Strategies from the 2000–01 Ebola outbreak in Uganda

AbstractBackgroundAn outbreak of Ebola virus disease was reported from Gulu district, Uganda, on Oct 8, 2000. Over a period of 3 months, the outbreak spread to two other parts of the country, namely Mbarara and Masindi districts. Response measures included surveillance, community mobilisation, and case and logistics management. Three coordination committees were formed: the National Task Force (NTF), the District Task Force (DTF), and the Interministerial Task Force (IMTF). The NTF and DTF were responsible for coordination and follow-up of implementation of activities at the national and district levels, respectively, while the IMTF provided political direction and handled sensitive issues related to stigma, trade, tourism, and international relations. This study documents this experience and draws lessons that are of interest to the rest of the world.MethodsThe international response was coordinated by the WHO under the umbrella organisation of the Global Outbreak and Alert Response Network. A WHO and Centers for Disease Control and Prevention case definition for Ebola was adapted and used to capture four categories of cases: alert cases, suspected cases, probable cases, and confirmed cases. Guidelines for identification and management of cases were developed and disseminated to people responsible for surveillance, case management, contact tracing, and information, education, and communication.FindingsFor the duration of the epidemic that lasted to Jan 16, 2001, 425 cases with 224 deaths were reported throughout Uganda. The case fatality rate was 53%. The attack rate (AR) was highest in women. The average AR for Gulu district was 12·6 cases per 10 000 inhabitants when the contacts of all cases were considered, and was 4·5 cases per 10 000 if limited only to contacts of laboratory confirmed cases. The secondary AR was 2·5% when nearly 5000 contacts were followed up for 21 days. Uganda was finally declared free of Ebola on Feb 27, 2001, 42 days after the last case was reported. The Government's role in coordination of both local and international support was of huge importance. The NTF and the corresponding district committees worked closely in the harmonised implementation of the mutually agreed programme. Community mobilisation using community-based health workers, cultural and religious leaders, and Members of Parliament was effective in transmitting information to the public.InterpretationPast experience in epidemic management shows that, in the absence of free availability of information to the public, rumours that are unhelpful to epidemic control efforts prevail and spread quickly. During this outbreak in Uganda, rumour was managed by frank and open discussion of the epidemic, daily updates, fact sheets, and press releases. Information was regularly disseminated to communities through mass media and press conferences. Community mobilisation and transmission of information to the public was critical in controlling the epidemic. All levels of the community spontaneously demonstrated solidarity and response to public health interventions—even in areas of relative insecurity, where the number of rebel abductions dropped considerably during the outbreak.FundingNone

Strengthening health systems in low-income countries by enhancing organizational capacities and improving institutions

Background: This paper argues that the global health agenda tends to privilege short-term global interests at the expense of long-term capacity building within national and community health systems. The Health Systems Strengthening (HSS) movement needs to focus on developing the capacity of local organizations and the institutions that influence how such organizations interact with local and international stakeholders. Discussion: While institutions can enable organizations, they too often apply requirements to follow paths that can stifle learning and development. Global health actors have recognized the importance of supporting local organizations in HSS activities. However, this recognition has yet to translate adequately into actual policies to influence funding and practice. While there is not a single approach to HSS that can be uniformly applied to all contexts, several messages emerge from the experience of successful health systems presented in this paper using case studies through a complex adaptive systems lens. Two key messages deserve special attention: the need for donors and recipient organizations to work as equal partners, and the need for strong and diffuse leadership in low-income countries. Summary: An increasingly dynamic and interdependent post-Millennium Development Goals (post-MDG) world requires new ways of working to improve global health, underpinned by a complex adaptive systems lens and approaches that build local organizational capacity

A survey of Sub-Saharan African medical schools

<p>Abstract</p> <p>Background</p> <p>Sub-Saharan Africa suffers a disproportionate share of the world's burden of disease while having some of the world's greatest health care workforce shortages. Doctors are an important component of any high functioning health care system. However, efforts to strengthen the doctor workforce in the region have been limited by a small number of medical schools with limited enrolments, international migration of graduates, poor geographic distribution of doctors, and insufficient data on medical schools. The goal of the Sub-Saharan African Medical Schools Study (SAMSS) is to increase the level of understanding and expand the baseline data on medical schools in the region.</p> <p>Methods</p> <p>The SAMSS survey is a descriptive survey study of Sub-Saharan African medical schools. The survey instrument included quantitative and qualitative questions focused on institutional characteristics, student profiles, curricula, post-graduate medical education, teaching staff, resources, barriers to capacity expansion, educational innovations, and external relationships with government and non-governmental organizations. Surveys were sent via e-mail to medical school deans or officials designated by the dean. Analysis is both descriptive and multivariable.</p> <p>Results</p> <p>Surveys were distributed to 146 medical schools in 40 of 48 Sub-Saharan African countries. One hundred and five responses were received (72% response rate). An additional 23 schools were identified after the close of the survey period. Fifty-eight respondents have been founded since 1990, including 22 private schools. Enrolments for medical schools range from 2 to 1800 and graduates range from 4 to 384. Seventy-three percent of respondents (n = 64) increased first year enrolments in the past five years. On average, 26% of respondents' graduates were reported to migrate out of the country within five years of graduation (n = 68). The most significant reported barriers to increasing the number of graduates, and improving quality, related to infrastructure and faculty limitations, respectively. Significant correlations were seen between schools implementing increased faculty salaries and bonuses, and lower percentage loss of faculty over the previous five years (<it>P </it>= 0.018); strengthened institutional research tools (<it>P </it>= 0.00015) and funded faculty research time (<it>P </it>= 0.045) and greater faculty involvement in research; and country compulsory service requirements (<it>P </it>= 0.039), a moderate number (1-5) of post-graduate medical education programs (<it>P </it>= 0.016) and francophone schools (<it>P </it>= 0.016) and greater rural general practice after graduation.</p> <p>Conclusions</p> <p>The results of the SAMSS survey increases the level of data and understanding of medical schools in Sub-Saharan Africa. This data serves as a baseline for future research, policies and investment in the health care workforce in the region which will be necessary for improving health.</p

Health Extension Workers Improve Tuberculosis Case Detection and Treatment Success in Southern Ethiopia: A Community Randomized Trial

Background: One of the main strategies to control tuberculosis (TB) is to find and treat people with active disease. Unfortunately, the case detection rates remain low in many countries. Thus, we need interventions to find and treat sufficient number of patients to control TB. We investigated whether involving health extension workers (HEWs: trained community health workers) in TB control improved smear-positive case detection and treatment success rates in southern Ethiopia. Methodology/Principal Finding: We carried out a community-randomized trial in southern Ethiopia from September 2006 to April 2008. Fifty-one kebeles (with a total population of 296, 811) were randomly allocated to intervention and control groups. We trained HEWs in the intervention kebeles on how to identify suspects, collect sputum, and provide directly observed treatment. The HEWs in the intervention kebeles advised people with productive cough of 2 weeks or more duration to attend the health posts. Two hundred and thirty smear-positive patients were identified from the intervention and 88 patients from the control kebeles. The mean case detection rate was higher in the intervention than in the control kebeles (122.2% vs 69.4%, p,0.001). In addition, more females patients were identified in the intervention kebeles (149.0 vs 91.6, p,0.001). The mean treatment success rate was higher in the intervention than in the control kebeles (89.3% vs 83.1%, p = 0.012) and more for females patients (89.8% vs 81.3%, p = 0.05). Conclusions/Significance: The involvement of HEWs in sputum collection and treatment improved smear-positive case detection and treatment success rate, possibly because of an improved service access. This could be applied in settings with low health service coverage and a shortage of health workers

Strategies from the 2000–01 Ebola outbreak in Uganda

Background: An outbreak of Ebola virus disease was reported from Gulu district, Uganda, on Oct 8, 2000. Over a period of 3 months, the outbreak spread to two other parts of the country, namely Mbarara and Masindi districts. Response measures included surveillance, community mobilisation, and case and logistics management. Three coordination committees were formed: the National Task Force (NTF), the District Task Force (DTF), and the Interministerial Task Force (IMTF). The NTF and DTF were responsible for coordination and follow-up of implementation of activities at the national and district levels, respectively, while the IMTF provided political direction and handled sensitive issues related to stigma, trade, tourism, and international relations. This study documents this experience and draws lessons that are of interest to the rest of the world. Methods: The international response was coordinated by the WHO under the umbrella organisation of the Global Outbreak and Alert Response Network. A WHO and Centers for Disease Control and Prevention case definition for Ebola was adapted and used to capture four categories of cases: alert cases, suspected cases, probable cases, and confirmed cases. Guidelines for identification and management of cases were developed and disseminated to people responsible for surveillance, case management, contact tracing, and information, education, and communication. Findings: For the duration of the epidemic that lasted to Jan 16, 2001, 425 cases with 224 deaths were reported throughout Uganda. The case fatality rate was 53%. The attack rate (AR) was highest in women. The average AR for Gulu district was 12·6 cases per 10 000 inhabitants when the contacts of all cases were considered, and was 4·5 cases per 10 000 if limited only to contacts of laboratory confirmed cases. The secondary AR was 2·5% when nearly 5000 contacts were followed up for 21 days. Uganda was finally declared free of Ebola on Feb 27, 2001, 42 days after the last case was reported. The Government's role in coordination of both local and international support was of huge importance. The NTF and the corresponding district committees worked closely in the harmonised implementation of the mutually agreed programme. Community mobilisation using community-based health workers, cultural and religious leaders, and Members of Parliament was effective in transmitting information to the public. Interpretation: Past experience in epidemic management shows that, in the absence of free availability of information to the public, rumours that are unhelpful to epidemic control efforts prevail and spread quickly. During this outbreak in Uganda, rumour was managed by frank and open discussion of the epidemic, daily updates, fact sheets, and press releases. Information was regularly disseminated to communities through mass media and press conferences. Community mobilisation and transmission of information to the public was critical in controlling the epidemic. All levels of the community spontaneously demonstrated solidarity and response to public health interventions—even in areas of relative insecurity, where the number of rebel abductions dropped considerably during the outbreak. Funding: None

Is the sector-wide approach (SWAp) improving health sector performance in Uganda?

LondonNO DIVISIONpub302pu