Uganda's experience in Ebola virus disease outbreak preparedness, 2018-2019.

BACKGROUND: Since the declaration of the 10th Ebola Virus Disease (EVD) outbreak in DRC on 1st Aug 2018, several neighboring countries have been developing and implementing preparedness efforts to prevent EVD cross-border transmission to enable timely detection, investigation, and response in the event of a confirmed EVD outbreak in the country. We describe Uganda's experience in EVD preparedness. RESULTS: On 4 August 2018, the Uganda Ministry of Health (MoH) activated the Public Health Emergency Operations Centre (PHEOC) and the National Task Force (NTF) for public health emergencies to plan, guide, and coordinate EVD preparedness in the country. The NTF selected an Incident Management Team (IMT), constituting a National Rapid Response Team (NRRT) that supported activation of the District Task Forces (DTFs) and District Rapid Response Teams (DRRTs) that jointly assessed levels of preparedness in 30 designated high-risk districts representing category 1 (20 districts) and category 2 (10 districts). The MoH, with technical guidance from the World Health Organisation (WHO), led EVD preparedness activities and worked together with other ministries and partner organisations to enhance community-based surveillance systems, develop and disseminate risk communication messages, engage communities, reinforce EVD screening and infection prevention measures at Points of Entry (PoEs) and in high-risk health facilities, construct and equip EVD isolation and treatment units, and establish coordination and procurement mechanisms. CONCLUSION: As of 31 May 2019, there was no confirmed case of EVD as Uganda has continued to make significant and verifiable progress in EVD preparedness. There is a need to sustain these efforts, not only in EVD preparedness but also across the entire spectrum of a multi-hazard framework. These efforts strengthen country capacity and compel the country to avail resources for preparedness and management of incidents at the source while effectively cutting costs of using a "fire-fighting" approach during public health emergencies

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Averting biodiversity collapse in tropical forest protected areas

The rapid disruption of tropical forests probably imperils global biodiversity more than any other contemporary phenomenon¹⁻³. With deforestation advancing quickly, protected areas are increasingly becoming final refuges for threatened species and natural ecosystem processes. However, many protected areas in the tropics are themselves vulnerable to human encroachment and other environmental stresses⁴⁻⁹. As pressures mount, it is vital to know whether existing reserves can sustain their biodiversity. A critical constraint in addressing this question has been that data describing a broad array of biodiversity groups have been unavailable for a sufficiently large and representative sample of reserves. Here we present a uniquely comprehensive data set on changes over the past 20 to 30 years in 31 functional groups of species and 21 potential drivers of environmental change, for 60 protected areas stratified across the world’s major tropical regions. Our analysis reveals great variation in reserve ‘health’: about half of all reserves have been effective or performed passably, but the rest are experiencing an erosion of biodiversity that is often alarmingly widespread taxonomically and functionally. Habitat disruption, hunting and forest-product exploitation were the strongest predictors of declining reserve health. Crucially, environmental changes immediately outside reserves seemed nearly as important as those inside in determining their ecological fate, with changes inside reserves strongly mirroring those occurring around them. These findings suggest that tropical protected areas are often intimately linked ecologically to their surrounding habitats, and that a failure to stem broad-scale loss and degradation of such habitats could sharply increase the likelihood of serious biodiversity declines.Keywords: Ecology, Environmental scienc

Associations with HIV testing in Uganda: an analysis of the Lot Quality Assurance Sampling database 2003–2012

Beginning in 2003, Uganda used Lot Quality Assurance Sampling (LQAS) to assist district managers collect and use data to improve their human immunodeficiency virus (HIV)/AIDS program. Uganda's LQAS-database (2003–2012) covers up to 73 of 112 districts. Our multidistrict analysis of the LQAS data-set at 2003–2004 and 2012 examined gender variation among adults who ever tested for HIV over time, and attributes associated with testing. Conditional logistic regression matched men and women by community with seven model effect variables. HIV testing prevalence rose from 14% (men) and 12% (women) in 2003–2004 to 62% (men) and 80% (women) in 2012. In 2003–2004, knowing the benefits of testing (Odds Ratio [OR] = 6.09, 95% CI = 3.01–12.35), knowing where to get tested (OR = 2.83, 95% CI = 1.44–5.56), and secondary education (OR = 3.04, 95% CI = 1.19–7.77) were significantly associated with HIV testing. By 2012, knowing the benefits of testing (OR = 3.63, 95% CI = 2.25–5.83), where to get tested (OR = 5.15, 95% CI = 3.26–8.14), primary education (OR = 2.01, 95% CI = 1.39–2.91), being female (OR = 3.03, 95% CI = 2.53–3.62), and being married (OR = 1.81, 95% CI = 1.17–2.8) were significantly associated with HIV testing. HIV testing prevalence in Uganda has increased dramatically, more for women than men. Our results concurred with other authors that education, knowledge of HIV, and marriage (women only) are associated with testing for HIV and suggest that couples testing is more prevalent than other authors

Characteristics of sexually active youths participating in LQAS surveys across Uganda between 2003 and 2010 (n = 4518).

<p>*Denominators may vary due to missing data.</p><p>**Response option only present for 12 districts surveyed in 2010.</p

Odds ratios of the effects of socio-demographic and behavioural characteristics on condom use and sexual practice.

<p>NR: Non-regular.</p><p>Ref: The reference group for the Odds Ratio calculation.</p><p>*Variable is statistically significant at p<0.1.</p><p>**Variable is statistically significant at p<0.05.</p><p>***Variable is statistically significant at p<0.01.</p>‡<p>Data collected in 2006, 2009, 2010 only.</p>†<p>Controlled for sex, age, education, marital status, age at first intercourse, region, survey year, perceived risk for HIV and ever tested for HIV.</p>††<p>Controlled for age, education, marital status, age at first intercourse, region, survey year, perceived risk for HIV and ever tested for HIV.</p

Overview of samples of youths included in this study across time and region in Uganda during 2003 to 2010.

<p>CU: Condom use.</p><p>NR: Non-regular.</p

Re-membering Mwanga: same-sex intimacy, memory and belonging in postcolonial Uganda

Proponents of Uganda’s Anti-Homosexuality Act 2014 have denounced homosexuality as an import from the West. Yet every June, hundreds of thousands of Christian pilgrims in Uganda commemorate a set of events, the hegemonic textual accounts of which pivot around the practice of native ‘sodomy’. According to these accounts, the last pre-colonial Kabaka (king) Mwanga of Buganda ordered the execution of a number of his male Christian pages in 1886 when, under the influence of their new religion, they refused his desire for physical intimacy. These events have assumed the place of a founding myth for Christianity in Uganda as a result of the Catholic Church’s canonization of its martyred pioneers. This article explores how public commemoration of these events can coexist with the claim that same-sex intimacy is alien to Uganda. Unlike previous scholarship on the martyrdoms, which has focused primarily on colonial discourse, the article pays attention to contemporary Ugandan remembering of the martyrdoms. And against the grain of queer African historical scholarship, which seeks to recover the forgotten past, it explores the critical possibilities immanent within something that is intensively memorialized. The article maps Ugandan public memory of the martyrdoms, unravelling genealogies of homophobia as well as possibilities for sexual dissidence that lurk within public culture