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Introduction: Despite the strong prevention efforts by the Uganda Ministry of Health (MOH), measles outbreaks continue to occur. The MOH responded to a measles outbreak in the hard to reach areas of Buvuma Islands, identifying 54 case-patients, 4 of whom developed complications and were hospitalized. We defined a measles case as; Any suspected case with a positive measles IgM antibodies or detection of measles viral RNA by PCR in a suspected case. We estimated the provider cost of responding to this outbreak, cost of prevention, and the cost the government would have saved with effective prevention. Methods: We interviewed health facility in charges, record clerks, and measles cases to collect information on patient management and days of illness. Using an itemized form, we systematically collected data on quantities and unit costs of all the resource inputs for both direct and indirect costs at national, district, and facility levels. Medical costs referred to hospital and clinic costs for medications, supplies, utilities, transport, and personnel; non-medical costs included those associated with person-hours spent on the outbreak investigation and control effort. Results: The overall cost of investigating and controlling this outbreak was $16,459.50 (including $5,526.30) of medical costs, $10,733.20 of non-medical costs) and the cost per capita of number of children 6months-5years was $117.80 (16,259.5/138 (number of children 6months-5years. This is the target for measles intensified immunization following an outbreak). Conclusion: The total cost incurred in this outbreak is four fold the amount needed to vaccinate all children in Buvuma which would have averted the outbreak. We recommended strengthening vaccination services in the entire country, especially hard-to-reach areas, to enable the government forego the extra cost and morbidity associated with outbreak control.

Background Compared to the general population in Uganda, fishing communities suffer greater burden of HIV/AIDS. We determined the level of comprehensive knowledge on HIV prevention and its associated factors among fishing communities of Lake Kyoga. Methods We conducted secondary analysis of data from the Lake Kyoga Behavioral Survey, a population-based sample survey on behavioral risk factors for HIV, syphilis, and schistosomiasis among adults in fishing communities of Lake Kyoga in 2013. We defined comprehensive knowledge as having correct knowledge on HIV prevention (consistent condom use, faithfulness, a healthy-looking person can have HIV, and HIV cannot be transmitted through food-sharing, witchcraft or handshake). We used logistic regression to determined potential factors associated with comprehensive knowledge on HIV prevention and control for confounding. Results Of 1780 persons in the sample, 51% (911/1780) were females. The mean age was 32 (range: 15–97) years. Overall, 51% (899/1780) of persons had comprehensive knowledge on HIV prevention. Level of comprehensive knowledge on HIV prevention was similar between females (52%, 449/911) and males (49%, 450/869). Males (76%, 658/869) had lower knowledge on HIV transmission from mother to child during breast feeding compared to females (81%, 738/911) (p-value 0.019). Fishermen (46%,324/711) who lived > 5 km away from a health center compared to 54% (572/1066) who lived within 5 km radius were less likely to have comprehensive knowledge on HIV prevention (PRRadj = 0.8; 95%CI = 0.5–0.92). Those who had ever tested for HIV were more likely to have comprehensive knowledge of HIV transmission (PRRadj = 1.1; 95% 1.03–1.70). Conclusion Half of the population of Lake Kyoga fishing community had comprehensive knowledge of HIV prevention. Long distances from health facilities reduced the level of comprehensive knowledge on HIV transmission. HIV testing increased the level of comprehensive knowledge on HIV transmission. Ministry of health should ensure that HIV/AIDS information; education and communication and HIV counseling and testing activities are intensified in fishing communities of Lake Kyoga, with more emphasis on communities living in distances of more than 5 km away from the health facility.

On October 25, 2016, media reports alerted the Uganda Ministry of Health to an outbreak of >80 cases of vomiting, syncope, and acute diarrhea among workers at a flower farm in central Uganda; 27 workers were hospitalized. On November 1, an investigation was undertaken by the Uganda Public Health Fellowship Program.* A case-control study found that working inside greenhouse 7, which had been fumigated with the organosulfur compound metam sodium the night of October 13, was strongly associated with illness. Employees who worked in this greenhouse during October 14-21 reported a strong "suffocating" smell in the greenhouse. Investigation revealed that, in violation of safety protocols, workers did not properly cover the soil after fumigation, allowing vapors to become trapped inside the greenhouse. The farm management, unaware of the lapse, failed to inform workers to avoid the vicinity of the fumigation. Respiratory protective measures were not routinely available for workers, which likely contributed to the severity and extent of the outbreak. Although metam sodium is generally considered to be of low risk when used according to manufacturer's instructions (1), occupational exposure in the absence of recommended safety measures can have serious health consequences. The investigation highlighted the importance of identifying potential occupational hazards to workers, as well as establishing safety protocols in occupational settings, training workers at risk, such as pesticide sprayers and flower pickers,† and ensuring enforcement of safety protocols. After this outbreak, the farm management reviewed, revised, and trained the workers on safety protocols to prevent future outbreaks.

Background On 12 October, 2016 a measles outbreak was reported in Mayuge District, eastern Uganda. We investigated the outbreak to determine its scope, identify risk factors for transmission, evaluate vaccination coverage and vaccine effectiveness, and recommend evidence-based control measures. Methods We defined a probable case as onset of fever (≥3 days) and generalized rash, plus ≥1 of the following: conjunctivitis, cough, and/or runny nose in a Mayuge District resident. A confirmed case was a probable case with measles-specific IgM (+) not explained by vaccination. We reviewed medical records and conducted active community case-finding. In a case-control investigation involving probable case-persons and controls matched by age and village, we evaluated risk factors for transmission for both cases and controls during the case-person’s likely exposure period (i.e., 7–21 days prior to rash onset). We estimated vaccine effectiveness (VE) using the formula: VE ≈ (1-ORprotective) × 100. We calculated vaccination coverage using the percentage of controls vaccinated. Results We identified 62 probable case-persons (attack rate [AR] = 4.0/10,000), including 3 confirmed. Of all age groups, children

Background We investigated progress towards UNAIDS 90-90-90 targets among female sex workers in Kampala, Uganda, who bear a disproportionate burden of HIV. Methods Between April and December 2012, 1,487 female sex workers, defined as women, 15–49 years, residing in greater Kampala, and selling sex for money in the last 6 months, were recruited using respondent-driven sampling. Venous blood was collected for HIV and viral load testing [viral load suppression (VLS) defined as

Introduction : Kampala Cancer Registry was established to provide comprehensive data on the burden and trends of cancer to guide decisions on prevention and treatment policies, strategies and interventions in Uganda. We analyzed the registry data between 2009 and 2013 to describe the distribution of the top five cancers, and to describe cancer diagnostic capacity. Methods : Kampala Cancer Registry collects data on cancer from health facilities, pathology laboratories and other available sources on cancers from residents of Kyadondo County, which includes Kampala and part of Wakiso District. The data are entered into the cancer registration system called CANREG. We extracted data from CANREG for statistical analysis. We calculated incidence rates by dividing the number of newly reported cancer cases by the population at risk for the same year using population projections from 2014 census. Percentage Morphological Verification (PMV) was obtained by dividing the number of cases of a particular cancer diagnosed microscopically by the total number of cases diagnosed. Results : a total of 8168 new cancer cases were registered; 55% (4522/8168) were among females. Among males, the incidence of prostate cancer increased with increasing age (4/100,000 among 30-39 year-olds compared to 4617/100,000 among 60+ year-olds). Kaposi Sarcoma affected mainly the mid-age groups (incidence: 266/100,000). In males, the top five cancers (overall incidence/100,000) were prostate (18), Kaposi Sarcoma (11), esophagus (6), leukemia (3) and liver (3). In females, the top five cancers (overall incidence/100,000) were cervix (20), breast (12), Kaposi Sarcoma (11), esophagus (3) and ovary (3). The overall PMV was 54.3, with Kaposi Sarcoma having the highest at 70% while leukemia had the lowest (29%). Conclusion : the top two cancers were prostate cancer and Kaposi Sarcoma in males, and breast and cervical cancers in females. Cancer diagnostic capacity needs to be scaled up for more effective cancer control in Kampala.

Background. Mother-to-Child Transmission of HIV accounts for more than 90% of all pediatric HIV infections. However, Prevention of Mother-to-Child Transmission (PMTCT) of HIV through provision of lifelong ART to HIV positive mothers faces various challenges which affect its success. One of such challenges is the loss to follow-up (LTFU) of mothers. Methodology. We conducted a cross-sectional study utilizing both quantitative and qualitative data collection methods. We were able to trace 279 HIV positive, pregnant, and lactating mothers among mothers who were initiated on lifelong ART for PMTCT in public health facilities in Ntungamo district, Western Uganda. The proportion of those who were lost to follow-up was determined, and Log binomial regression with stepwise backward elimination method was employed to identify factors associated with LTFU. Focus group discussions (FDGs) of women on lifelong ART and key informant interviews (KIIs) of peer educators were also performed. Results. Out of the 279 mothers that were successfully traced and interviewed, 103 (37%) were identified as lost to follow-up. The prevalence of LTFU was higher among those whose transport costs were above $2.75, adj (adjusted) PR (Prevalence Ratio) 1.6 (95% CI; 1.02-2.55); those who waited beyond one hour before being attended to, adj PR 1.74 (95% CI; 1.02-2.96); and those who assumed that their infant was already infected, adj PR 1.76 (95% CI; 1.15-2.70). On interviews, LTFU in these mothers was attributed to fear of swallowing antiretroviral drugs, HIV related stigma and discrimination, inadequate facilitation of the peer educators, long patient waiting time, and transportation to the health facilities. Conclusion. More than one-third of mothers initiated on lifelong ART for PMTCT in Ntungamo district were lost to follow-up over a period of 25 months. Recommendations. Provision of regular and adequate pre-ART and ART adherence counseling and provision of routine health education would reduce LTFU.

Introduction : fresh political clashes in South Sudan led to an influx of >40,000 refugees to Adjumani District, Northern Uganda in July 2016. This influx overstretched Adjumani Refugee Camp’s capacity to manage refugees, potentially creating a fertile ground for disease outbreaks. We conducted a Rapid Health Assessment to assess health status, identify potential public health threats, and recommend evidence-based interventions. Methods : we used a structured questionnaire to collect data among a convenient sample of refugees through face-to-face interviews. We interviewed health workers using a standardized checklist on the availability of essential health services. We determined the presence of Global Acute Malnutrition (GAM) using mid-upper arm circumference. We collected data on water, sanitation, hygiene promotion and shelter through on-site observations and record reviews. Refugees voluntarily sought participation during the assessment. Results : we interviewed 197 refugees. The ratio of latrine stances to persons was 1:223 (vs. recommended 1:50). Water supply was 7.8 liters/person/day (vs. recommended 15 liters). Of 131 refugees who had various ailments, 49 (37%) did not utilize the health services provided by relief agencies. Of the 197 refugees interviewed, 175 (89%) did not have mosquito nets. GAM was present in 520 (6.8%) of 7,544 children aged 6–59 months screened at the Elegu border. A double portion for lunch and supper was served once, and supper was eaten without heating. We observed poor hygienic practices, including open defecation, use of unsafe water collected from a nearby river for drinking and daily utility, poor sewage drainage, and overcrowding in shelters. Hand-washing facilities were insufficient. Self-disposal of placentae post-delivery was reported. Conclusion : inadequacies in basic sanitary supplies, hygienic practices, and disease prevention measures make this refugee camp vulnerable for disease outbreaks. We recommended provision of hand-washing facilities, safe water, excreta disposal facilities, and health education to the refugees.

Introduction : typhoid is a disease of public health importance in Uganda. A data audit conducted among 12 public health facilities for week 15 to week 21 in Nakaseke District recorded a high number of typhoid cases (342). Likewise, analysis of records in the MOH weekly surveillance system for week 18 to 21 estimated about 134 typhoid cases per 50,000 which are higher than the recommended threshold (20 persons per 50,000 populations) in the community.

We report on the results of a respondent-driven sampling survey among men who have sex with men (MSM) in Kampala, Uganda, where same-sex behavior is criminalized and highly stigmatized. We enrolled 608 MSM aged 18 + years and residing in greater Kampala from June 2012-November 2013. Anonymous data were collected through audio-computer assisted self-interviews; blood was tested for HIV-1 antibodies, CD4 + T cell counts, and viral load. Estimated HIV prevalence was 12.2 % (95 % confidence interval [CI] 8.0–16.1), increasing with age. One in five (19.6 %) stated knowing their HIV-positive status and a similar proportion of HIV-infected MSM were virally suppressed (19.3 %; 95 % CI 3.3–33.1). HIV-related risk behaviors included unprotected anal sex (35.8 % at last sex act), selling sex (38.5 %), having multiple steady (54.3 %) or casual (63.6 %) partners, and ever injecting drugs (31.6 %). Forty percent experienced homophobic abuse; 44.5 % ever experienced suicide ideation. HIV prevalence among MSM remains high whereas knowledge of seropositive status and suppression of viral load remains low. MSM report a wide range of high risk behaviors, frequent homophobic abuse, poor mental health, as well as low levels of testing and treatment. Better access to tailored prevention and treatment services to improve population-level viral load suppression are warranted.