Ebola. A virus disease that brings panic when mentioned and with good reason. According to Africa Centres for Disease Control and Prevention (Africa CDC), Ebola virus disease (EVD) is a severe, often fatal, illness originally transmitted to humans from wild animals (such as fruit bats, porcupines, and non-human primates) and then transmitted from human to human through direct contact with the blood, secretions, organs or other bodily fluids of an infected person. It can also be transmitted through surfaces and materials (e.g. bedding, clothing) contaminated with these fluids. The virus was first discovered in 1976 in the Ebola River region of Congo.
On 20 September 2022, Ugandan health authorities confirmed an outbreak of the Sudan Ebola Virus, following laboratory confirmation of a patient from a village in Mubende District, Central Uganda. According to the Ministry of Health of Uganda’s last EVD report, the outbreak claimed the lives of 55 people and infected over 114 people in 9 districts which also disrupted the socio-economy of the affected communities. The report also indicated that more than 87 people recovered among the confirmed cases.
The Minister of Health of the Republic of Uganda, Honourable Dr. Jane Ruth Aceng elaborated, “Uganda has experienced seven Ebola outbreaks since the year 2000, when our first Ebola outbreak was extremely devastating, with over 400 cases and 250 deaths. Uganda started putting systems in place for early detection and response. Subsequently, we expanded laboratory capacity to the extent that we have several mobile laboratories that we can deploy anywhere at any time. We also started the Field Epidemiology Training Program (FETP) program, and Laboratory training program at that time, to increase the number of field epidemiologists who could investigate and act as rapid response teams in the event of an outbreak. We also addressed the sample transport network because samples come from any part of the country. In addition, we developed a village health team surveillance manual and trained our village health team so they’re on a lot at any one time.”
As part of the response, Africa CDC, with funding from the Rockefeller Foundation through Africa Public Health Foundation (APHF), trained and deployed 1,926 Community Health Workers (CHWs) in two districts, Mukono (980) and Wakiso (946), to support the Ebola response from November 2022 to January 2023. The two districts were considered high risk, given the high population density and movement of persons for trade and other purposes. The training focused on equipping the CHWs with skills in disease surveillance, contact tracing, infection prevention and control, risk communication, and community engagement.
Dr. Ebere Okere, CEO of Africa Public Health Foundation stated, “Having resources readily available enabled a rapid response in the affected districts in Uganda, as time is of the essence during a public health emergency. It allows for the mobilization of personnel, equipment, and supplies to the affected areas, enabling a more efficient and targeted response. This readiness helped to minimize the impact of the Sudan Ebola Virus outbreak, reduce its spread, and increased the chances of controlling the outbreak effectively. We are grateful to our donors, Rockefeller Foundation for availing this grant that enhanced the overall capacity to manage the crisis effectively.”
In the two districts, the CHWs were able to record 10,366 suspected cases and 282 community deaths. In addition, they referred all the suspected cases to the Ministry of Health gazetted facilities and conducted 447,069 household visits. Additionally, 29 alerts were found to be within the case definition of the Ebola virus and samples were taken and sent to the Uganda Virus Research Institute.
Dr. Lul Riek, Ag. Regional Collaborating Center Coordinator for East Africa remarked, “Outbreaks begin and end in communities. This was the approach we introduced as Africa CDC by strengthening Community engagement during the Ebola response in the most affected districts through the involvement of local council chairpersons, religious leaders, and village health teams. This was the turning point in the controlling of the outbreak.”
On the 11th of January 2023, Uganda was declared Ebola free. However, the Ministry of Health (MOH) recommended continued surveillance in communities through the deployment of CHWs to remain on high alert and be able to quickly identify and locate new infections. Africa CDC will continue to work with MOH to enhance surveillance by supporting the establishment of Events Based Surveillance in priority districts, strengthening biosafety and biosecurity in priority areas identified by MOH, and supporting the ecological study and documentation of the outbreak.