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

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Date
2015Author
Okware, Sam I.
Omaswa, Francis
Talisuna, Ambrose
Amandua, Jacinto
Amone, Jackson
Onek, Paul
Opio, Alex
Wamala, Joseph
Lubwama, Julius
Luswa, Lukwago
Kagwa, Paul
Tylleskar, Thorkild
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Show full item recordAbstract
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.
Methods: Detailed records of the outbreak presentation, cases, and outcomes were reviewed and analyzed. Each outbreak
was described and the outcomes examined for the different scenarios.
Results: Early detection and action provided the best outcomes and results. The ideal scenario occurred in the Luwero
outbreak during which only a single case was observed. Rural outbreaks were easier to contain. The community imposed
quarantine prevented the spread of ebola following introduction into Masindi district. The outbreak was confined to the
extended family of the index case and only one case developed in the general population. However, the outbreak invasion
of the town slum areas escalated the spread of infection in Gulu municipality. Community mobilization and leadership was
vital in supporting early case detection and isolations well as contact tracing and public education.
Conclusion: Palliative care improved survival. Focusing on treatment and not just quarantine should be emphasized as it
also enhanced public trust and health seeking behavior.
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