Two Clusters of Meningococcal Meningitis in Bunyangabu District, Uganda: October, 2017

Introduction: On 13 November 2017, the Uganda Ministry of Health through the Public Health Emergency Operations Centre was notified of an unknown illness that caused sudden deaths of 3 children in Bunyangabu District. The case-patients presented with fever, convulsions, loss of consciousness and neck stiffness. We investigated to establish the cause, scope of outbreak and recommend preventive measures. Methods: We defined a suspected case as onset of fever, neck stiffness and any of the following: convulsions, loss of consciousness, headache, vomiting, nausea in a resident of Kabonero or Kateebwa sub-counties, Bunyangabu District from 1 September to 30 November 2017. We reviewed medical records and conducted active case finding in affected communities. We analyzed case data by person, place and time and assessed vaccination status of the case-patients. A cerebro spinal fluid (CSF) sample from one case-patient for laboratory analysis was collected and tested using standard gram staining procedure. Results: Between 1 September and 30 October 2017, 5 cases with 3 deaths (case fatality rate = 60%) occurred in Bunyangabu District. The mean age of case-patients was 4 years. Two sub-counties of Kabonero and Kateebwa were affected. Of the 5 case-patients, one (20%) had laboratory confirmation of meningococcal meningitis. One (20%) had proof of full vaccination with Pneumococcal Conjugate Vaccine, one (20%) was partially vaccinated and three (60%) had not received any vaccination. Conclusion: These were two unrelated clusters of meningococcal meningitis outbreak caused by Neisseria meningitides. We recommended that the Ministry of Health extends vaccination to susceptible sub-populations in districts outside the meningitis belt

Two clusters of meningococcal meningitis in Bunyangabu District, Uganda: October, 2017

Introduction: On 13 November 2017, the Uganda Ministry of Health through the Public Health Emergency Operations Centre was notified of an unknown illness that caused sudden deaths of 3 children in Bunyangabu District. The case-patients presented with fever, convulsions, loss of consciousness and neck stiffness. We investigated to establish the cause, scope of outbreak and recommend preventive measures. Methods: We defined a suspected case as onset of fever, neck stiffness and any of the following: convulsions, loss of consciousness, headache, vomiting, nausea in a resident of Kabonero or Kateebwa sub-counties, Bunyangabu District from 1 September to 30 November 2017. We reviewed medical records and conducted active case finding in affected communities. We analyzed case data by person, place and time and assessed vaccination status of the case-patients. A cerebro spinal fluid (CSF) sample from one case-patient for laboratory analysis was collected and tested using standard gram staining procedure. Results: Between 1 September and 30 October 2017, 5 cases with 3 deaths (case fatality rate = 60%) occurred in Bunyangabu District. The mean age of case-patients was 4 years. Two sub-counties of Kabonero and Kateebwa were affected. Of the 5 case-patients, one (20%) had laboratory confirmation of meningococcal meningitis. One (20%) had proof of full vaccination with Pneumococcal Conjugate Vaccine, one (20%) was partially vaccinated and three (60%) had not received any vaccination. Conclusion: These were two unrelated clusters of meningococcal meningitis outbreak caused by Neisseria meningitides. We recommended that the Ministry of Health extends vaccination to susceptible sub-populations in districts outside the meningitis belt

Outbreak of gastrointestinal anthrax following eating beef of suspicious origin: Isingiro District, Uganda, 2017.

INTRODUCTION:Gastrointestinal anthrax is a rare but serious disease. In August 2017, Isingiro District, Uganda reported a cluster of >40 persons with acute-onset gastroenteritis. Symptoms included bloody diarrhoea. We investigated to identify the etiology and exposures, and to inform control measures. METHODS:We defined a suspected case as acute-onset of diarrhoea or vomiting during 15-31 August 2017 in a resident (aged≥2 years) of Kabingo sub-county, Isingiro District; a confirmed case was a suspected case with a clinical sample positive for Bacillus anthracis by culture or PCR. We conducted descriptive epidemiology to generate hypotheses. In a case-control study, we compared exposures between case-patients and neighbourhood-matched controls. We used conditional logistic regression to compute matched odds ratios (MOR) for associations of illness with exposures. RESULTS:We identified 61 cases (58 suspected and 3 confirmed; no deaths). In the case-control study, 82% of 50 case-patients and 12% of 100 controls ate beef purchased exclusively from butchery X during the week before illness onset (MOR = 46, 95%CI = 4.7-446); 8.0% of case-patients and 3.0% of controls ate beef purchased from butchery X and elsewhere (MOR = 19, 95%CI = 1.0-328), compared with 6.0% of case-patients and 30% of controls who did not eat beef. B. anthracis was identified in two vomitus and one stool sample. Butchery X slaughtered a sick cow and sold the beef during case-patients' incubation period. CONCLUSION:This gastrointestinal anthrax outbreak occurred due to eating beef from butchery X. We recommended health education, safe disposal of the carcasses of livestock or game animals, and anthrax vaccination for livestock

Trends and spatial distribution of neonatal sepsis, Uganda, 2016–2020

Abstract Background In Uganda, sepsis is the third-leading cause of neonatal deaths. Neonatal sepsis can be early-onset sepsis (EOS), which occurs ≤ 7 days postpartum and is usually vertically transmitted from the mother to newborn during the intrapartum period, or late-onset sepsis (LOS), occurring 8–28 days postpartum and largely acquired from the hospital environment or community. We described trends and spatial distribution of neonatal sepsis in Uganda, 2016–2020. Methods We conducted a descriptive incidence study using routinely-reported surveillance data on in-patient neonatal sepsis from the District Health Information System version 2 (DHIS2) during 2016–2020. We calculated incidence of EOS, LOS, and total sepsis as cases per 1,000 live births (LB) at district (n = 136), regional (n = 4), and national levels, as well as total sepsis incidence by health facility level. We used logistic regression to evaluate national and regional trends and illustrated spatial distribution using choropleth maps. Results During 2016–2020, 95,983 neonatal sepsis cases were reported, of which 71,262 (74%) were EOS. Overall neonatal sepsis incidence was 17.4/1,000 LB. EOS increased from 11.7 to 13.4 cases/1,000 LB with an average yearly increase of 3% (p < 0.001); LOS declined from 5.7 to 4.3 cases/1,000 LB with an average yearly decrease of 7% (p < 0.001). Incidence was highest at referral hospitals (68/1,000 LB) and lowest at Health Center IIs (1.3/1,000 LB). Regionally, total sepsis increased in Central (15.5 to 23.0/1,000 LB, p < 0.001) and Northern regions (15.3 to 22.2/1,000 LB, p < 0.001) but decreased in Western (23.7 to 17.0/ 1,000 LB, p < 0.001) and Eastern (15.0 to 8.9/1,000, p < 0.001) regions. Conclusion The high and increasing incidence of EOS in Uganda suggests a major gap in sepsis prevention and quality of care for pregnant women. The heterogenous distribution of neonatal sepsis incidence requires root cause analysis by health authorities in regions with consistently high incidence. Strengthening prevention and treatment interventions in Central and Northern regions, and in the most affected districts, could reduce neonatal sepsis. Employment of strategies which increase uptake of safe newborn care practices and prevent neonatal sepsis, such as community health worker (CHW) home visits for mothers and newborns, could reduce incidence

Experiences of Using the Toll Free Telephone Line to Access Maternal and Newborn Health Services in Central Uganda: A Qualitative Study

<p>Maternal mortality remains a significant public health challenge in Sub-Saharan Africa. Most of these deaths are preventable and can be addressed with low cost, effective interventions with an understanding of the <i>three delays</i> associated with maternal morbidity and mortality. This qualitative study used Focused Group Discussions (FGDs) to collect data in four health facilities. A total of 10 FGDs were conducted; two with health workers, four with women, and another four with both men and women. Each session lasted 45-60 minutes and had a moderator, observer and note taker. All discussions were audio recorded after obtaining consent from the participants. Interviews were transcribed verbatim and translated to English from audio recordings. Data analysis was performed using the thematic analysis with major themes determined appriori while sub themes emerge using QDA DATA Miner software. This data comprises of 10 full text transcripts from the group discussion sessions</p><p><br></p><p><br></p><p><br></p><p><br></p