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Introduction:the Democratic Republic of Congo (DRC) declared its 10thoutbreak of Ebola virus disease (EVD) in 42 years on August 1st2018. The rapid rise and spread of the EVD outbreak threatened health security in neighboring countries and global health security. The United Nations developed an EVD preparedness and readiness (EVD-PR) plan to assist the nine neighboring countries to advance their critical preparedness measures. In Uganda, EVD-PR was implemented between 2018 and 2019. The World Health Organization commissioned an independent evaluation to assess the impact of the investment in EVD-PR in Uganda. Objectives: i) to document the program achievements; ii) to determine if the capacities developed represented good value for the funds and resources invested; iii) to assess if more cost-effective or sustainable alternative approaches were available; iv) to explore if the investments were aligned with country public health priorities; and v) to document the factors that contributed to the program success or failure. Methods:during the EVD preparedness phase, Uganda's government conducted a risk assessment and divided the districts into three categories, based on the potential risk of EVD. Category I included districts that shared a border with the DRC provinces where EVD was ongoing or any other district with a direct transport route to the DRC. Category II were districts that shared a border with the DRC but not bordering the DRC provinces affected by the EVD outbreak. Category III was the remaining districts in Uganda. EVD-PR was implemented at the national level and in 22 category I districts. We interviewed key informants involved in program design, planning and implementation or monitoring at the national level and in five purposively selected category I districts. Results:Ebola virus disease preparedness and readiness was a success and this was attributed mainly to donor support, the ministry of health's technical capacity, good coordination, government support and community involvement. The resources invested in EVD-PR represented good value for the funds and the activities were well aligned to the public health priorities for Uganda. Conclusion:Ebola virus disease preparedness and readiness program in Uganda developed capacities that played an essential role in preventing cross border spread of EVD from the affected provinces in the DRC and enabled rapid containment of the two importation events. These capacities are now being used to detect and respond to the COVID-19 pandemic.

Introduction : on March 28, 2016 a cluster of deaths resulting from jaundice and hemorrhagic symptoms occurred in Masaka, Central Uganda. We investigated this outbreak to determine the nature of disease, identify risk factors, and recommend control and prevention measures. Methods : we defined a suspected case-person as onset in residents of Masaka, Rukungiri and Kalangala districts from January 2016 onwards of fever not responding to malaria treatment, plus ≥2 of the following: abdominal pain/diarrhea, headache, jaundice, unexplained bleeding. A confirmed case was a suspected case with positive IgM or PCR tests for yellow fever. We conducted medical record reviews and active community case-finding. In a case-control study we compared potential exposures between 32 case-persons and 128 asymptomatic controls matched by age, sex and village. We also conducted entomological studies and environmental assessments. Results : we identified 32 cases (7 confirmed). The overall attack rate (AR, per 100,000) was 0.48 overall (6.4 Masaka, 3.1 Rukungiri and 1.9 Kalangala); the case-fatality rate was 22% (7/32). Men (AR=1.2/10,000) and persons aged 30-39 years (AR = 4.0/10,000) were most affected. 20 (63%) of 32 case-persons and 35 (27%) of 128 control-persons cultivated in forest areas (ORM-H=4.3; 95%CI=1.9-9.7); 23 (71%) of 32 case-persons and 32 (25%) 128 control-persons cultivate in swampy areas (ORM-H=7.5; 95%CI=2.0-18). No one interviewed during this investigation was vaccinated against yellow fever. Sylvatic monkeys and Aedes mosquitoes were identified in the nearby forest areas. Conclusion : this was a sylvatic yellow fever outbreak that occurred in a susceptible population, likely transmitted by mosquito bites during cultivation in forest and swampy areas. We recommended yellow fever vaccination in affected districts and enhanced yellow fever surveillance in neighboring districts. The outbreak stopped following the vaccination.

Podoconiosis, a form of non-infectious elephantiasis, is a disabling Neglected Tropical Disease. In August 2015, a non-government organization reported an increase in elephantiasis cases in Kamwenge District. We conducted an investigation to confirm the diagnosis, identify causes and risk factors, and guide control efforts. We defined a suspect case-person as a Kamwenge resident with bilateral asymmetrical swelling of lower limbs lasting ≥ 1month, plus ≥ 1 of the following: skin itching; burning sensation; plantar oedema; lymph-ooze; prominent skin markings; rigid toes; mossy papillomata. A probable case was a suspect case with negative microfilaria antigen immunological-card test results. We conducted active case-finding in affected communities. In a case-control study we compared shoe-use and feet-washing practices before disease onset among 40 probable case-persons and 75 asymptomatic village control-persons, matched by age (± 5y) and sex. We collected soil samples to characterize soil-irritant composition. Our active case-finding identified 52 suspect cases in two affected sub-counties during 1980-2015 (incidence = 2.9/100,000/year), including 40 probable cases (mean age = 47y; range: 13-80y). The annual case counts did not increase significantly over time. All case-persons had negative immunological-card test. In the case-control study, 93% (37/40) of probable case-persons and 31% (23/75) of controls-persons never wore shoes at work (OR M-H = 6.7; 95%CI = 1.7-26); 80% (32/40) of probable case-persons and 55% (39/75) of control-persons never wore shoes at home (OR M-H =4.4, 95%CI=1.5-13); 70% (27/39) of probable case-persons and 47% (34/72) of control-persons washed feet at day-end rather than immediately after work (OR = 11, 95%CI = 2.1-57). Soils samples were characterized as being rich black-red volcanic clay. The reported elephantiasis was podoconiosis, which was associated with prolonged foot exposure to volcanic soil. We recommended health education on foot protection and washing, and universal use of protective shoes.

Introduction : living conditions in refugee settings present a fovourable environment for eruption of infectious disease outbreaks. At the end of April 2015, the Uganda Ministry of Health was alerted of an influx of refugees from Burundi into Uganda. Nakivale Refugee Settlement has been in existence since 1959 and had a population of 72,000 refugees of various nationalities by the time of this influx. We assessed the refugee settlement to detect potential public health risks among refugees and identify health service delivery gaps.

Introduction : rabies is one of the most deadly infectious diseases, with a case fatality rate approaching 100%. Despite availability of effective post exposure treatment, rabies still kills 50,000 to 60,000 people worldwide each year, majority of whom in the developing world. There is paucity of information on burden and trends of rabies in developing countries to guide planning processes and rabies control strategies. We analyzed surveillance data on animal bite injuries, a proxy of rabies, to describe trends and geographical distribution of animal bites and deaths due to suspected rabies in Uganda. We described trends and geographical distribution of animal bite injuries and rabies suspected deaths in Uganda from 2013 to 2015. Methods : we retrospectively analyzed health facility surveillance data collected from January 2013 to December 2015. We used line graphs to describe monthly trends and used logistical regression to test significance of observed trends at p Results : a total of 55,592 cases of animal bites were reported during the study period of which 25% (n=13,869) were in Central region, 15% (n=8,488) in Eastern region, 38% (n=21,239) in Northern region and 22% (n=11,996) in Western region. Up to 59% of animal bite injuries were inflicted on males and 80% were persons aged above 5 years. The overall incidence of animal bites was 285 bites per 100,000 population in Northern region, 141 per 100,000 in Central region, 130 per 100,000 in Western region and 91 per 100,000 in Eastern region. Cases of animal bites increased significantly in all regions of the country (p Conclusion : the increase in number of animal bite injuries implies that rabies remains an important public health challenge in Uganda which requires special attention at all levels of planning. There is need to strengthen surveillance and rabies prevention and control strategies to address this public health problem.