Uganda field epidemiology residents investigate H1N1 influenza outbreak, recommend process improvements
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by
AFENET
Discrepancies between health facility records and DHIS2 data can significantly complicate early detection and magnitude estimation of disease outbreaks. This underreporting subsequently affects fast and full appreciation of the scale of an outbreak at national level.
The observation was made by a team of residents of the Advanced Field Epidemiology Training Program (FETP) under the Uganda Public Health Fellowship who were recently involved in a H1N1 influenza outbreak investigation in Kisoro District, in the Southwest of the East African country.
Daniel Wenani (team lead), Charity Mutesi and Hannington Katumba conducted the investigation together with the Kisoro District Health Team members, including: the District Health Officer, District Surveillance Focal Person, District Laboratory Focal Person and the health facility in charges and surveillance focal persons.
During their investigations of the outbreak, which was confirmed on March 28, the team found that many health facility records did not match DHIS2 records.
Based on challenges registered during the investigation, team further made a raft of proposals aimed at improving future disease outbreak investigations.
“Cross-border surveillance efforts must also be intensified given Kisoro’s porous borders with Rwanda and DRC. Continuous sensitization of health workers, especially in lower-level facilities and private clinics, on case management and rational drug use remains essential to mitigate future outbreaks. Lastly, there is need to establish a sentinel site for influenza-like illnesses and severe acute respiratory illnesses in the area to monitor trends of respiratory tract illnesses,” the team wrote in their report.
Reflecting on the investigation, Mr Daniel Wenani, observed that “the outbreak investigation provided critical insights into gaps in surveillance and response systems and has laid the foundation for more resilient influenza surveillance in Kisoro and neighboring districts.”
About H1N1 influenza outbreak in Kisoro
On March 17, 2025, the District Health Team (DHT) was alerted by the in-charge of Buhozi Health Center III regarding an increase in numbers of cases presenting with symptoms suggestive of acute respiratory infections in Kisoro District. The reported cases were mainly from Busanza Subcounty, where the health facility is located. In response, the DHT randomly collected five nasopharyngeal swab samples from affected individuals who tested positive for H1N1. Following confirmation, on March 28, 2025, the Ministry of Health (MoH) national rapid response team was dispatched to Kisoro District to investigate the H1N1 influenza outbreak.
