The Independent Uganda: You get the Truth we Pay the Price
Health workers comb affected districts for remnant cases
NEWS ANALYSIS | RONALD MUSOKE | Uganda’s Ministry of Health together with its partners, the World Health Organization (WHO) Country Office and, the Africa Centres for Disease Control and Prevention (Africa CDC), have in recent weeks intensified sensitisation of communities in the Ebola virus disease-affected districts.
Thanks to support from the Contingency Fund for Emergencies, on March 12, the WHO Uganda Country Office teamed-up with the Ministry of Health, Baylor College of Medicine, Children’s Foundation-Uganda, Médicins Sans Frontières (MSF), Africa CDC, and the Joint Mobile Emerging Disease Intervention Clinical Capability (JMEDICC) programme to conduct rapid Ebola case management trainings for 117 health care workers from Kampala, Wakiso, Mukono, Fort Portal, Bundibugyo and Ntoroko districts.
In the eastern district of Mbale, the Africa CDC’s epidemiologists, risk communication and community engagement (RCCE), infection prevention and control (IPC) and lab experts in collaboration with the Ministry of Health trained over 730 community health workers to enhance outbreak preparedness and response towards Ebola, Mpox and Marburg.
The trainings have been aimed at improving case detection, notification and referral of Ebola suspected cases of “health care facility level” while adhering to infection prevention and control measures.
The World Health Organization’s risk communication and community engagement teams have also been interacting with communities in the affected districts to amplify prevention messages, emphasizing early diagnosis, and highlighting the benefits of proactive health behaviour.
According to the WHO Country Office in Uganda, clear and factual communication can reduce stigma and make individuals feel safe to seek testing and treatment. In recent days, the WHO team has visited Kawanda, a trading centre in the north of Kampala, where the index case for the current Ebola outbreak resided. The team interacted and shared critical information with Boda Boda or motorcycle taxi riders.
Dr. Jerome Ntege, a medical anthropologist at WHO-Uganda Country Office, explained why targeting this group of people in the communities is important. “Boda Bodas are the community ambulances,” Dr Ntege said in a video message. “Whoever is sick looks for Boda Boda. The Boda Bodas take you to the hospital.”
At a school in Kawempe, one of Kampala’s most populous divisions, the focus has been on learners who are still going on with their school term. “Learners are very effective because they can pass on the messages to their friends and also to their families,” said Rita Mwagale, the Risk Communication and Community Engagement Officer at WHO-Uganda.
In eastern Uganda, where the index case who succumbed to the virulent disease on Jan.29 was buried, the WHO’s risk communication and community engagement teams have been engaging the communities on preventive measures and how to respond when individuals in their midst present with Ebola signs and symptoms.
Isaac Sugar Ray, a Risk Communications and Community Engagement Officer at WHO-Uganda said it’s about the mindset, in another video message. He said the moment community members know what to do, the work for health workers becomes light. “The most important thing is to pass on this information, pass on the messages that inform them how to prevent, how to control and what to do just in case one develops the signs and symptoms.”
Current Ebola situation
On Jan.30, Uganda declared its eighth Ebola outbreak in the country since 2000 when a health worker working at Mulago National Referral Hospital in Kampala, the country’s capital, was declared to have died of the disease a day earlier.
The Ministry of Health alongside its partners went to work, searching for contacts of the index case, testing them, isolating and quarantining the ones the teams found already sick. Eight infected people were found and the patients underwent treatment at the Ebola Treatment Unit in Kampala and Mbale Regional Referral Hospital in eastern Uganda. Over 200 contacts were also picked from the communities, quarantined and closely monitored.
On Feb.18, the Ministry of Health discharged the eight patients who had been receiving treatment for the Sudan virus disease since the outbreak was announced. The health ministry working in partnership with the World Health Organization (WHO) sent home the recovered patients following two negative tests which had been carried out 72 hours apart.
“The patients we are discharging today are safe and free of the disease. I urge their families and communities to receive and interact with them normally,” said Dr Jane Ruth Aceng, the Minister of Health during the ceremony which was held at Mulago Hospital on Feb.18.
Monitoring of contacts continues
Dr. Aceng said the index case’s contacts or, the people who were linked to the nurse who died of the disease, were still under strict quarantine and monitoring at Kampala, Jinja, and Mbale quarantine facilities. “None of these contacts have exhibited symptoms so far, though they will remain under quarantine for 21 days from the time of their contact or exposure to the index case,” she said.
She said the ministry had instituted several control measures including; the quarantining of all identified contacts, strict monitoring for signs and symptoms of Ebola and isolating symptomatic contacts and testing their samples for the virus.
Dr. Aceng noted that the health ministry and its partners had learnt from previous outbreaks and best practices across the continent. “The ministry has been implementing mandatory institutional quarantine for all identified contacts,” she said.
She explained that institutional quarantine refers to carefully chosen hotels or hostels to house the individuals where the ministry and partners’ teams visit to assess if they have developed symptoms consistent with Ebola and also provide psychosocial support. “This ensures daily evaluation by technical teams and timely detection of any clinical symptoms and immediate interventions,” she said.
“The discharging of the patients today (Feb.18) not only marks an important milestone in our collective efforts to control the outbreak, but it also brings huge relief to their families and communities,” said Dr Kasonde Mwinga, the WHO Representative in Uganda.
Dr. Mwinga said the UN health agency would continue working with Ugandan authorities to ensure the response remained active. “The next 42 days are critical in ensuring no new cases arises. If no new infection occurred during this period, this outbreak would be declared over.”
Second death upsets response
But on Feb.25, the Ministry of Health announced a new death of an Ebola patient. It was that of a four-and-half-year-old child from Kibuli, a suburb in Kampala city. The child is said to have died with “classical presentation of Ebola” from Mulago Hospital.
While giving the latest periodical update on Ebola on March 6, Dr Aceng said although many people had assumed that Ebola was over, “that’s not how we declare a country free of an Ebola outbreak.”
“Usually, from the date of the discharge of the last patient, we begin a 42-day countdown and in those 42 days, we carry out intense surveillance in affected areas to ensure that there is no case left and we are 100% sure.”
“We were only a few days into the countdown when a new fatality was confirmed. But it’s not a surprise. It’s within the outbreak period. My humble appeal to Ugandans is to remain vigilant and report all cases with signs and symptoms that are similar to Ebola.”
Dr Aceng noted that from where the outbreak is, the country can ably manage if the people in the communities give the health workers critical information that is crucial for them to take action.
“Support the health workers to support you,” she said. “Remember when you are got early, your chances of survival are higher; that’s why the eight people were all discharged in good condition because supportive treatment was given to them early but when you’re not and you take a critical course, it’s very difficult to save your lives.”
No new cases reported
On March 13, Dr. Jean Kaseya, the Africa CDC Director-General said during a virtual press briefing on health emergencies in Africa no new Ebola cases have been reported in Uganda since the last update on March 6.
He said there are just two active cases under admission. “There have been 14 cases (12 confirmed cases and 2 probable cases), while total contacts are 337 with 268 contacts registered as completed follow-up,” he said, adding that there are now 69 contacts. “In total, there have been 14 cases registered, with four deaths and 8 recoveries, giving a CFR of 28.5%,” he said.
Understanding Ebola
The Sudan virus disease is a severe, often fatal illness affecting humans and other primates that is due to Orthoebolavirus sudanense (Sudan virus), a viral species belonging to the same genus of the virus causing Ebola virus disease.
The virus can be transmitted through human-to-human transmission via direct contact through broken skin or mucous membranes with blood or body fluids (sweat, urine, faeces, vomitus, semen or breast milk of a person who is sick with Ebola or has died from Ebola).
The disease can also spread via contaminated objects such as medical equipment or personal items that have come into contact with infected body fluids or when one comes into close contact with blood, secretions, organs or bodily fluids of infected animals such as fruit bats, chimpanzees, gorillas, monkeys, forest antelopes found sick or dead in the forest.
A suspected Ebola case may present with symptoms such as sudden onset of fever, fatigue, chest pain, headache, diarrhoea, vomiting, restlessness, yellowing of the eyes and later on unexplained bleeding which usually appears in later stages after the above symptoms. I will now move to mpox disease.
Case fatality rates of Sudan virus disease have varied from 41% to 100% in past outbreaks, epidemiologists say. However, there are no approved treatments or vaccines for Sudan virus. Early initiation of supportive treatment has been shown to significantly reduce deaths from Sudan virus disease.
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