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AFENET supports Ebola outbreak response in Uganda

On 20 September 2022, the Uganda ministry of health declared an outbreak of Ebola Virus Disease (EVD) caused by Sudan ebolavirus species after confirmation at the Uganda Virus Research Institute (UVRI) of a case in Mubende District. The National Task Force (NTF) mobilized the National Rapid Response Team (NRRT) and partners to mount a coordinated, swift, and effective response to the EVD outbreak.

AFENET mobilized and deployed six (6) epidemiologists from the AFENET Corps of Disease Detectives (ACoDD) platform to support the response for a total of 198 person-days of deployment. The ACoDD are graduates and residents from the Field Epidemiology Training Program (FETP) from Uganda and other FETPs in AFENET member countries. By mid-October 2022, the EVD outbreak had spread from Mubende District to Kassanda, Kyegegwa, Bunyangabu, and Kagadi districts, and Kampala Capital City. An additional 5 ACoDD members were deployed for 140 person-days of deployment to support Kassanda District and Kampala Capital City.

The ACoDD members were deployed to strengthen EVD surveillance through supervision, mentorship, and provision of technical support in contact tracing, alert management, active case search, community-based surveillance, risk communication, and community engagement, infection prevention and control (IPC), data management, and data analysis to support decision making at local and national levels.

The responders under AFENET were also tasked to activate districts to set up alert and verification systems, and conduct training with health workers and Village Health Teams (VHTs) on surveillance, risk communication, and community engagements.

Dr Ditu Kazambu (AFENET Director of Programs, standing with a cap and AFENET jacket) and Dr Ben Masiira (standing in AFENET jacket) sensitizing the community at Lwenzo village, Kassanda District.
Dr Ditu Kazambu (AFENET Director of Programs, standing with a cap and AFENET jacket) and Dr Ben Masiira (standing in AFENET jacket) sensitizing the community at Lwenzo village, Kassanda District.

Initial Impact

Overall, the AFENET responders have achieved their primary objectives of deployment. They established an alert and verification desk where evacuation of suspect cases in Mubende district (grossing on average 110 alerts in a 24-hour period), Kagadi (8), and Kakumiro (11) was done, the team also supported setting up of alert management system in Kassanda district. Alerts were verified in Kagadi ( 27), Kakumiro ( 34), and Mubende ( over 3,000).

The teams also trained health workers and VHTs in event-based surveillance, case-based surveillance, contact tracing, and follow-up of 252 and 453 health workers and VHTs, respectively. Additionally, the team followed up EVD contacts including 92 in Kakumiro and 68 in Kagadi districts.

Similarly, a partnership involving the Africa Centres for Disease Control (Africa CDC), African Field Epidemiology Network (AFENET), the Uganda Health ministry, and the Bill and Melinda Gates Foundation has seen the training and retooling of close to 1000 Village Health Teams (VHTs) in Kassanda district. After the training, each VHTs was equipped with a T-Shirt, Jacket, Umbrella, Pair of gum boats, Bag (Backpack), and Infra-Red thermometer. These will be facilitated for a period of three months (November 2022 to January 2023) to ensure Kassanda District the new Epicentre and Uganda generally are declared EVD-free.

Challenges

During the course of the deployment, the region was initially faced by some challenges, which included; inadequate personnel for field verification of suspects in the communities which included epidemiologists and laboratorians to pick samples, inadequate Personal Protective Equipment (PPEs) for the field verification team, inadequate cars for transporting the field verification teams to the communities.

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Lessons

The teams have drawn a number of lessons during the execution of their duties. Decision algorithm and alert verification tools were developed which reduced the time taken to make decisions and subsequently improved the turnaround time for evacuation of suspects from the community to the Ebola Treatment Unit and/or safe and dignified burial (SDB) for the dead suspects.

The team notes that it is possible to establish epidemiological links among cases in an outbreak but difficult to ascertain the index case using one methodology, triangulation of information about cases is key to reaching index case and a better understanding of epidemic evolution like ecological studies. Risk communication & community engagement (RCCE), IPC, and Psychosocial support (PSS) coupled with surveillance in joint teams to the community is key in this outbreak response.

Uganda EVD Quick Statistics as at 08 November 2022

Cumulative Confirmed Cases

Recoveries

Deaths

Health Worker Cases

135

62

53 (H/W-06)

18