Browsing by Author "Ario, Alex Riolexus"
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Item Evaluation of Public Health Surveillance Systems in Refugee Settlements in Uganda, 2016–2019: Lessons Learned(Conflict and Health, 2022) Ario, Alex Riolexus; Barigye, Emily Atuheire; Nkonwa, Innocent Harbert; Bulage, Lilian; Okello, Paul Edward; Kizito, Susan; Kwesiga, Benon; Kasozi, JuliusCivil wars in the Great Lakes region resulted in massive displacement of people to neighboring countries including Uganda. With associated disease epidemics related to this conflict, a disease surveillance system was established aiming for timely detection of diseases and rapid response to outbreaks. We describe the evaluation of and lessons learned from the public health surveillance system set up in refugee settlements in Uganda. We conducted a cross-sectional survey using the US Centers for Disease Control and Prevention Updated Guidelines for Evaluating Public Health Surveillance Systems and the Uganda National Technical Guidelines for Integrated Disease Surveillance and Response in four refugee settlements in Uganda—Bidibidi, Adjumani, Kiryandongo and Rhino Camp. Using semi-structured questionnaires, key informant and focus group discussion guides, we interviewed 53 health facility leaders, 12 key personnel and 224 village health team members from 53 health facilities and 112 villages and assessed key surveillance functions and attributes. All health facilities assessed had key surveillance staff; 60% were trained on Integrated Disease Surveillance and Response and most village health teams were trained on disease surveillance. Case detection was at 55%; facilities lacked standard case definitions and were using parallel Implementing Partner driven reporting systems. Recording was at 79% and reporting was at 81%. Data analysis and interpretation was at 49%. Confirmation of outbreaks and events was at 76%. Preparedness was at 72%. Response was at 34%. Feedback was at 82%. Evaluate and improve the system was at 67%. There was low capacity for detection, response and data analysis and interpretation of cases (< 60%). The surveillance system in the refugee settlements was functional with many performing attributes but with many remaining gaps. There was low capacity for detection, response and data analysis and interpretation in all the refugee settlements. There is need for improvement to align surveillance systems in refugee settlements with the mainstream surveillance system in the country. Implementing Partners should be urged to offer support for surveillance and training of surveillance staff on Integrated Disease Surveillance and Response to maintain effective surveillance functions. Functionalization of district teams ensures achievement of surveillance functions and attributes. Regular supervision of and support to health facility surveillance personnel is essential. Harmonization of reporting improves surveillance functions and attributes and appropriation of funds by government to districts to support refugee settlements is complementary to maintain effective surveillance of priority diseases in the northern and central part of Uganda.Item Factors Associated with Utilisation of Couple HIV Counselling and Testing Among HIV‑Positive Adults in Kyoga Fishing Community Uganda, May 2017: Cross Sectional Study(AIDS and behavior, 2017) Nakiire, Lydia; Kabwama, Steven; Majwala, Robert; Bbale, Joy Kusiima; Makumbi, Issa; Kalyango, Joan; Kihembo, Christine; Masiira, Ben; Bulage, Lilian; Kadobera, Daniel; Ario, Alex Riolexus; Nsubuga, PeterCouple HIV counseling and testing (CHCT) is key in preventing heterosexual HIV transmission and achievement of 90-90-90 UNAIDS treatment targets by 2020. We conducted secondary data analysis to assess utilization of CHCT and associated factors using logistic regression. 58/134 participants (49%) had ever utilized CHCT. Disclosure of individual HIV results to a partner [aOR = 16; 95% CI: (3.6–67)], residence for > 1 < 5 years [aOR = 0.04; 95% CI (0.005–0.33)], and none mobility [aOR = 3.6; 95% CI (1.1–12)] were significantly associated with CHCT. Age modified relationship between CHCT and disclosure (Likelihood-ratio test LR chi2 = 4.2 (p value = 0.041). Disclosure of individual HIV results with a partner and residence for more than 1 year improved utilization of CHCT; mobility reduced the odds of CHCT. Interventions should target prior discussion of individual HIV results among couples and mobile populations to increase CHCT.Item Increasing trend in all–cause mortality at Regional Referral Hospitals in Uganda during the COVID–19 pandemic (2020–2021)(Quarterly Epidemiological, 2022-11-18) Ahirirwe, Sherry Rita; Kwiringira, Andrew; Kwesiga, Benon; Bulage, Lilian; Kadobera, Daniel; Ario, Alex RiolexusTesting limitations and inadequate mortality surveillance systems complicate the analysis of data on the true burden of deaths associated with pandemics. One solution is to calculate excess mortality (EM). We described temporal trends in all–cause mortality at regional referral hospitals (RRHs) in Uganda and estimated EM during two years of the COVID19 pandemic compared with five years of historical data (2015–2019).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 Low proportion of women who came knowing their HIV status at first antenatal care visit, Uganda, 2012–2016: a descriptive analysis of surveillance data(BMC Pregnancy and Childbirth, 2020) Nakanwagi, Miriam; Bulage, Lilian; Kwesiga, Benon; Ario, Alex Riolexus; Agasha, Doreen Birungi; Lukabwe, Ivan; Matovu, John Bosco; Taasi, Geoffrey; Nabitaka, Linda; Mugerwa, Shaban; Musinguzi, JoshuaHIV testing is the cornerstone for HIV care and support services, including Prevention of Mother to Child Transmission of HIV (PMTCT). Knowledge of HIV status is associated with better reproductive health choices and outcomes for the infant’s HIV status. We analyzed trends in known current HIV status among pregnant women attending the first antenatal care (ANC) visit in Uganda, 2012–2016. We conducted secondary data analysis using District Health Information Software2 data on all pregnant women who came for ANC visit during 2012–2016. Women who brought documented HIV negative test result within the previous 4 weeks at the first ANC visit or an HIV positive test result and/or own HIV care card were considered as knowing their HIV status. We calculated proportions of women with known current HIV status at first ANC visit, and described linear trends both nationally and regionally. We tested statistical significance of the trend using modified Poisson regression with generalized linear models. For known HIV positive status, we only analyzed data for years 2015–2016 because this is when this data became available. There was no significant difference in the number of women that attended first ANC visits over years 2012 -2016. The proportion of women that came with known HIV status increased from 4.4% in 2012 to 6.9% in 2016 and this increase was statistically significant (p < 0.001). Most regions had an increase in trend except the West Nile and Mid-Eastern (p < 0.001). The proportion of women that came knowing their HIV positive status at first ANC visit was slightly higher than that of women that were newly tested HIV positive at first ANC visit in 2015 and 2016 Although the gap in women that come at first ANC visit without knowing their HIV positive status might be reducing, a large proportion of women who were infected with HIV did not know their status before the first ANC visit indicating a major public health gap. We recommend advocacy for early ANC attendance and hence timely HIV testing and innovations to promptly identify HIV positive women of reproductive age so that timely PMTCT interventions can be made.Item Prompt Response to a Cross-border Plague Outbreak in Zombo District, Minimized Spread, Uganda, March 2019(African Field Epidemiology Network, 2022-04-27) Gonahasa, Doreen Nsiimire; Basuta, Bernadette Mirembe; Nabatanzi, Sandra; Kwesiga, Benon; Bulage, Lilian; Ario, Alex RiolexusPlague, which is caused by the bacterium Yersinia pestis, is a priority zoonotic disease targeted for elimination in Uganda. On 6 March 2019, the Uganda Ministry of Health was notified of a patient in Zombo District with clinical presentation similar to pneumonic plague, and a positive plague rapid diagnostic test (RDT). We determined the scope of the outbreak, determined the mode of transmission, and recommended evidence-based control and prevention measures. Methods: A suspected pneumonic plague case was one with two or more of the following signs and symptoms: cough (bloody or wet), chest pain, difficulty in breathing, or fever in a resident of Zombo District during February 1-March 31, 2019. A confirmed case was a suspected case testing positive for Yersinia pestis by rapid diagnostic test, culture or serology. We actively searched for case-patients, traced contacts and took samples as appropriate. We performed descriptive epidemiology of the outbreak. Results: We identified one suspected and one confirmed pneumonic plague case. On February 26, 2019, a 4-year-old boy was buried in DRC near the Uganda border after succumbing to bubonic plague. Case-patient A (35-year-old mother to the boy), fell ill with suspected pneumonic plague while attending to him. She was referred to a health facility in Uganda on February 28 but died on arrival. On March 4, Case-patient B (23-year-old sister to Case-patient A), presented with pneumonic plague symptoms to the same Uganda facility and tested plague-positive by RDT, culture, and serological tests. Contacts (n=114) were traced and given prophylaxis; no new cases were reported. Conclusion: This fatal plague outbreak started as bubonic and later manifested as pneumonic. There was cross-border spread from DRC to Uganda with no cross-border efforts at prevention and control. Person-to-person transmission appears to have occurred. The quick and effective response likely minimized spread.Item Severe morbidity and hospital-based mortality from Rift Valley fever disease between November 2017 and March 2020 among humans in Uganda(BMC, 2024-05) Anywaine, Zacchaeus; Hansen, Christian; Warimwe, George M; Abu-Baker Mustapher, Ggayi; Nyakarahuka, Luke; Balinandi, Stephen; Ario, Alex Riolexus; Lutwama, Julius J; Elliott, Alison; Kaleebu, PontianoAbstract Background Rift Valley fever (RVF) is a zoonotic viral disease of increasing intensity among humans in Africa and the Arabian Peninsula. In Uganda, cases reported prior to 2016 were mild or not fully documented. We report in this paper on the severe morbidity and hospital-based mortality of human cases in Uganda. Methods Between November 2017 and March 2020 human cases reported to the Uganda Virus Research Institute (UVRI) were confirmed by polymerase chain reaction (PCR). Ethical and regulatory approvals were obtained to enrol survivors into a one-year follow-up study. Data were collected on socio-demographics, medical history, laboratory tests, potential risk factors, and analysed using Stata software. Results Overall, 40 cases were confirmed with acute RVF during this period. Cases were not geographically clustered and nearly all were male (39/40; 98%), median age 32 (range 11–63). The median definitive diagnosis time was 7 days and a delay of three days between presumptive and definitive diagnosis. Most patients (31/40; 78%) presented with fever and bleeding at case detection. Twenty-eight (70%) cases were hospitalised, out of whom 18 (64%) died. Mortality was highest among admissions in regional referral (11/16; 69%) and district (4/5; 80%) hospitals, hospitalized patients with bleeding at case detection (17/27; 63%), and patients older than 44 years (9/9; 100%). Survivors mostly manifested a mild gastro-intestinal syndrome with nausea (83%), anorexia (75%), vomiting (75%), abdominal pain (50%), and diarrhoea (42%), and prolonged symptoms of severe disease including jaundice (67%), visual difficulties (67%), epistaxis (50%), haemoptysis (42%), and dysentery (25%). Symptom duration varied between two to 120 days. Conclusion RVF is associated with high hospital-based mortality, severe and prolonged morbidity among humans that present to the health care system and are confirmed by PCR. One-health composite interventions should be developed to improve environmental and livestock surveillance, prevent infections, promptly detect outbreaks, and improve patient outcomes.Item Spatial distribution of pathogenic fungal isolates from clinical samples in Uganda: Diagnostic gaps and trends, January 2020 - May 2024(Public Library of Science, 2025-07-17) tim, Priscilla;; Gidudu, Samuel;; Bagaya, Bernard Ssentalo ;; Kambugu, Andrew;; Najjuka, Grace;; Winfred, Atuhaire D.;; Kanamwanji, Benedict;; Nabende, Esther;; Atukunda, Adella;; Kabazzi, Jonathan;; Joyoo, Sylvia;; Nansikombi, Hildah Tendo;; Ario, Alex RiolexusPathogenic fungi cause approximately 13 million infections and 1.5 million deaths worldwide each year, yet surveillance and diagnosis remain inadequate in resource-limited settings. In Uganda, fungal infections affect approximately 4,099,357 per 45 million people annually, resulting in severe invasive diseases if untreated. This study describes laboratory-confirmed pathogenic fungal isolates from clinical samples in Uganda from January 2020 to May 2024, and highlights gaps in diagnostic capacity. We abstracted data from the National Microbiology Reference Laboratory database, disaggregated pathogenic fungal isolates by the sex and age group of the patients, sample type, and isolated species, district, and year of isolation. Pathogenic fungal isolates were confirmed by culture and biochemical tests. Using Epi Info 7 software, we analyzed frequencies. Among 8,136 clinical samples tested, fungal pathogens were isolated from 744 (9%) samples. Of these, the majority were obtained from female (92%), persons aged 16-35 years (68%). Most fungal pathogens (93.7%) were isolated from superficial clinical samples, while 6.3% from deep samples. High-vaginal swabs accounted for 71% of the clinical samples, with most cases from Kampala (32%) and Mbarara (26%) districts. The pathogenic fungal species identified included C. albicans (65.4%), non-albicans Candida spp. (30.6%) and C. neoformans (3.9%). We observed a sharp decline of identified pathogenic fungi from 299 (40%) in 2020-39 (5%) in 2024, reflecting diagnostic disruptions during the COVID-19 pandemic. Candida spp. were the most commonly isolated pathogenic fungi, mainly among females and individuals aged 16-35 years from Kampala and Mbarara districts. There is need for targeted interventions against candidiasis in these groups and locations. This study also highlights the gaps in fungal diagnostic capacity in Uganda, as the national database was limited to Candida and Cryptococcus, emphasizing the need for improved diagnostic infrastructure, capacity-building and surveillance to enhance detection of pathogenic fungi.Item Trends and distribution of Vibrio cholerae isolates at the National Microbiology Reference Laboratory, Ministry of Health, Uganda, 2014 –2023(Uganda Public Health, 2018) Baliruno, Leah Naluwagga; Namusoosa, Rita; Gidudu, Samuel; Okello, Paul Edward; Nakigozi, Harriet; Okiria, Chris; Ssewanyana, Isaac; Nabadda, Suzan; Najjuka, Grace; Ario, Alex RiolexusBackground: As per the World Health Organization, countries including Uganda are to end cholera by 2030 through prevention and treatment. This achievement can be hindered due to rapid changes in antimicrobial response patterns and serotype among other factors. We described confirmed cholera cases by person, place, time, serotype, antimicrobial resistance, and multi-antimicrobial-resistant phenotype patterns, Uganda, 2014–2023. Methods: We conducted a descriptive study using the 2014 – 2023 data on confirmed cholera cases abstracted from the National Microbiology Reference Laboratory (NMRL) register. We described the cases by age group, sex, district, serotype, reporting period, antimicrobial resistance (resistant and intermediate)(rates), and multi-antimicrobialresistant phenotype patterns. We described the confirmed cases and the antimicrobial resistance patterns over time. Mann-Kendall tests for trends were used to test the significance of AMR trends. Results: We identified 489 confirmed cholera cases between January 2014 to December 2023 whose V. cholerae isolates were referred by 35 districts in Uganda. The majority of the identified confirmed cholera cases were male (239, 49%), aged 21- 40 years (170, 38%), had V. cholerae 01 Ogawa (256, 52%) and were from Kampala District (138, 28%). We observed a gradual decline in confirmed cholera cases over time with peaks in 2015, 2018 and 2023. Vibro cholerae 01 ogawa was observed to dominate throughout the period. We observed consistent resistance by V. cholerae to 6 antimicrobials from 2014 to 2023. 194 (39.7%) isolates showed multiple antimicrobialresistant with 90 (18.6%) resistant to more than one class of antimicrobials. Conclusion: We observed males, persons aged 21-40 years, and Kampala District as being most affected with cholera in Uganda with peaks in 2015, 2018, and 2023 and Vibro cholerae 01 Ogawa as the predominate serotype. Consistent antimicrobial resistance was exhibited over time between 2014 and 2023. Intensifying cholera disease prevention by the Ministry of Health targeting males, persons aged 21-40 years, and Kampala District is critical. Routine antimicrobial surveillance to guide informed antimicrobial use and prevent the spread of AMR, especially during cholera outbreaks is important.Item Trends of Injuries due to Gender Based Violence, Uganda, 2012 – 2016, a retrospective descriptive analysis(African Field Epidemiology Network, 2020-08-07) Biribawa, Claire; Nuwemastiko, Rebecca; Oporia, Frederick; Baguma, Ezekiel; Bulage, Lilian; Okethwangu, Denis; Ario, Alex Riolexus; Kobusingye, OliveContext: Child obesity, one of the major contributors to noncommunicable diseases in developing countries, is rising following drastic economic growth and lifestyle changes. In Uganda, noncommunicable diseases as a cause of death have increased from 15% in 1990 to 35% in 2019. Aim: The study aimed to investigate schoolchildren’s obesity status, lifestyle behaviors, and the factors of obesity in urban Uganda. Methods: The study was conducted with a cross-sectional, descriptive quantitative design. The survey using the researcher-developed questionnaire and physical measurement tools for 330 children aged 9 to 11 years old in 6 elementary schools in urban Uganda in November 2018. The Japanese Red Cross College of Nursing Institutional Review Board approved this study (Approval Number: 2018-066). Results: Obesity status among schoolchildren in urban Uganda was 67.6% normal, 25.2% underweight, 5.4% overweight, and 1.8% obese. Conclusion: Obesity and overweight have not been predominant in this population. However, children's growth must be carefully monitored to prevent future overweight and obesity due to the limited availability of school health services and rapid lifestyle changes. Demographic factors associated with obesity status (waist-hip ratio, body fat, and body mass index) were gender, financial access to food, screen time, sleep time