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Introduction. Rift Valley fever (RVF) is a mosquito-borne viral zoonosis. The Uganda Ministry of Health received alerts of suspected viral haemorrhagic fever in humans from Kiruhura, Buikwe, Kiboga, and Mityana districts. Laboratory results from Uganda Virus Research Institute indicated that human cases were positive for Rift Valley fever virus (RVFV) by polymerase chain reaction. We investigated to determine the scope of outbreaks, identify exposure factors, and recommend evidence-based control and prevention measures. Methods. A suspected case was defined as a person with acute fever onset, negative malaria test result, and at least two of the following symptoms: headache, muscle or joint pain, bleeding, and any gastroenteritis symptom (nausea, vomiting, abdominal pain, diarrhoea) in a resident of Kiruhura, Buikwe, Mityana, and Kiboga districts from 1st October 2017 to 30th January 2018. A confirmed case was defined as a suspected case with laboratory confirmation by either detection of RVF nucleic acid by reverse-transcriptase polymerase chain reaction (RT-PCR) or demonstration of serum IgM or IgG antibodies by ELISA. Community case finding was conducted in all affected districts. In-depth interviews were conducted with human cases that were infected with RVF who included herdsmen and slaughterers/meat handlers to identify exposure factors for RVF infection. A total of 24 human and 362 animal blood samples were tested. Animal blood samples were purposively collected from farms that had reported stormy abortions in livestock and unexplained death of animals after a short illness (107 cattle, 83 goats, and 43 sheep). Convenient sampling for the wildlife (10 zebras, 1 topi, and 1 impala) was conducted to investigate infection in animals from Kiruhura, Buikwe, Mityana, and Kiboga districts. Human blood was tested for anti-RVFV IgM and IgG and animal blood for anti-RVFV IgG. Environmental assessments were conducted during the outbreaks in all the affected districts. Results. Sporadic RVF outbreaks occurred from mid-October 2017 to mid-January 2018 affecting humans, domestic animals, and wildlife. Human cases were reported from Kiruhura, Buikwe, Kiboga, and Mityana districts. Of the 24 human blood samples tested, anti-RVFV IgG was detected in 7 (29%) human samples; 1 human sample had detectable IgM only, and 6 had both IgM and IgG. Three of the seven confirmed human cases died among humans. Results from testing animal blood samples obtained from Kiruhura district indicated that 44% (64/146) cattle, 46% (35/76) goats, and 45% (9/20) sheep tested positive for RVF. Among wildlife, (1/10) zebras, (1/1) topi, and (1/1) impala tested positive for RVFV by serological tests. One blood sample from sheep in Kiboga district tested RVFV positive. All the human cases were exposed through contact or consumption of meat from infected animals. Conclusion. RVF outbreaks occurred in humans and animals in Kiruhura, Buikwe, Mityana, and Kiboga districts. Human cases were potentially infected through contact with infected animals and their products.

Improving care for preterm babies could significantly increase child survival in low-and middle income countries. However, attention has mainly focused on facility-based care with little emphasis on transition from hospital to home after discharge. Our aim was to understand the experiences of the transition process among caregivers of preterm infants in Uganda in order to improve support systems. A qualitative study among caregivers of preterm infants in Iganga and Jinja districts in eastern Uganda was conducted in June 2019 through February 2020, involving seven focus group discussions and five in-depth interviews. We used thematic-content analysis to identify emergent themes related to the transition process. We included 56 caregivers, mainly mothers and fathers, from a range of socio-demographic backgrounds. Four themes emerged: caregivers’ experiences through the transition process from preparation in the hospital to providing care at home; appropriate communication; unmet information needs; and managing community expectations and perceptions. In addition, caregivers’ views on ‘peer-support’ was explored. Caregivers’ experiences, and their confidence and ability to provide care were related to preparation in the hospital after birth and until discharge, the information they received and the manner in which healthcare providers communicated. Healthcare workers were a trusted source of information while in the hospital, but there was no continuity of care after discharge which increased their fears and worries about the survival of their infant. They often felt confused, anxious and discouraged by the negative perceptions and expectations from the community. Fathers felt left-out as there was very little communication between them and the healthcare providers. Peer-support could enable a smooth transition from hospital to home care. Interventions to advance preterm care beyond the health facility through a well-supported transition from facility to home care are urgently required to improve health and survival of preterm infants in Uganda and other similar settings.

Background: Rift Valley Fever (RVF) is a viral hemorrhagic fever that can be fatal to humans and livestock. During June-October 2018, reported RVF cases increased sharply in eight western and central Ugandan districts. We investigated to identify the scope of the outbreak, determine risk factors, and recommend control measures.Methods: We defined a probable case as acute onset of unexplained fever with thrombocytopenia or leukopenia, plus ≥1 of: unexplained bleeding, blurred vision, or unexplained death during June–October 2018 in a resident of the affected districts. A confirmed case was a probable case with a positive PCR test for RVF. We reviewed medical records and actively searched for cases in communities. In a case-control study, we compared exposures of cases and age-, sex-, and neighbourhood-matched controls. We reviewed livestock RVF surveillance data.Results: We identified 19 cases (17 confirmed, 2 probable); 13 (68%) died. The mean age of the case-patients was 36 (range: 27-55) years. The attack rate in men (15/10,000) was 19 times higher than in women (0.78/10,000). Stratified epidemic curves indicated multiple point-source outbreaks, often following skinning/butchering livestock or eating grilled meat from livestock that had been sick or died of unknown causes (‘sick/dead livestock’). All case-patients with data (n=18) ate or butchered meat from sick/dead livestock. Of the 18 case-patients and 90 controls who participated in the case-control study, 10 case-patients (56%) and five controls (5.6%) cut or handled raw meat from sick/dead livestock (ORadj=14, 95%CI=2.8-72). RVF-seropositive livestock were identified from serum samples taken from farms where human cases had occurred.Conclusion. Human RVF outbreaks in Western and Central Uganda in 2018 were caused by contact with raw meat of sick/dead livestock. We recommended wearing protective gear during butchering, and safe handling and disposal of carcasses of sick/dead livestock. RVF surveillance data between human and livestock health sectors should be shared to facilitate early warning and detection for RVF.

Many pregnant mothers miss antenatal care attendance and health facility deliveries despite several interventions either due to knowledge gap on the benefits or lack of transport means to reach the health centre. Therefore, training of “boda-boda” (motor-cycle) riders in Busoga Region in Uganda was conducted to determine its effect on health facility-based deliveries. The study was a non-randomized control trial with intervention and control groups from selected health centers and communities in Busoga Region. Interventions included the training of boda-boda riders for 5 days to give them knowledge; with a six months follow-up to determine the impact of training. Questionnaires, interviews and focus group discussions were used to collect quantitative and qualitative data. Descriptive statistical analysis was computed for the quantitative data and thematic analysis for qualitative data. Findings revealed improved knowledge of boda-boda riders on maternal referrals from 49.1% to 79.0% in the intervention arm compared to 43.8% to 45.2% in the control arm. Use of boda-boda transport by mothers improved from 0% to 70.5% in the intervention arm compared to only 0% to 51.2% in the control arm. Also, of the 70.5% of the mothers who used boda-boda transport, 69.4% were transported by trained boda-boda riders and only 30.6% by un-trained boda-boda riders. Apart from age (p=0.000; CI=2.785 – 53.284) and ownership of the motorcycle (p=0.002; CI=0.992 – 8.658), the rest of the socio-demographic determinants of health facility-based deliveries were not statistically significant. Age of boda-boda riders (25–34 years, p=0.000) and ownership of the play a pivotal role in the improvement of health facility-based deliveries. Training of boda-boda riders and other key stakeholders impacted on the community based maternal referrals in the study area.

Background Since the declaration of the 10th Ebola Virus Disease (EVD) outbreak in DRC on 1st Aug 2018, several neighboring countries have been developing and implementing preparedness efforts to prevent EVD cross-border transmission to enable timely detection, investigation, and response in the event of a confirmed EVD outbreak in the country. We describe Uganda’s experience in EVD preparedness. Results On 4 August 2018, the Uganda Ministry of Health (MoH) activated the Public Health Emergency Operations Centre (PHEOC) and the National Task Force (NTF) for public health emergencies to plan, guide, and coordinate EVD preparedness in the country. The NTF selected an Incident Management Team (IMT), constituting a National Rapid Response Team (NRRT) that supported activation of the District Task Forces (DTFs) and District Rapid Response Teams (DRRTs) that jointly assessed levels of preparedness in 30 designated high-risk districts representing category 1 (20 districts) and category 2 (10 districts). The MoH, with technical guidance from the World Health Organisation (WHO), led EVD preparedness activities and worked together with other ministries and partner organisations to enhance community-based surveillance systems, develop and disseminate risk communication messages, engage communities, reinforce EVD screening and infection prevention measures at Points of Entry (PoEs) and in high-risk health facilities, construct and equip EVD isolation and treatment units, and establish coordination and procurement mechanisms. Conclusion As of 31 May 2019, there was no confirmed case of EVD as Uganda has continued to make significant and verifiable progress in EVD preparedness. There is a need to sustain these efforts, not only in EVD preparedness but also across the entire spectrum of a multi-hazard framework. These efforts strengthen country capacity and compel the country to avail resources for preparedness and management of incidents at the source while effectively cutting costs of using a “fire-fighting” approach during public health emergencies.