Browsing by Author "Aceng, Jane Ruth"
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Item Continental concerted efforts to control the seventh outbreak of Ebola Virus disease in Uganda: The first 90 days of the response(Journal of public health in Africa, 2023-10-24) Aceng, Jane Ruth; Bosa, Henry Kyobe; Atwine, Diana; Mwebesa, Henry; Kagirita, Atek; Ouma, Ahmed OgwellOn 20th September 2022, Uganda declared the 7th outbreak of Ebola virus disease (EVD) caused by the Sudan Ebola strain following the confirmation of a case admitted at Mubende Regional Referral Hospital. Upon confirmation, the Government of Uganda immediately activated the national incident management system to initiate response activities. Additionally, a multi-country emergency stakeholder meeting was held in Kampala; convening Ministers of Health from neighbouring Member States to undertake cross-border preparedness and response actions. The outbreak spanned 69 days and recorded 164 cases (142 confirmed, 22 probable), 87 recoveries and 77 deaths (case fatality ratio of 47%). Nine out of 136 districts were affected with transmission taking place in 5 districts but spilling over in 4 districts without secondary transmission. As part of the response, the Government galvanised robust community mobilisation and initiated assessment of medical counter measures including therapeutics, new diagnostics and vaccines. This paper highlights the response actions that contributed to the containment of this outbreak in addition to the challenges faced with a special focus on key recommendations for better control of future outbreaks.Item Ebola Viral Hemorrhagic Disease Outbreak in West Africa- Lessons from Uganda.(African health sciences, 2014) Mbonye, Anthony K.; Wamala, Joseph F.; Nanyunja, Miriam; Opio, Alex; Makumbi, Issa; Aceng, Jane RuthThere has been a rapid spread of Ebola Viral Hemorrhagic disease in Guinea, Liberia and Sierra Leone since March 2014. Since this is the first time of a major Ebola outbreak in West Africa; it is possible there is lack of understanding of the epidemic in the communities, lack of experience among the health workers to manage the cases and limited capacities for rapid response. The main objective of this article is to share Uganda’s experience in controlling similar Ebola outbreaks and to suggest some lessons that could inform the control of the Ebola outbreak in West Africa.The article is based on published papers, reports of previous Ebola outbreaks, response plans and experiences of individuals who have participated in the control of Ebola epidemics in Uganda. The success in the control of Ebola epidemics in Uganda has been due to high political support, effective coordination through national and district task forces. In addition there has been active surveillance, strong community mobilization using village health teams and other community resources persons, an efficient laboratory system that has capacity to provide timely results. These have coupled with effective case management and infection control and the involvement of development partners who commit resources with shared responsibility.Several factors have contributed to the successful quick containment of Ebola outbreaks in Uganda. West African countries experiencing Ebola outbreaks could draw some lessons from the Uganda experience and adapt them to contain the Ebola epidemic.Item Estimating the Effect and Cost-Effectiveness of Facemasks in Reducing the Spread of the Severe Acute Respiratory Syndrome- Coronavirus 2 (SARS-CoV-2) in Uganda(medRxiv., 2020) Nannyonga, Betty K.; Wanyenze, Rhoda K.; Kaleebu, Pontiano; Ssenkusu, John M.; Lutalo, Tom; Makumbi, Fredrick Edward; Kwizera, Arthur; Byakika, Pauline; Kirungi, Willford; Bosa, Henry Kyobe; Ssembatya, Vincent A.; Mwebesa, Henry; Atwine, Diana; Aceng, Jane Ruth; Woldermariam, Yonas TegegnEvidence that face masks provide effective protection against respiratory infections in the community is scarce. However, face masks are widely used by health workers as part of droplet precautions when caring for patients with respiratory infections. It would therefore be reasonable to suggest that consistent widespread use of face masks in the community could prevent further spread of the Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2). In this study we examine public face mask wearing in Uganda where a proportion wears masks to protect against acquiring, and the other to prevent from transmitting SARS-CoV-2. The objective of this study was to determine what percentage of the population would have to wear face masks to reduce susceptibility to and infectivity of SARS-COV-2 in Uganda, keeping the basic reproduction number below unity and/or flattening the curve. We used an SEIAQRD model for the analysis. Results show that implementation of facemasks has a relatively large impact on the size of the coronavirus epidemic in Uganda. We find that the critical mask adherence is 5 per 100 when 80% wear face masks. A cost-effective analysis shows that utilizing funds to provide 1 public mask to the population has a per capita compounded cost of USD 1.34. If provision of face masks is done simultaneously with supportive care, the per capita compounded cost is USD 1.965, while for the case of only treatment and no provision of face masks costs each Ugandan USD 4.0579. We conclude that since it is hard to achieve a 100% adherence to face masks, government might consider provision of face masks in conjunction with provision of care.Item Estimating the Effect and Cost-Effectiveness of Facemasks in Reducing the Spread of the Severe Acute Respiratory Syndrome- Coronavirus 2 (SARS-CoV-2) in Uganda(CC-BY-ND 4.0 International license ., 2020) Nannyonga, Betty K.; Wanyenze, Rhoda K.; Kaleebu, Pontiano; Ssenkusu, John M.; Lutalo, Tom; Makumbi, Fredrick Edward; Kwizera, Arthur; Byakika, Pauline; Kirungi, Willford; Kyobe Bosa, Henry; Ssembatya, Vincent A.; Mwebesa, Henry; Atwine, Diana; Aceng, Jane Ruth; Woldermariamç, Yonas TegegnEvidence that face masks provide effective protection against respiratory infections in the community is scarce. However, face masks are widely used by health workers as part of droplet precautions when caring for patients with respiratory infections. It would therefore be reasonable to suggest that consistent widespread use of face masks in the community could prevent further spread of the Severe Acute Respiratory Syndrome-Coronavirus 2 (SARSCoV- 2). In this study we examine public face mask wearing in Uganda where a proportion wears masks to protect against acquiring, and the other to prevent from transmitting SARSCoV- 2. The objective of this study was to determine what percentage of the population would have to wear face masks to reduce susceptibility to and infectivity of SARS-COV-2 in Uganda, keeping the basic reproduction number below unity and/or flattening the curve. We used an SEIAQRD model for the analysisItem Infodemic: How an Epidemic of Misinformation Could Lead to a High Number of the Novel Corona Virus Disease Cases in Uganda(Preprints, 2020) Nannyonga, Betty K.; Wanyeze, Rhoda K.; Kaleebu, Pontiano; Ssenkusu, John M.; Ssengooba, Freddie; Lutalo, Tom; Kirungi, Willford; Makumbi, Fredrick Edward; Bosa, Henry Kyobe; Ssembatya, Vincent A.; Mwebesa, Henry; Atwine, Diana; Aceng, Jane Ruth; Woldermariam, Yonas TegegnMisinformation during the COVID-19 outbreak has shaped our perception of the disease. Some people thinkthe disease is a bioweapon while others are convinced that it is a hoax. Heightened anxiety often producesfearful rumors, some of which are absurd while others seem plausible and are laced with some truths. But, how does misinformation affect disease spread? In this paper, we construct a mathematical model parameterized by Ugandan data, to study the effect of misinformation on community COVID-19 spread. The analysis shows that misinformation leads to high number of COVID-19 cases in a community, and the effect is highest in the rumour initiators and spreaders. This analysis underscores the importance of addressing misinformation in COVID risk communication.Item Investigation of Marburg Virus Disease Outbreak in Kween District, Eastern Uganda, 2017(PLoS neglected tropical diseases, 2019) Ario, Alex Riolexus; Makumbi, Issa; Nkonwa, Innocent Herbert; Eyu, Patricia; Opio, Denis Nixon; Nakiire, Lydia; Kwesiga, Benon; Kadobera, Daniel; Tusiime, Patrick; Bulage, Lilian; Zhu, Bao-Ping; Aceng, Jane RuthIn October 2017, a blood sample from a resident of Kween District, Eastern Uganda, tested positive for Marburg virus. Within 24 hour of confirmation, a rapid outbreak response was initiated. Here, we present results of epidemiological and laboratory investigations.A district task force was activated consisting of specialised teams to conduct case finding, case management and isolation, contact listing and follow up, sample collection and testing, and community engagement. An ecological investigation was also carried out to identify the potential source of infection. Virus isolation and Next Generation sequencing were performed to identify the strain of Marburg virus.Seventy individuals (34 MVD suspected cases and 36 close contacts of confirmed cases) were epidemiologically investigated, with blood samples tested for MVD. Only four cases met the MVD case definition; one was categorized as a probable case while the other three were confirmed cases. A total of 299 contacts were identified; during follow- up, two were confirmed as MVD. Of the four confirmed and probable MVD cases, three died, yielding a case fatality rate of 75%. All four cases belonged to a single family and 50% (2/4) of the MVD cases were female. All confirmed cases had clinical symptoms of fever, vomiting, abdominal pain and bleeding from body orifices. Viral sequences indicated that the Marburg virus strain responsible for this outbreak was closely related to virus strains previously shown to be circulating in Uganda.This outbreak of MVD occurred as a family cluster with no additional transmission outside of the four related cases. Rapid case detection, prompt laboratory testing at the Uganda National VHF Reference Laboratory and presence of pre-trained, well-prepared national and district rapid response teams facilitated the containment and control of this outbreak within one month, preventing nationwide and global transmission of the disease.Item Is the glass half full or half empty? A qualitative exploration on treatment practices and perceived barriers to biomedical care for patients with nodding syndrome in post-conflict northern Uganda(BMC Research Notes, 2015) Mwaka, Amos Deogratius; Okello, Elialilia S.; Abbo, Catherine; Odwong, Francis Okot; Olango, Willy; Etolu, John Wilson; Oriyabuzu, Rachel; Lagoro, David Kitara; Mutamba, Byamah Brian; Idro, Richard; Opar, Bernard Toliva; Aceng, Jane Ruth; Lukwago, Assuman; Neema, StellaNodding syndrome has increasingly become an issue of public health concern internationally. The etiology of the disorder is still unknown and there are yet no curative treatments. We explored perceptions about treatment practices and barriers to health seeking for nodding syndrome in Pader and Kitgum districts in northern Uganda in order to provide data necessary for informing policy on treatment adherence and rehabilitations.We used focus group discussions and individual interviews to gain deep insights into help-seeking and treatment practices for nodding syndrome. Purposive sampling was used to identify information-rich participants that included village health teams, community members not directly affected with nodding syndrome, district leaders, healthcare professionals, and caregivers of children affected with nodding syndrome. We used qualitative content analysis to analyze data and presented findings under distinct categories and themes.Caregivers and communities sought care from multiple sources including biomedical facilities, traditional healers, traditional rituals from shrines, and spiritual healing. Nodding syndrome affected children reportedly have showed no enduring improvement with traditional medicines, traditional rituals, and prayers. A substantial minority of participants reported minimal improvements in symptoms of convulsions with use of western medicines. Challenges involved in health seeking included; (1) health system factors e.g. long distances to facilities, frequent unavailability of medicines, few healthcare providers, and long waiting times; (2) contextual and societal challenges e.g. lack of money for transport and medical bills, overburdening nature of the illness that does not allow time for other activities, and practical difficulties involved in transporting the physically deformed and mentally retarded children to the health facilities.Help-seeking for nodding syndrome is pluralistic and include use of traditional and biomedical practices. Western medicines admittedly showed at least short term control on nodding syndrome symptoms, especially convulsions and led in a few cases to regain of functional abilities. However, multiple barriers hinder health seeking and interfere with adherence to biomedical treatments. Regarding cure, there are hitherto no treatments participants perceive cure nodding syndrome.Item Meeting the UN Sustainable Development Goal for Sanitation and Hygiene in the Era of COVID-19(The Journal of Record,, 2020) Aceng, Jane RuthWe are a decade away from 2030 and well off-track to achieve the sanitation and hygiene-related targets of Sustainable Development Goal (SDG) 6.2, which is as follows: By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations.1 These targets must be pursued for the good of all, but particularly and urgently to prepare nations to better respond to outbreaks or pandemics of infectious disease. To this goal, the Water Supply and Sanitation Collaborative Council (WSSCC) of the United Nations Office for Project Services announced2 its steering committee's landmark decision on May 4, to approve a new strategy for 2021–2025 and over the course of this year, to evolve the organization into the Sanitation and Hygiene Fund. A strong focus on those left behind and least able to respond will be at the heart of the fund, and through its new strategy, it will pursue four main strategic priorities: 1.) scale up household sanitation and hygiene services; 2.) address menstrual health and hygiene (MHH) gaps, promote gender equality and the empowerment of women and girls; 3.) increase sustainable water, sanitation, hygiene, and MHH services in schools and health care facilities; and 4.) support all forms of innovation which work toward providing access to safely managed services for all. The fund will provide grants to low-income countries for community-based solutions for sanitation and hygiene. This catalytic funding—primarily for countries in Africa and Asia—will be in addition to domestic financing and will leverage SDG interlinkages through a partnership approach. In response to the news, Jane Ruth Aceng, Minister of Health for Uganda, who has been a partner of WSSCC since 2010, issued the following statement: The current COVID-19 pandemic illustrates the role of sanitation and hygiene in the prevention of disease. Currently, more than half of the world's population does not have access to safely managed sanitation and three billion lack basic hygiene services. Across the world, including Uganda, people still live with inadequate sanitation and hygiene services in their houses, in their schools, and even in their health care facilities. Globally, open defecation is still practiced by 673 million people, predominantly those of disadvantaged rural communities. The poorest, least developed countries of the world are particularly affected. This is one of the biggest and longest-standing weaknesses in global health, and it has tragic consequences. In my country, Uganda, an estimated 75 percent of the overall disease burden derives from inadequate sanitation and hygiene. Each year, 23,000 Ugandans die from diarrhea, of which 19,700 are children below the age of five. Some 90 percent of these deaths are directly attributable to inadequate water, poor sanitation, and unhygienic practices. In other words, they would be entirely preventable through basic water, sanitation, and hygiene interventions. With estimates indicating that only 12 percent of health-care facilities in Uganda have basic sanitation services, the need to provide water, sanitation and hygiene (WASH) services is acute, especially in maternity and primary-care environments. In schools, the lack of proper WASH facilities leads to absenteeism and dropouts of adolescent girls. Of concern is the absence of means for girls to manage menstruation, which deters them from attending classes. Similarly, inadequate sanitation and hygiene facilities in the workplace mean that women are unable to manage menstruation, risking work absenteeism and depriving society of their full participation.Item Multidistrict Outbreak of Marburg Virus Disease—Uganda, 2012(The Journal of infectious diseases, 2015) Knust, Barbara; Schafer, Ilana J.; Wamala, Joseph; Nyakarahuka, Luke; Okot, Charles; Shoemaker, Trevor; Dodd, Kimberly; Gibbons, Aridth; Balinandi, Stephen; Tumusiime, Alex; Campbell, Shelley; Newman, Edmund; Lasry, Estrella; DeClerck, Hilde; Boum, Yap; Makumbi, Issa; Bosa, Henry Kyobe; Mbonye, Anthony; Aceng, Jane Ruth; Nichol, Stuart T.; Ströher, Ute; Rollin, Pierre E.In October 2012, a cluster of illnesses and deaths was reported in Uganda and was confirmed to be an outbreak of Marburg virus disease (MVD). Patients meeting the case criteria were interviewed using a standard investigation form, and blood specimens were tested for evidence of acute or recent Marburg virus infection by reverse transcription–polymerase chain reaction (RT-PCR) and antibody enzyme-linked immunosorbent assay. The total count of confirmed and probable MVD cases was 26, of which 15 (58%) were fatal. Four of 15 laboratory-confirmed cases (27%) were fatal. Case patients were located in 4 different districts in Uganda, although all chains of transmission originated in Ibanda District, and the earliest case detected had an onset in July 2012. No zoonotic exposures were identified. Symptoms significantly associated with being a MVD case included hiccups, anorexia, fatigue, vomiting, sore throat, and difficulty swallowing. Contact with a case patient and attending a funeral were also significantly associated with being a case. Average RT-PCR cycle threshold values for fatal cases during the acute phase of illness were significantly lower than those for nonfatal cases. Following the institution of contact tracing, active case surveillance, care of patients with isolation precautions, community mobilization, and rapid diagnostic testing, the outbreak was successfully contained 14 days after its initial detection.Item Prevalence Of Protective Tetanus Antibodies And Immunological Response Following Tetanus Toxoid Vaccination Among Men Seeking Medical Circumcision Services In Uganda(PloS one, 2018) Makumbi, Fredrick; Byabagambi, John; Muwanika, Richard; Kigozi, Godfrey; Gray, Ronald; Galukande, Moses; Bagaya, Bernard; Ssebagala, Darix; Karamagi, Esther; Rahimzai, Mirwais; Kaggwa, Mugagga; Watya, Stephen; Mbonye, Anthony K.; Aceng, Jane Ruth; Musinguzi, Joshua; Kiggundu, Valerian; Njeuhmeli, Emmanuel; Nanteza, BarbaraTetanus infection associated with men who had male circumcision has been reported in East Africa, suggesting a need for tetanus toxoid-containing vaccines (TTCV).To determine the prevalence of tetanus toxoid antibodies following vaccination among men seeking circumcision. We enrolled 620 consenting men who completed a questionnaire and received TTCV at enrollment (day 0) prior to circumcision on day 28. Blood samples were obtained at day 0 from all enrollees and on days 14, 28 and 42 from a random sample of 237 participants. Tetanus toxoid (TT) IgG antibody levels were assayed using EUROIMMUN. Analyses included prevalence of TT antibodies at enrollment and used a mixed effects model to determine the immunological response.Mean age was 21.4 years, 65.2% had knowledge of tetanus, 56.6% knew how tetanus was contracted, 22.8% reported ever receipt of TTCV, and 16.8% had current/recently healed wounds. Insufficient tetanus immunity was 57.1% at enrollment, 7.2% at day 14, 3.8% at day 28, and 0% at day 42. Antibody concentration was 0.44IU/ml (CI 0.35–0.53) on day 0, 3.86IU/ml (CI 3.60–4.11) on day 14, 4.05IU/ml (CI 3.81–4.29) on day 28, and 4.48IU/ml (CI 4.28–4.68) on day 42. TT antibodies increased by 0.24IU/ml (CI 0.23, 0.26) between days 0 and 14 and by 0.023IU/ml (CI 0.015, 0.031) between days 14 and 42 days. Immunological response was poorer in HIV-infected clients and men aged 35+ years.Insufficient immunity was common prior to TTCV, and a protective immunological response was achieved by day 14. Circumcision may safely be provided 14 days after vaccination in HIV-uninfected men aged less than 35 years.Item Rectal Artemether Versus Intravenous Quinine For The Treatment Of Cerebral Malaria In Children In Uganda: Randomised Clinical Trial(BMJ, 2005) Aceng, Jane Ruth; Byarugaba, Justus S.; Tumwine, James K.Cerebral malaria is the most severe and life threatening complication of Plasmodium falciparum malaria and carries a case fatality rate1 of 5-40%, with most deaths occurring within the first 24 hours.2 Although the recommended treatment of cerebral malaria is intravenous quinine,1 alternative drugs are necessary where intravenous treatment is not possible.3 Most studies comparing rectal artemether with intravenous quinine were carried out in adults.4–6 The results were variable, and information on the use of artemether in children is limited.6 One recent study found that a single dose of rectal artesunate is associated with rapid reduction in parasite density in children and adults with moderately severe malaria.7 If found effective, rectal artemether might be particularly useful for treating severely ill children at peripheral health units,2 where facilities for intravenous treatment are often lacking.3 8 Using rectal formulations might prevent potentially life threatening complications arising from delays in administering effective antimalarial treatment to children with cerebral malaria. We compared the efficacy and safety of rectal artemether with that of intravenous quinine in the treatment of children, aged 6 months to 5 years, with cerebral malaria.Item Uganda’s Experience in Ebola Virus Disease Outbreak Preparedness, 2018–2019(Globalization and health, 2020) Aceng, Jane Ruth; Ario, Alex R.; Muruta, Allan N.; Nanyunja, Miriam; N. Bakainaga, Andrew; Talisuna, Ambrose O.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.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 As of 31 May 2019, there was no confirmed case of EVD as Uganda has continued to make significantand 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.