Bob Omoda Amodan

On 26th September 2022, the Ministry of Health received a notification of a measles outbreak in Lamwo District. Eight (8) out of the eleven blood samples collected from suspected case-persons of Palabek Gem and Palabek Ogilli Sub-Counties for testing turned positive for measles-specific IgM antibodies at the UVRI. On 29th September 2022, a team of Epidemiologists from the Ministry of Health was deployed. We conducted an epidemiological investigation to determine the scope of the outbreak, and associated risk factors to prevent further transmission. We defined a probable and confirmed case in line with Uganda’s national technical guidelines for integrated disease surveillance and response. We reviewed outpatient and inpatient health facility records of all health facilities to generate a line list from 1st July to 30th September 2022. We then conducted a case-control study, with Mantel Haenszel odds ratios to determine the factors associated with the outbreak. The study identified fifty-six measles cases (48 probable and eight confirmed), with 54% being male, and 89% being South Sudanese nationals. The highest attack rate was among children <1 year (51/10,000) and Zone 8 parish in the Palabek Refugee Settlement (72/10,000). The index case was a 6-year-old South Sudanese boy who entered Uganda on 7th July 2022 and later developed symptoms on 24th July 2022. In this study, we estimated vaccination coverage and the vaccine effectiveness at 63% and 72%, respectively. Malnutrition (ORMH=3.73, 95% CI: 1.22-11.43) and receiving one or no doses of measles vaccine (ORMH=7.0, 95% CI: 2.8-17.6) were the risk factors. We recommended mass administration of vitamin A supplementation and a measles vaccine dose to children under five years of age regardless of the vaccination status. To prevent future outbreaks, we recommended improvement of nutrition and implementation of periodic measles follow-up vaccination campaigns.

Introduction: Uganda planned to start its COVID-19 vaccination campaign in March 2021, prioritising healthcare workers, security personnel, elderly and people with comorbidities. However, the willingness to receive the vaccine and potential barriers and hindrances were unknown. To understand the barriers to uptake of the COVID-19 vaccine prior to its rollout, we explored the communities’ knowledge, attitudes and barriers. Methods: We conducted a mixed-methods cross-sectional study in Kampala and Ankole subregions in February 2021. For the household survey, we used three-stage sampling to select three districts in each subregion and, thereafter, 12 villages per district. One adult in each household was interviewed. Additionally, we conducted focus group discussions and key informant interviews to explore knowledge, attitudes and barriers to COVID-19 vaccination. Modified Poisson regression was used to identify factors associated with willingness to receive to COVID-19 vaccine Results: Among 1728 respondents, 52% were under 40 years old, and 67% were female. Fifty-nine percent of those who had heard of the vaccine primarly obtained information from radio and television (TV). Despite one-quarter reporting that they had heard that the vaccine could cause death or genetic changes, 85% were willing to receive it. Persons in the Kampala subregion were less willing than those in the Ankole subregion to take the vaccine (76% vs 94%, adjusted prevalence ratio (aPR)=0.85, 95% CI: 0.81 to 0.89). Trust in the effectiveness of non-vaccine COVID-19 preventive measures (aPR=0.89, 95% CI: 0.80 to 0.99), living in urban areas (aPR=0.84, 95% CI: 0.76 to 0.91) and lack of information on vaccine safety (aPR=0.91, 95% CI: 0.83 to 0.93) reduced interest in taking the vaccine. Conclusions: Vaccine willingness was high despite some misinformation and safety concerns, which more prevalent in Kampala than in the Ankole subregion. While radio and TV were major sources of COVID-19 vaccine information, social media was the biggest propagator of COVID-19 vaccine misinformation. Therefore, providing credible information about vaccine safety could reinforce uptake, especially among urban residents. Additionally, local and national leaders should publicise their acceptance of vaccines and debunk misinformation.

On 1 May 2020, the first COVID-19 community case was detected in Masindi District, Uganda. The index case, a policeman, reportedly had an extremely high number of contacts. Although central-level epidemiologists had previously conducted contact tracing in the country, this approach was considered unfeasible in this situation. Therefore, we set out to develop Health Assistants' (HAs) expertise in Masindi District to conduct active COVID-19 surveillance and compared the costs of deploying central-level and local-level responders. We worked with Masindi District Task Force to identify 31 Health Assistants (HAs), who were trained for 2 days on COVID-19 contact tracing and community-based surveillance (CBS). We established a CBS system involving local leaders and village health teams who supported the HAs to trace and monitor all contacts each day. We determined and compared response costs between use of 31 HAs and 10 central-level epidemiologists for this work. HAs identified 729 contacts and, each HA visited or telephoned 20-25 contacts daily for 14 days after their last exposure to the index case. Only 4 out of 729 (<1%) contacts were lost to follow-up. All the 729 contacts tested negative for SARS-CoV-2 on Day 14. The new CBS system received and investigated 531 separate community alerts for suspected cases, unlinked to the index case. Using HAs vs central-level epidemiologists reduced the 14-day response costs by 70% ($8,400 vs $2,500). Local training on contact tracing and CBS enabled a less costly approach to alert response, contact tracing, and control of COVID-19 at district level. Use of HAs to conduct contact tracing and CBS can increase community and district ownership of COVID-19 response.

Background: Polio is disease caused by poliovirus which can in turn cause irreversible paralytic disease, presenting as Acute Flaccid Paralysis (AFP). A sensitive AFP surveillance system, in which all reported AFP cases are evaluated, first to determine if they are true AFP cases or not, is key for tracking polio eradication. True AFP cases are then later categorized as polio AFP or non-polio AFP (NPAFP) cases. Sensitivity is defined by meeting an annual NPAFP rate/100,000 population < 15 years of ≥ 4/100,000, and an annual stool adequacy (SA) rate of ≥ 80%. We describe Uganda’s AFP surveillance performance between 2015–2020, based on the WHO-recommended indicators, including; NPAFP and stool adequacy rate. Methods: We performed a descriptive analysis of national AFP surveillance data, 2015–2020 obtained from ministry of health. We evaluated proportion of reported AFP cases that were true AFP, and changes in NPAFP and stool adequacy (SA) rate over the study period. We evaluated the trends in achieving the targeted NPAFP and SA rates from 2015–2020. We used QGIS to illustrate patterns in NPAFP and SA rates across districts and subregions. Results: Among 3,605 AFP cases reported and investigated countrywide from 2015–2020, 3,475 (96%) were true AFP cases. All the true AFP cases were non-polio related. District reporting was near-complete (97–100% each year). Overall, the mean NPAFP rate declined from 3.1/100,000 in 2015 to 2.1/100,000 in 2020. Less than 40% of districts met the NPAFP target rate in all years. The proportion of districts achieving the NPAFP target rate of ≥ 4/100,000 significantly declined from 35% in 2015 to 20% in 2020. The mean annual SA rate nationally was 88% from 2015–2020. Only 66% of districts achieved the SA target rate of ≥ 80% in the study period. The proportion of districts with SA rate ≥ 80% significantly increased from 68 to 80% between 2015 and 2020. Conclusion: Most districts reported AFP cases. However, there was a decline in the NPAFP rate from 2015–2020 and few districts achieved the target rate. The suboptimal AFP surveillance system performance leaves the country at risk of missing ongoing poliovirus transmission. We recommend health worker training on active AFP searches, intensified supportive supervision, increase the number of environmental surveillance sentinel sites to boost AFP surveillance in the country, and periodic review meetings with districts to assess AFP surveillance performance.

Since emergency approval of COVID-19 vaccines for children aged between 12 and 15 years old was recently obtained in the United States and Europe, we aimed to assess the willingness to vaccinate children with a COVID-19 vaccine in lower- and middle-income countries (LMICs). Therefore, we launched an online cross-sectional survey in several LMICs. Questions relating to socio-demographic information, knowledge of COVID-19, level of fear/worry of being infected with COVID-19, and willingness to vaccinate children with the COVID-19 vaccine at 50%, 75% and 95% effectiveness levels, were asked. Of the 6571 participants (mean age = 39 ± 14 years), 64.0%, 72.6%, and 92.9% were willing to vaccinate children at 50%, 75%, and 95% effectiveness levels, respectively. Respondents who were undergraduates, who were more worried/fearful about COVID-19, had higher knowledge scores regarding COVID-19, and a higher belief that COVID-19 vaccination is important to protect others, were more willing to accept COVID-19 vaccination of children. COVID-19 vaccination of children will limit the spread of the virus, especially in schools; it may decrease the need for school closures which has a negative effect on child development. Findings from this study are useful for health promotion strategies during COVID-19 vaccination implementation among children in LMICs.

Vaccination is fast becoming a key intervention against the ongoing COVID-19 pandemic. We conducted cross-sectional online surveys to investigate COVID-19 vaccine acceptance across nine Low- and Middle-Income Countries (LMICs; N = 10,183), assuming vaccine effectiveness at 90% and 95%. The prevalence of vaccine acceptance increased from 76.4% (90% effectiveness) to 88.8% (95% effectiveness). Considering a 90% effective vaccine, Malaysia, Thailand, Bangladesh, and five African countries (Democratic Republic of Congo, Benin, Uganda, Malawi, and Mali) had lower acceptance odds compared to Brazil. Individuals who perceived taking the vaccine as important to protect themselves had the highest acceptance odds (aOR 2.49) at 95% effectiveness.Vaccine acceptance was also positively associated with COVID-19 knowledge, worry/fear regarding COVID-19, higher income, younger age, and testing negative for COVID-19. However, chronic disease and female gender reduced the odds for vaccine acceptance. The main reasons underpinning vaccine refusal were fear of side effects (41.2%) and lack of confidence in vaccine effectiveness (15.1%). Further research is needed to identify country-specific reasons for vaccine hesitancy in order to develop mitigation strategies that would ensure high and equitable vaccination coverage across LMICs.

We conducted an online survey in the first two months of the Coronavirus Disease 2019 (COVID-19) epidemic in Uganda to assess the level and determinants of adherence to and satisfaction with the COVID-19 preventive measures recommended by the government. We generated Likert scales for adherence and satisfaction outcome variables and measured them with four preventive measures, including handwashing, wearing face masks, physical distancing, and coughing/sneezing hygiene. Of 1726 respondents (mean age: 36 years; range: 12–72), 59% were males, 495 (29%) were adherent to, and 545 (32%) were extremely satisfied with all four preventive measures. Adherence to all four measures was associated with living in Kampala City Centre (AOR: 1.7, 95% CI: 1.1–2.6) and receiving COVID-19 information from health workers (AOR: 1.2, 95% CI: 1.01–1.5) or village leaders (AOR: 1.4, 95% CI: 1.02–1.9). Persons who lived with younger siblings had reduced odds of adherence to all four measures (AOR: 0.75, 95% CI: 0.61–0.93). Extreme satisfaction with all four measures was associated with being female (AOR: 1.3, 95% CI: 1.1–1.6) and health worker (AOR: 1.2, 95% CI: 1.0–1.5). Experiencing violence at home (AOR: 0.25, 95% CI: 0.09–0.67) was associated with lower satisfaction. Following reported poor adherence and satisfaction with preventive measures, behavior change programs using health workers should be expanded throughout, with emphasis on men.