Browsing by Author "Kamugisha, J."

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    An outbreak of Ebola in Uganda
    (Tropical Medicine & International Health, 2002) Okware, S. I.; Omaswa, F. G.; Zaramba, S.; Opio, A.; Lutwama, J. J.; Kamugisha, J.; Rwaguma, E. B.; Kagwa, P.; Lamunu, M.
    An outbreak of Ebola disease was reported from Gulu district, Uganda, on 8 October 2000. The outbreak was characterized by fever and haemorrhagic manifestations, and affected health workers and the general population of Rwot-Obillo, a village 14 km north of Gulu town. Later, the outbreak spread to other parts of the country including Mbarara and Masindi districts. Response measures included surveillance, community mobilization, case and logistics management. Three coordination committees were formed: National Task Force (NTF), a District Task Force (DTF) and an 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. The international response was coordinated by the World Health Organization (WHO) under the umbrella organization of the Global Outbreak and Alert Response Network. A WHO/ CDC case definition for Ebola was adapted and used to capture four categories of cases, namely, the alert , suspected , probable and confirmed cases . Guidelines for identification and management of cases were developed and disseminated to all persons responsible for surveillance, case management, contact tracing and Information Education Communication (IEC). For the duration of the epidemic that lasted up to 16 January 2001, a total of 425 cases with 224 deaths were reported countrywide. The case fatality rate was 53%. The attack rate (AR) was highest in women. The average AR for Gulu district was 12.6 cases/10 000 inhabitants when the contacts of all cases were considered and was 4.5 cases/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 Ebola free on 27 February 2001, 42 days after the last case was reported. The Government’s role in coordination of both local and international support was vital. The NTF and the corresponding district committees harmonized implementation of a mutually agreed programme. Community mobilization using community-based resource persons and political organs, such as Members of Parliament was effective in getting information to the public. This was critical in controlling the epidemic. Past experience in epidemic management has shown that in the absence of regular provision of information to the public, there are bound to be deleterious rumours. Consequently rumour was managed by frank and open discussion of the epidemic, providing daily updates, fact sheets and press releases. Information was regularly disseminated to communities through mass media and press conferences. Thus all levels of the community spontaneously demonstrated solidarity and response to public health interventions. Even in areas of relative insecurity, rebel abductions diminished considerably.
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    Containing a haemorrhagic fever epidemic: the Ebola experience in Uganda (October 2000—January 2001)
    (International journal of infectious diseases, 2004) Lamunu, M.; Lutwama, J. J.; Kamugisha, J.; Opioa, A.; Nambooze, J.; Ndayimirije, N.; Okware, S.
    he Ebola virus, belonging to the family of filoviruses, was first recognized in 1976 when it caused concurrent outbreaks in Yambuku in the Democratic Republic of Congo (DRC), and in the town of Nzara in Sudan. Both countries share borders with Uganda. A total of 425 cases and 224 deaths attributed to Ebola haemorrhagic fever (EHF) were recorded in Uganda in 2000/01. Although there was delayed detection at the community level, prompt and efficient outbreak investigation led to the confirmation of the causative agent on 14 October 2000 by the National Institute of Virology in South Africa, and the subsequent institution of control interventions. Control interventions: Public health interventions to contain the epidemic aimed at minimizing transmission in the health care setting and in the community, reducing the case fatality rate due to the epidemic, strengthening co-ordination for the response and building capacity for on-going surveillance and control. Co-ordination of the control interventions was organized through the Interministerial Committee, National Ebola Task Force, District Ebola Task Forces, and the Technical Committees at national and district levels. The World Health Organization (WHO) under the Global Outbreak Alert and Response Network co-ordinated the international response. The post-outbreak control interventions addressed weaknesses prior to outbreak detection and aimed at improving preparations for future outbreak detection and response. Challenges to control efforts included inadequate and poor quality protective materials, deaths of health workers, numerous rumors and the rejection of convalescent cases by members of the community. Conclusions: This was recognized as the largest reported outbreak of EHF in the world. Control interventions were very successful in containing the epidemic. The community structures used to contain the epidemic have continued to perform well after containment of the outbreak, and have proved useful in the identification of other outbreaks. This was also the first outbreak response co-ordinated by the WHO under the Global Outbreak Alert and Response Network, a voluntary organization recently created to co-ordinate technical and financial resources to developing countries during outbreaks.