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Public Health Surveillance at Namugongo: Martyrs’ Day celebration, Uganda

Annually, the 3rd of June is a public holiday in Uganda set aside in celebration of the Uganda martyrs day. This event has gained tremendous acknowledgement by Christians around the world. As such, over 2000 Christians trek from the neighboring East African Countries.

This year AFENET in collaboration with the Ministry of Health deployed 21 epidemiologists to conduct surveillance at the Namugongo shrine. The objective of the surveillance was to obtain syndromic data from pilgrims so as to improve timely treatment of any suspected cases as well as to improve programming for a better martyr’s day.

The surveillance teams participated in screening pilgrims for any symptoms that may be associated with Viral Hemorrhagic fevers, assessing the quality of water drank by pilgrims at the two sites in Namugongo, assesing the standard of food eaten by pilgrims at Namugongo and describe the trends of the commonly occurring syndromes among the pilgrims.

Different sentinel surveillance posts were set up in the two shrines for monitoring any person suspected to have viral haemorrhagic symptoms. Rapid screening of pilgrims was done at two levels. Pilgrims from suspected countries were screened by a team of specially trained personnel. Any person with a temperature reading beyond 38 degrees centigrade was referred to the nearest sentinel surveillance post for the second stage of screening.

The lake water source from the catholic shrine was purposively chosen because majority of pilgrims use this water for faith based reasons.

Sampling of food eaten by pilgrims at Namugongo

Food samples were randomly chosen from three random food sellers. The investigators collected the food samples which were then analyzed at the microbiology laboratory at Makerere university College of veterinary medicine, animal resources and biosecurity using the surface spread method as adopted from the FAO manual of food quality control.

A sentinel surveillance system was set up in all health and medical posts spread out in the area of the shrine as has always been the case. A syndromic patient surveillance form was used to capture demographic information about the patients as well as the symptoms and duration of these symptoms. Additional information was collected about whether the pilgrims drank the lake water or not. Sample size determination was guided by Keish Leslie sample size formula for cross-sectional studies. The number of people that drank the lake water was determined from previous studies done in Namugongo. Data was collected from a total of 713 pilgrims seeking outpatient care. The current data was compared with data collected from previous studies to establish trends of commonly occurring syndromes.

From 30th May to 3rd June 2018, a total of 1,154 pilgrims from the Democratic Republic of Congo were screened. However none of them presented with symptoms of Viral hemorrhagic fevers. Among the general population, 707 pilgrims reported to the sentinel surveillance posts for outpatient care. The mean (SD) age of the pilgrims was 42.6(15.7).

Of these, one cholera suspected case who was later confirmed to be a true cholera patient after laboratory analysis was captured by the surveillance team. She was identified on the 3rd of June having arrived in Namugongo on the 2nd of June 2018 by bus. She was a 43 year old pilgrim from Mbale municipality.

She provided a stool sample which was shipped to the Central Public Health Laboratory (CPHL) for culture and sensitivity testing. She was evacuated to Naguru hospital isolation ward on 3rd June 2018. On the 4 of June 2018, she tested positive for Vibrio cholera serotype 01 inaba by culture sensitivity testing. She was then transferred to Mulago National Referral Hospital cholera treatment camp on 4 June 2018 where she was managed and discharged the same day.

The successful screening of pilgrims revealed no serious threat to any of the viral hemorrhagic fevers but also helped to identify a pilgrim with cholera. This goes to further strengthen the need for surveillance at such events because if not identified, this patient could have died if not attended to in a timely manner.

The team recommended improved refuse disposal at similar mass gatherings. Open defecation should be prohibited and the pond water preserved as holy but be purified. Government should ensure proper inspection of meat, certification of food handlers and adequate health education at such mass gatherings.