Comparison of surveillance and response capacities for Ebola and Marburg viral disease epidemics between previously affected and non-affected districts of Uganda: lessons for future preparedness

Abstract

Introduction: Ebola and Marburg virus genera belong to Filoviridae. The Marburg virus and Ebola Zaire, Sudan, and Bundibugyo subtypes have caused large viral hemorrhagic fever outbreaks. The first Ebola/Marburg Viral Diseases (E/MVD) outbreak in Uganda occurred in Gulu in 2000/01 and subsequently four more EVDs and four MVD outbreaks have occurred, affecting 628 cases with 269 deaths inclusive of 20 health workers. Not only do E/MVDs cause high mortality and morbidity but are considered as global health security threats. Uganda is implementing IDSR and IHR2005 to strengthen her health systems to support surveillance and response systems against Ebola/Marburg and other infectious disease outbreaks. Robust and real-time active surveillance and response systems are required to enable early detection, diagnosis, tracking and mapping emerging and reemerging infectious diseases. Objective: The main objective of this study to compare surveillance and response capabilities for E/MVD outbreaks in previously affected districts of Kabale, Kagadi and Luwero and nonaffected districts of Amolatar, Kamuli and Soroti in Uganda. Methodology: This study was conducted in 3 previously Ebola /Marburg affected and 3 nonaffected comparator districts. This was a cross sectional study utilizing quantitative data collection methods. Data were collected from 6 District Task Force committees, 79 health facilities and 257 community respondents. The study drew respondents purposively following their roles and responsibilities at district, facility and community levels. These included district Task Force committee members, health workforce both veterinary and human health, and community resource persons. Checklists were used to collect District Task Force and facility data while questionnaires for community resource persons. Data were analyzed in comparison between previously affected and non- affected districts and presented as percentages and frequencies for continuous variables; variable comparison was tested using bivariate and xiv multivariate logistic regression analysis at 5% significance level. The surveillance and response capacity difference between previously affected and comparator districts were presented as proportion differences. Results: Community members in previously affected districts had more knowledge about simplified community standard case definitions [aOR=3.09, 1.56-7.19] and signs and symptoms of E/MVD in humans[aOR=2.23, 1.09-4.23] than those in non- affected ones. Community members in previously affected districts were more willing to use restrictive control measures[aOR=3.14,1.38-6.19] to respond to E/MVDs compared to those in non-affected districts. Conclusion: District capacities developed during an E/MVDs epidemic phase infer some residual capability for preparedness to future epidemics. Previously affected districts had more E/MVD preparedness levels in all assessed capacities compared to their counterparts.