As the COVID-19 pandemic continues to ravage health care systems, economies, livelihoods, and cultures across the world, responses across countries have varied greatly. Uganda adopted its own model taking into consideration its culture, values, environment, socio-economic activities, beliefs, previous successful epidemic experience, and appears a hybrid policy to the Norwegian model. This model of response is perhaps based on Uganda's long experience in successful control of many previous epidemics which afflicted it and the neighboring countries, e.g, HIV and AIDs in the 1980s, Measles in the 1990s, Hepatitis B in the 2000s, Ebola in 2000, 2017 and 2018 and Marburg in 2018. In our view the near complete lockdown through shutting down air, road, water travels and congregate settings as well as the restriction of people's movement through the stay home policy may have, so far, played a significant role in this pandemic containment and control. Most notable is that there is an established and clear leadership structure, experienced health workforce, good political will, enabling environment, and good epidemic response by the population. Even though one can reasonably argue that the numbers of COVID-19 cases seen in Uganda so far, are not anywhere close to those large numbers seen in the USA, Asia and other European countries, Uganda's story on how it is managing the pandemic is worth sharing as it might provide useful lessons for future public health interventions to a pandemic of this magnitude, particularly in low-resource settings. Uganda's President continued to provide national leadership, guidance, and coordination to the COVID-19 National task force for the response. The President and Ministry of Health authorities employed both electronic and social media such as radios, music, Televisions, SMS messages, twitters, group emails, and WhatsApp messages to engage, mobilize, and sensitize the population on COVID-19 preventive interventions through provision of regular updates. In conclusion, simultaneous multiple public health interventions through a structured leadership may in part contribute to reasonable and timely control of a pandemic such as COVID-19.
Background The advent of the novel coronavirus disease 2019 (COVID-19) has caused millions of deaths worldwide. As of December 2021, there is inadequate data on the outcome of hospitalized patients suffering from COVID-19 in Africa. This study aimed at identifying factors associated with hospital mortality in patients who suffered from COVID-19 at Gulu Regional Referral Hospital in Northern Uganda from March 2020 to October 2021. Methods This was a single-center, retrospective cohort study in patients hospitalized with confirmed SARS-CoV-2 at Gulu Regional Referral Hospital in Northern Uganda. Socio-demographic characteristics, clinical presentations, co-morbidities, duration of hospital stay, and treatments were analyzed, and factors associated with the odds of mortality were determined. Results Of the 664 patients treated, 661 (99.5%) were unvaccinated, 632 (95.2%) recovered and 32 (4.8%) died. Mortality was highest in diabetics 11 (34.4%), cardiovascular diseases 12 (37.5%), hypertensives 10 (31.3%), females 18 (56.3%), ≥50-year-olds 19 (59.4%), no formal education 14 (43.8%), peasant farmers 12 (37.5%) and those who presented with difficulty in breathing/shortness of breath and chest pain 32 (100.0%), oxygen saturation (SpO 2 ) at admission <80 4 (12.5%), general body aches and pains 31 (96.9%), tiredness 30 (93.8%) and loss of speech and movements 11 (34.4%). The independent factors associated with mortality among the COVID-19 patients were females AOR = 0.220, 95%CI: 0.059–0.827; p = 0.030; Diabetes mellitus AOR = 9.014, 95%CI: 1.726–47.067; p = 0.010; Ages of 50 years and above AOR = 2.725, 95%CI: 1.187–6.258; p = 0.018; tiredness AOR = 0.059, 95%CI: 0.009–0.371; p < 0.001; general body aches and pains AOR = 0.066, 95%CI: 0.007–0.605; p = 0.020; loss of speech and movement AOR = 0.134, 95%CI: 0.270–0.660; p = 0.010 and other co-morbidities AOR = 6.860, 95%CI: 1.309–35.957; p = 0.020. Conclusion The overall Gulu Regional Hospital mortality was 32/664 (4.8%). Older age, people with diabetics, females, other comorbidities, severe forms of the disease, and those admitted to HDU were significant risk factors associated with hospital mortality. More efforts should be made to provide “ additional social protection ” to the most vulnerable population to avoid preventable morbidity and mortality of COVID-19 in Northern Uganda.
Many antiretroviral treatment (ART) adherence measurement methods have been employed by different studies, but no single method has been found to be appropriate for all settings. This study aimed to determine baseline levels of adherence using 2 measures of adherence.Levels of adherence in 967 patients continuing to receive ART in 4 health facilities were assessed over a 28-week period using a clinic-based pill count method and a patient self-report questionnaire. Factors associated with adherence were also determined.Mean adherence (95% confidence interval) was 97.3% (96.8% to 97.9%) and 98.4% (97.9% to 98.8%) for the clinic-based pill count and patient self-report methods, respectively. Proportion of clients achieving optimal adherence (≥ 95%) was 89.9% by pill count and 94.2% by self-report. The 2 adherence measures were closely correlated with each other (r = 0.87, P = 0.000). Adherence increased with age (P = 0.014) with patients aged 40 years and below being less likely to achieve optimal adherence [odds ratio = 0.55; 95% confidence interval (0.34 to 0.89)].There is a very high level of optimal adherence among patients still on treatment. The combined use of these 2 replicable and reliable methods of measuring adherence is vital to ART programs in resource-constrained settings.
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.
hepatitis B virus (HBV) is one of the commonest causes of acute and chronic liver diseases worldwide. HBV can be transmitted by exposure to infected blood and human secretions through sharp injuries and splashes. Health workers are among the most high-risk groups because they regularly interact with patients. A seroprevalence survey conducted in Uganda in 2014 found a higher prevalence of HBV in Gulu Municipality compared to the rest of Uganda.a cross-sectional study was conducted among health workers in Gulu Regional Hospital. A stratified random sampling was used. Knowledge ratings and Likert scale were used to score knowledge, attitudes and risks of HBV infections in a qualitative assessment. Ethical approval was obtained and SPSS was used for data analysis. A p-value less than 0.05 was considered significant.one hundred and twenty-six (126) respondents participated; 65 (51.6%) were male, 80 (63.5%) were aged 20-29 years, 74 (58.7%) were not married, 86 (68.3%) had a work experience of 0-9 years, 64 (50.8%) had good knowledge, 90(71.4%) had positive attitude, 114 (90.5%) had high to very high pre-exposure risks, and 75 (59.5%) had moderate to high exposure and post-exposure risks. There was no significant difference in knowledge (X2= 13.895; p = 0.178) and work experience (X2= 21.196; p = 0.097) among the health workers.there is a high pre-exposure, exposure and post-exposure risks of HBV infection among health workers in Gulu Hospital. There is need to augment awareness on HBV infection and design strategies to strengthen and implement infection control measures including HBV vaccination among health workers.
Abstract Background The COVID-19 pandemic has dramatically impacted communities worldwide, particularly in developing countries. To successfully control the pandemic, correct information and more than 80% vaccine coverage in a population were required. However, misinformation and disinformation could impact this, thus increasing COVID-19 vaccine hesitancy in communities. Several studies observed the effect of misinformation and disinformation on COVID-19 vaccine acceptance and other responses to the pandemic in the African continent. Thus, the most trusted sources of information on COVID-19 vaccines are critical for the successful management and control of the pandemic. This study aimed to assess the most trusted sources of information on COVID-19 vaccines during the pandemic in Uganda. Methods We conducted a cross-sectional study on 587 adult population members in northern Uganda. Single-stage stratified and systematic sampling methods were used to select participants from northern Uganda. An interviewer-administered questionnaire with an internal validity of Cronbach’s α = 0.72 was used for data collection. An Institution Review Board (IRB) approved this study and Stata version 18 was used for data analysis. A Pearson Chi-square (χ2) analysis was conducted to assess associations between trusted sources of COVID-19 vaccine information and selected independent variables. Fisher’s exact test considered associations when the cell value following cross-tabulation was < 5. A P-value < 0.05 was used as evidence for an association between trusted sources of information and independent variables. All results were presented as frequencies, proportions, Chi-square or Fisher’s exact tests, and P-values at 95% Confidence Intervals (CI). Results In a study of 587 participants, most were males, 335(57.1%), in the age group of 25–34 years, 180(31.4%), and the most trusted source of COVID-19 vaccine information were the traditional media sources for example, Televisions, Radios, and Newspapers, 349(33.6%). There was no significant association between sex and trusted sources of COVID-19 vaccine information. However, by age-group population, COVID-19 vaccine information was significantly associated with internet use (14.7% versus 85.3%; p = 0.02), information from family members (9.4% versus 90.6%; p < 0.01), and the Government/Ministry of Health (37.9% versus 62.1%; p < 0.01). Between healthcare workers and non-health workers, it was significantly associated with internet use (32.2% versus 67.8%; p = 0.03), healthcare providers (32.5% versus 67.5%; p < 0.018), the Government/Ministry of Health (31.1% versus 68.9%; p < 0.01), and scientific articles (44.7% versus 55.3%; p < 0.01). Conclusion The most trusted sources of COVID-19 vaccine information in northern Uganda were Televisions, Radios, and Newspapers. The trusted sources of COVID-19 vaccine information were not significantly different between males and females. However, there were significant differences among age groups and occupations of participants with younger age groups (≤ 44 years) and non-healthcare workers having more trust in Televisions, Radios, and Newspapers. Thus, for effective management of an epidemic, there is a need for accurate communication so that misinformation, disinformation, and malinformation in the era of “infodemic” do not disrupt the flow of correct information to communities.
As SARS-CoV-2 rapidly spread across the globe, short-term modeling forecasts provided time-critical information for containment and mitigation strategies. Global projections had so far incorrectly predicted large numbers of COVID-19 cases in Africa and that its health systems would be overwhelmed. Significantly higher COVID-19-related mortality were expected in Africa mainly because of its poor socio-economic determinants that make it vulnerable to public health threats, including diseases of epidemic potential. Surprisingly as SARS-CoV-2 swept across the globe, causing tens of thousands of deaths and massive economic disruptions, Africa has so far been largely spared the impact that threw China, USA, and Europe into chaos. To date, 42 African countries imposed lockdowns on movements and activities. Experience from around the world suggests that such interventions effectively suppressed the spread of COVID-19. However, lockdown measures posed considerable economic costs that, in turn, threatened lives, put livelihoods at risk, exacerbated poverty and the deleterious effects on cultures, health and behaviours. Consequently, there has been great interest in lockdown exit strategies that preserve lives while protecting livelihoods. Nonetheless in the last few weeks, African countries have started easing restrictions imposed to curb the spread of SARS-CoV-2. WHO recommends lifting of lockdowns should depend on the ability to contain SARS-CoV-2 and protect the public once restrictions are lifted. Yet, the greatest challenge is the critical decision which must be made in this time of uncertainties. We propose simple strategies on how to ease lockdowns in Africa based on evidence, disease dynamics, situational analysis and ability of national governments to handle upsurges.
Abstract Background: The advent of the novel coronavirus disease 2019 (COVID-19) has caused millions of deaths worldwide. There is a lack of data on the outcome of hospitalized African patients suffering from COVID-19.This study aimed at identifying factors associated with hospital mortality in patients who suffered from COVID-19 at Gulu Regional Referral Hospital in Northern Uganda from March 2020 to October 2021. Methods: This was a single-center, retrospective study in patients hospitalized with confirmed COVID-19 at Gulu Regional Referral Hospital in Northern Uganda. Socio-demographic characteristics, clinical presentations, comorbidities, duration of hospital stay, and treatment were analyzed, and factors associated with increased odds of mortality were determined. Results: Of the 664 patients treated, 661(99.5%) were unvaccinated, 632(95.2%) recovered and 32(4.8%) died. Mortality was highest in diabetics 11(34.4%), cardiovascular diseases 12(37.5%), hypertensive 10(31.3%), females 18(56.3%), > 50-year-olds 19(59.4%), no formal education 14(43.8%), peasant farmers 12(37.5%) and those who presented with difficulty in breathing/shortness of breath and chest pain 32(100.0%), Oxygen saturation (Sp0 2 ) <80 4(12.5%), general body aches and pains 31(96.9%), tiredness 30(93.8%) and loss of speech and movements 11(34.4%). The independent factors associated with mortality among the COVID-19 patients were females AOR=0.220,95%CI:0.059-0.827;p=0.030; Diabetes mellitus AOR=9.014, 95%CI:1.726-47.067;p=0.010; tiredness AOR=0.059,95%CI:0.009-0.371; p=0.0000; general body aches and pains AOR=0.066,95%CI:0.007-0.605; p=0.020; loss of speech and movement AOR=0.134,95%CI:0.270-0.660;p=0.010 and other comorbidities AOR=6.860, 95%CI:1.309-35.957;p=0.020. Conclusion: The overall hospital mortality was 4.8%. Older age, people with diabetics, females, other comorbidities, severe forms of the disease, and those admitted to HDU were significant risk factors associated with hospital mortality. More efforts should be made to provide “Enhanced shielding” to the most vulnerable population to avoid preventable morbidity and mortality of COVID-19 in Northern Uganda.
The double burden of malnutrition (DBM) is rising globally, particularly in sub-Saharan Africa. In Sierra Leone, the incidence of overweight, obesity (OWOB), and overnutrition among women has sharply increased. This finding accompanies the high incidence of undernutrition, which has been prevalent for decades. This study aimed to determine the prevalence of different malnutrition categories (underweight, overweight, obesity, and overnutrition) and associated factors among women of reproductive age (15-49 years) in Sierra Leone using secondary data analysis of the Sierra Leone Demographic Health Survey of 2019 (SLDHS-2019).We conducted secondary data analysis of the SLDHS-2019 of 7,514 women aged 15-49 years. We excluded pregnant, post-natal, lactating, and post-menopausal women. Data was collected using validated questionnaires, and respondents were selected through a multistage stratified sampling approach. A multivariable logistic regression analysis was used to determine factors associated with malnutrition among 15-49-year-old women in Sierra Leone.Among 15-49-year-old women in Sierra Leone, the prevalence of underweight was 6.7% (95%CI: 4.5-8.9%); overweight at 19.7% (95%CI: 17.7-21.7%); obesity was 7.4% (95% CI: 5.2-9.6%); and overnutrition, 27.1% (95%CI: 25.2-29.0%). Women aged 25-34 years were more likely to be underweight (adjusted Odds Ratios, aOR = 1.670, 95%CI: 1.254-2.224; p < 0.001) than those aged 15-24 years; women who were not married were less likely to be underweight (aOR = 0.594, 95%CI: 0.467-0.755; p < 0.001) than married women. Women from the North were less likely to be underweight (aOR = 0.734, 95%CI: 0.559-0.963; p = 0.026) than the East, and those who did not listen to the radio were less likely to be underweight (aOR = 0.673; 95%CI: 0.549-0.826; p < 0.001) than those who did. Overweight was less likely among 25-34 years (aOR = 0.609, 95%CI: 0.514-0.722; p < 0.001) and 35-49 years (aOR = 0.480, 95%CI: 0.403-0.571; p < 0.001) age-groups than 15-24 years; more likely among not married women (aOR = 1.470, 95%CI:1.249-1.730; p < 0.001) than married; less likely among working-class (aOR = 0.840, 95%CI: 0.720-0.980; p = 0.026) than not working-class; most likely in women from the North (aOR = 1.325, 95%CI:1.096-1.602; p = 0.004), and less likely among women from the South (aOR = 0.755, 95%CI: 0.631-0.903; p = 0.002) than the East; less likely among women of middle-wealth-index (aOR = 0.656, 95%CI: 0.535-0.804; p < 0.001), richer-wealth-index (aOR = 0.400, 95%CI: 0.309-0.517; p < 0.001), and richest-wealth-index (aOR = 0.317, 95%CI: 0.234-0.431; p < 0.001) than the poorest-wealth-index; and more likely among women who did not listen to radios (aOR = 1.149; 95%CI:1.002-1.317; p = 0.047) than those who did. The predictors of overweight among women 15-49 years are the same as obesity and overnutrition, except overnutrition and obesity were less likely in female-headed households (aOR = 0.717,95%CI: 0.578-0.889; p < 0.001).The prevalence of all categories of malnutrition among women of reproductive age in Sierra Leone is high, affirming a double burden of malnutrition in this study population. Underweight was more likely among the 25-34-year age group than 15-24-year. The predictors of overweight, obesity, and overnutrition were being unmarried/single, residing in the North, and not listening to the radio. There is an urgent need for policymakers in Sierra Leone to design comprehensive educational programs for women of reproductive age on healthy lifestyles and the dangers of being underweight or over-nourished.
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