region, analyses involving the non-structural protein coding regions should be performed in order to identify evolutionary processes shaping FMD viral populations

Laboratory capacity for diagnosis of foot-and-mouth disease in Eastern Africa: implications for the progressive control pathway

<p>Abstract</p> <p>Background</p> <p>Accurate diagnosis is pertinent to any disease control programme. If Eastern Africa is to work towards control of foot-and-mouth disease (FMD) using the Progressive Control Pathway for FMD (PCP-FMD) as a tool, then the capacity of national reference laboratories (NRLs) mandated to diagnose FMD should match this task. This study assessed the laboratory capacity of 14 NRLs of the Eastern Africa Region Laboratory Network member countries using a semi-structured questionnaire and retrospective data from the World Reference Laboratory for FMD annual reports and Genbank® through National Centre for Biotechnology Information for the period 2006–2010.</p> <p>Results</p> <p>The questionnaire response rate was 13/14 (93%). Twelve out of the 13 countries/regions had experienced at least one outbreak in the relevant five year period. Only two countries (Ethiopia and Kenya) had laboratories at biosecurity level 3 and only three (Ethiopia, Kenya and Sudan) had identified FMD virus serotypes for all reported outbreaks. Based on their own country/region assessment, 12/13 of these countries /regions were below stage 3 of the PCP-FMD. Quarantine (77%) and vaccination (54%) were the major FMD control strategies employed. The majority (12/13) of the NRLs used serological techniques to diagnose FMD, seven used antigen ELISA and three of these (25%) also used molecular techniques which were the tests most frequently requested from collaborating laboratories by the majority (69%) of the NRLs. Only 4/13 (31%) participated in proficiency testing for FMD. Four (31%) laboratories had no quality management systems (QMS) in place and where QMS existed it was still deficient, thus, none of the laboratories had achieved accreditation for FMD diagnosis.</p> <p>Conclusions</p> <p>This study indicates that FMD diagnostic capacity in Eastern Africa is still inadequate and largely depends on antigen and antibody ELISAs techniques undertaken by the NRLs. Hence, for the region to progress on the PCP-FMD, there is need to: implement regional control measures, improve the serological diagnostic test performance and laboratory capacity of the NRLs (including training of personnel as well as upgrading of equipment and methods, especially strengthening the molecular diagnostic capacity), and to establish a regional reference laboratory to enforce QMS and characterization of FMD virus containing samples.</p

Low topotype diversity of recent foot-and-mouth disease virus serotypes O and A from districts located along the Uganda and Tanzania border

Foot-and-mouth disease (FMD) is one of the most important livestock diseases in East Africa with outbreaks reported annually that cause severe economic losses. It is possible to control disease using vaccination, but antigenic matching of the vaccine to circulating strains is critical. To determine the relationship between foot-and-mouth disease viruses circulating in districts along the Uganda and Tanzanian border between 2016 and 2017 and currently used vaccines, phylogenetic analysis of the full VP1 virus sequences was carried out on samples collected from both sides of the border. A total of 43 clinical samples were collected from animals exhibiting signs of FMD and VP1 sequences generated from 11 of them. Eight out of the 11 sequences obtained belonged to serotype O and three belonged to serotype A. The serotype O sequences obtained showed limited nucleotide divergence (average of 4.9%) and belonged to topotype East Africa-2, whereas the most common O-type vaccine strain used in the region (O/KEN/77/78) belonged to East Africa-1. The serotype A viruses belonged to topotype Africa-G1 (average nucleotide divergence 7.4%), as did vaccine strain K5/1980. However, vaccine strain K35/1980 belonged to Africa G VII with an average sequence divergence of 20.5% from the study sequences. The genetic distances between current vaccine strains and circulating field strains underscores the crucial need for regular vaccine matching and the importance of collaborative efforts for better control of FMD along this border area

Unrecognized circulation of SAT 1 foot-and-mouth disease virus in cattle herds around Queen Elizabeth National Park in Uganda

BACKGROUND: Foot-and-mouth disease (FMD) is endemic in Uganda in spite of the control measures used. Various aspects of the maintenance and circulation of FMD viruses (FMDV) in Uganda are not well understood; these include the role of the African buffalo (Syncerus caffer) as a reservoir for FMDV. To better understand the epidemiology of FMD at the livestock-wildlife-interface, samples were collected from young, unvaccinated cattle from 24 pastoral herds that closely interact with wildlife around Queen Elizabeth National Park in Uganda, and analysed for evidence of FMDV infection. RESULTS: In total, 37 (15 %) of 247 serum samples had detectable antibodies against FMDV non-structural proteins (NSPs) using a pan-serotypic assay. Within these 37 sera, antibody titres ≥ 80 against the structural proteins of serotypes O, SAT 1, SAT 2 and SAT 3 were detected by ELISA in 5, 7, 4 and 3 samples, respectively, while neutralizing antibodies were only detected against serotype O in 3 samples. Two FMDV isolates, with identical VP1 coding sequences, were obtained from probang samples from clinically healthy calves from the same herd and are serotype SAT 1 (topotype IV (EA-I)). Based on the VP1 coding sequences, these viruses are distinct from previous cattle and buffalo SAT 1 FMDV isolates obtained from the same area (19–30 % nucleotide difference) and from the vaccine strain (TAN/155/71) used within Uganda (26 % nucleotide difference). Eight herds had only one or a few animals with antibodies against FMDV NSPs while six herds had more substantial evidence of prior infection with FMDV. There was no evidence for exposure to FMDV in the other ten herds. CONCLUSIONS: The two identical SAT 1 FMDV VP1 sequences are distinct from former buffalo and cattle isolates from the same area, thus, transmission between buffalo and cattle was not demonstrated. These new SAT 1 FMDV isolates differed significantly from the vaccine strain used to control Ugandan FMD outbreaks, indicating a need for vaccine matching studies. Only six herds had clear serological evidence for exposure to O and SAT 1 FMDV. Scattered presence of antibodies against FMDV in other herds may be due to the occasional introduction of animals to the area or maternal antibodies from past infection and/or vaccination. The evidence for asymptomatic FMDV infection has implications for disease control strategies in the area since this obstructs early disease detection that is based on clinical signs in FMDV infected animals. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12917-015-0616-1) contains supplementary material, which is available to authorized users

Determinants of Uptake of Mass Drug Administration for Schistosomiasis Control in Butiaba Sub-county, Uganda

Introduction: Schistosomiasis is one of the Neglected Tropical Diseases (NTDs) targeted for elimination in Uganda by 2025 through Mass Drug Administration (MDA) using praziquantel.  To achieve this, WHO estimates indicate that MDA coverage and uptake of 75% is required. However, coverage remains suboptimal with insufficient knowledge and inadequate drug supply often cited as key reasons. There is a need to add to the body of knowledge in various settings to enable more robust mitigation measures. This study aimed to assess the uptake of praziquantel for MDA and associated factors in Butiaba sub-county along the shores of Lake Albert in Uganda. Methods: A cross-sectional study was conducted in five randomly selected villages within Butiaba sub-county between July and September 2021 using quantitative and qualitative approaches. Semi-structured questionnaires were administered to 450 adults, with additional two Focus Group Discussions and Key Informant interviews held with implementation structures from the village to district level. Results: Self-reported uptake of praziquantel within twelve months of the most recent MDA exercise was 71.56% (95% CI: 67.14 – 75.68). Of all the participants, 5.78% reported have never swallowed praziquantel in their lifetime, and 75% (96/128) of participants who didn’t swallow praziquantel in the last twelve months reported having at least swallowed the drug in the last ten years. Respondents were less likely to have swallowed praziquantel if they had no knowledge about schistosomiasis signs (AOR= 0.18, 95% CI: 0.08–0.39) and more likely if they were between the ages 30-39years (AOR= 2.31, 95% CI: 1.35–3.95) or 40 years and above (AOR= 2.86, 95% CI: 1.45 – 4.95). Operational  challenges such as the inadequate supply of praziquantel and financial constraints also influence the uptake of praziquantel during MDA in Butiaba sub-county. Conclusion: The uptake of praziquantel during MDA in Butiaba sub-county was high but still below the WHO target of 75%. People with limited knowledge of schistosomiasis symptoms and those aged 18 – 29 years were less likely to take Praziquantel. Irregular drug supply was also a key challenge. Recommendation: Rigorous health education and ensuring a continuous supply of Praziquantel are key to improving MDA uptake