Assessment of core capacities for the International Health Regulations (IHR[2005]) – Uganda, 2009

<p>Abstract</p> <p>Background</p> <p>Uganda is currently implementing the International Health Regulations (IHR[2005]) within the context of Integrated Disease Surveillance and Response (IDSR). The IHR(2005) require countries to assess the ability of their national structures, capacities, and resources to meet the minimum requirements for surveillance and response. This report describes the results of the assessment undertaken in Uganda.</p> <p>Methods</p> <p>We conducted a descriptive cross-sectional assessment using the protocol developed by the World Health Organisation (WHO). The data collection tools were adapted locally and administered to a convenience sample of HR(2005) stakeholders, and frequency analyses were performed.</p> <p>Results</p> <p>Ugandan national laws relevant to the IHR(2005) existed, but they did not adequately support the full implementation of the IHR(2005). Correspondingly, there was a designated IHR National Focal Point (NFP), but surveillance activities and operational communications were limited to the health sector. All the districts (13/13) had designated disease surveillance offices, most had IDSR technical guidelines (92%, or 12/13), and all (13/13) had case definitions for infectious and zoonotic diseases surveillance. Surveillance guidelines were available at 57% (35/61) of the health facilities, while case definitions were available at 66% (40/61) of the health facilities. The priority diseases list, surveillance guidelines, case definitions and reporting tools were based on the IDSR strategy and hence lacked information on the IHR(2005). The rapid response teams at national and district levels lacked food safety, chemical and radio-nuclear experts. Similarly, there were no guidelines on the outbreak response to food, chemical and radio-nuclear hazards. Comprehensive preparedness plans incorporating IHR(2005) were lacking at national and district levels. A national laboratory policy existed and the strategic plan was being drafted. However, there were critical gaps hampering the efficient functioning of the national laboratory network. Finally, the points of entry for IHR(2005) implementation had not been designated.</p> <p>Conclusions</p> <p>The assessment highlighted critical gaps to guide the IHR(2005) planning process. The IHR(2005) action plan should therefore be developed to foster national and international public health security.</p

High Hepatitis E Seroprevalence Among Displaced Persons in South Sudan.

AbstractLarge protracted outbreaks of hepatitis E virus (HEV) have been documented in displaced populations in Africa over the past decade though data are limited outside these exceptional settings. Serological studies can provide insights useful for improving surveillance and disease control. We conducted an age-stratified serological survey using samples previously collected for another research study from 206 residents of an internally displaced person camp in Juba, South Sudan. We tested serum for anti-HEV antibodies (IgM and IgG) and estimated the prevalence of recent and historical exposure to the virus. Using data on individuals' serostatus, camp arrival date, and state of origin, we used catalytic transmission models to estimate the relative risk of HEV infection in the camp compared with that in the participants' home states. The age-adjusted seroprevalence of anti-HEV IgG was 71% (95% confidence interval = 63-78), and 4% had evidence of recent exposure (IgM). We estimated HEV exposure rates to be more than 2-fold (hazard ratio = 2.3, 95% credible interval = 0.3-5.8) higher in the camp than in the participants' home states, although this difference was not statistically significant. HEV transmission may be higher than previously appreciated, even in the absence of reported cases. Improved surveillance in similar settings is needed to understand the burden of disease and minimize epidemic impact through early detection and response

Outbreak of Marburg hemorrhagic fever among miners in Kamwenge and Ibanda Districts, Uganda, 2007

Marburg hemorrhagic fever was detected among 4 miners in Ibanda District, Uganda, from June through September, 2007. Infection was likely acquired through exposure to bats or bat secretions in a mine in Kamwenge District, Uganda, and possibly human-to-human transmission between some patients. We describe the epidemiologic investigation and the health education response

Managing Ebola from rural to urban slum settings: experiences from Uganda.

Managing Ebola in Uganda.Five outbreaks of ebola occurred in Uganda between 2000-2012. The outbreaks were quickly contained in rural areas. However, the Gulu outbreak in 2000 was the largest and complex due to insurgency. It invaded Gulu municipality and the slum- like camps of the internally displaced persons (IDPs). The Bundigugyo district outbreak followed but was detected late as a new virus. The subsequent outbreaks in the districts of Luwero district (2011, 2012) and Kibaale (2012) were limited to rural areas

Ebola Hemorrhagic Fever Associated with Novel Virus Strain, Uganda, 2007–2008

Case-fatality rate is lower for this strain than for the other 3 Ebola species known to be pathogenic to humans

Prevalence and factors associated with depression and suicidal ideation during the COVID-19 pandemic among university students in Uganda: a cross-sectional study

Background: The COVID-19 pandemic has negatively impacted psychosocial well-being and mental health of students across the world. Although students are vulnerable to depression and suicidal ideation, few studies have been conducted in Uganda. This study aimed to determine the prevalence of depression and suicidal ideation, and associated factors among undergraduate university students in Uganda. Methods: A cross-sectional study was conducted among undergraduates [N = 540; 363 males; mean age = 23.3 (± 2.64) years] recruited from four universities using an online questionnaire that explored sociodemographic factors, depression, and other associated factors. The Patient Health Questionnaire (PHQ-9) was used to assess depression, and Item 9 was used to assess suicidal ideation in the past 2 weeks. Multivariable logistic regression analyses were performed to determine the factors associated with depression and suicidal ideation. Results: The prevalence of moderate to severe depression was 20% (n = 108) (cut-off: 10/27 based on the PHQ-9), and the prevalence of past-2-week suicidal ideation was 13.89% (n = 75) (cut-off: 1/3 based on the PHQ-9 Item 9). About half of the individuals who screened positive for depression had suicidal ideation. Factors associated with depression were: having relationship issues [adjusted odds ratio (aOR) = 1.79, 95% confidence interval (CI) = 1.13–2.81, p = 0.012], and having a history of sexual abuse (aOR = 2.06, 95% CI = 1.10–3.84, p = 0.023). Factors associated with reducing the risk of depression were: satisfaction with current academic performance (aOR = 0.50, 95% CI = 0.32–0.79, p = 0.003), and being in the fifth year of academic study (aOR = 0.16, 95% CI = 0.03–0.73, p = 0.018). Factors associated with suicidal ideation were: smoking cigarettes and/or marijuana (aOR = 4.83, 95% CI = 1.10–21.12, p = 0.037), and having financial tuition constraints (aOR = 1.85, 95% CI = 1.08–3.16, p = 0.024), However, satisfaction with current academic performance reduced the likelihood of suicidal ideation (aOR = 0.40, 95% CI = 0.23–0.70, p = 0.001). Conclusion: Approximately one-fifth of undergraduate university students were moderately to severely depressed, especially those who had relationship issues and those with a history of sexual abuse. Suicidal ideation was common among smokers and those having financial tuition constraints. Therefore, it is recommended that the university authorities implement measures to provide psychological support for the students with problems concerning financial tuition constraints, relationships, and sexual abuse. Also, all students with depression should be screened for suicidality

Dental service patterns among private and public adult patients in Australia

Background While the majority of dental care in Australia is provided in the private sector those patients who attend for public care remain a public health focus due to their socioeconomic disadvantage. The aims of this study were to compare dental service profiles provided to patients at private and public clinics, controlling for age, sex, reason for visit and income. Methods Data were collected in 2004–06, using a three-stage, stratified clustered sample of Australians aged 15+ years, involving a computer-assisted telephone interview (CATI), oral examination and mailed questionnaire. Analysis was restricted to those who responded to the CATI. Results A total of 14,123 adults responded to the CATI (49% response) of whom 5,505 (44% of those interviewed) agreed to undergo an oral epidemiological examination. Multivariate analysis controlling for age, sex, reason for visit and income showed that persons attending public clinics had higher odds [Odds ratio, 95%CI] of extraction (1.69, 1.26–2.28), but lower odds of receiving oral prophylaxis (0.50, 0.38–0.66) and crown/bridge services (0.34, 0.13–0.91) compared to the reference category of private clinics. Conclusion Socio-economically disadvantaged persons who face barriers to accessing dental care in the private sector suffer further oral health disadvantage from a pattern of services received at public clinics that has more emphasis on extraction of teeth and less emphasis on preventive and maintenance care.David S Brennan, Liana Luzzi and Kaye F Roberts-Thomso

Eff ectiveness of one dose of oral cholera vaccine in response to an outbreak: a case-cohort study

Background Oral cholera vaccines represent a new eff ective tool to fi ght cholera and are licensed as two-dose regimens with 2–4 weeks between doses. Evidence from previous studies suggests that a single dose of oral cholera vaccine might provide substantial direct protection against cholera. During a cholera outbreak in May, 2015, in Juba, South Sudan, the Ministry of Health, Médecins Sans Frontières, and partners engaged in the fi rst fi eld deployment of a single dose of oral cholera vaccine to enhance the outbreak response. We did a vaccine eff ectiveness study in conjunction with this large public health intervention. Methods We did a case-cohort study, combining information on the vaccination status and disease outcomes from a random cohort recruited from throughout the city of Juba with that from all the cases detected. Eligible cases were those aged 1 year or older on the fi rst day of the vaccination campaign who sought care for diarrhoea at all three cholera treatment centres and seven rehydration posts throughout Juba. Confi rmed cases were suspected cases who tested positive to PCR for Vibrio cholerae O1. We estimated the short-term protection (direct and indirect) conferred by one dose of cholera vaccine (Shanchol, Shantha Biotechnics, Hyderabad, India). Findings Between Aug 9, 2015, and Sept 29, 2015, we enrolled 87 individuals with suspected cholera, and an 898-person cohort from throughout Juba. Of the 87 individuals with suspected cholera, 34 were classifi ed as cholera positive, 52 as cholera negative, and one had indeterminate results. Of the 858 cohort members who completed a follow-up visit, none developed clinical cholera during follow-up. The unadjusted single-dose vaccine eff ectiveness was 80·2% (95% CI 61·5–100·0) and after adjusting for potential confounders was 87·3% (70·2–100·0). Interpretation One dose of Shanchol was eff ective in preventing medically attended cholera in this study. These results support the use of a single-dose strategy in outbreaks in similar epidemiological settings

Mother's occupation and sex ratio at birth

<p>Abstract</p> <p>Background</p> <p>Many women are working outside of the home, occupying a multitude of jobs with varying degrees of responsibilities and levels of psychological stress. We investigated whether different job types in women are associated with child sex at birth, with the hypothesis that women in job types, which are categorized as "high psychological stress" jobs, would be more likely to give birth to a daughter than a son, as females are less vulnerable to unfavourable conditions during conception, pregnancy and after parturition, and are less costly to carry to term.</p> <p>Methods</p> <p>We investigated the effects of mother's age, maternal and paternal job type (and associated psychological stress levels) and paternal income on sex ratio at birth. Our analyses were based on 16,384 incidences of birth from a six-year (2000 to 2005 inclusive) childbirth dataset from Addenbrooke's Hospital in Cambridge, UK. We obtained a restricted data set from Addenbrooke's hospital with: maternal age, maternal and paternal occupations, and whether or not the child was first-born.</p> <p>Results</p> <p>Women in job types that were categorized as "high stress" were more likely to give birth to daughters, whereas women in job types that were categorized as "low stress" had equal sex ratios or a slight male bias in offspring. We also investigated whether maternal age, and her partner's income could be associated with reversed offspring sex ratio. We found no association between mother's age, her partner's job stress category or partner income on child sex. However, there was an important interaction between job stress category and partner income in some of the analyses. Partner income appears to attenuate the association between maternal job stress and sex ratios at moderate-income levels, and reverse it at high-income levels.</p> <p>Conclusions</p> <p>To our knowledge this is the first report on the association between women's job type stress categories and offspring sex ratio in humans, and the potential mitigating effect of their partners' income.</p

Socio-demographic disparity in oral health among the poor: a cross sectional study of early adolescents in Kilwa district, Tanzania

There is a lack of studies considering social disparity in oral health emanating from adolescents in low-income countries. This study aimed to assess socio-demographic disparities in clinical- and self reported oral health status and a number of oral health behaviors. The extent to which oral health related behaviors might account for socio-demographic disparities in oral health status was also examined. A cross-sectional study was conducted in Kilwa district in 2008. One thousand seven hundred and forty five schoolchildren completed an interview and a full mouth clinical examination. Caries experience was recorded using WHO criteria, whilst type of treatment need was categorized using the ART approach. The majority of students were caries free (79.8%) and presented with a low need for dental treatment (89.3%). Compared to their counterparts in opposite groups, rural residents and those from less poor households presented more frequently with caries experience (DMT>0), high need for dental treatment and poor oral hygiene behavior, but were less likely to report poor oral health status. Stepwise logistic regressions revealed that social and behavioral variables varied systematically with caries experience, high need for dental treatment and poor self reported oral health. Socio-demographic disparities in oral health outcomes persisted after adjusting for oral health behaviors. Socio-demographic disparities in oral health outcomes and oral health behaviors do exist. Socio-demographic disparities in oral health outcomes were marginally accounted for by oral health behaviors. Developing policies and programs targeting both social and individual determinants of oral health should be an urgent public health strategy in Tanzania