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Introduction Disease surveillance provides vital data for disease prevention and control programs. Incomplete and untimely data are common challenges in planning, monitoring, and evaluation of health sector performance, and health service delivery. Weekly surveillance data are sent from health facilities using mobile tracking (mTRAC) program, and synchronized into the District Health Information Software version 2 (DHIS2). The data are then merged into district, regional, and national level datasets. We described the completeness and timeliness of weekly surveillance data reporting on epidemic prone diseases in Uganda, 2020–2021. Methods We abstracted data on completeness and timeliness of weekly reporting of epidemic-prone diseases from 146 districts of Uganda from the DHIS2.Timeliness is the proportion of all expected weekly reports that were submitted to DHIS2 by 12:00pm Monday of the following week. Completeness is the proportion of all expected weekly reports that were completely filled and submitted to DHIS2 by 12:00pm Wednesday of the following week. We determined the proportions and trends of completeness and timeliness of reporting at national level by year, health region, district, health facility level, and facility ownership. Results National average reporting timeliness and completeness was 44% and 70% in 2020, and 49% and 75% in 2021. Eight of the 15 health regions achieved the target for completeness of ≥ 80%; Lango attained the highest (93%) in 2020, and Karamoja attained 96% in 2021. None of the regions achieved the timeliness target of ≥ 80% in either 2020 or 2021. Kampala District had the lowest completeness (38% and 32% in 2020 and 2021, respectively) and the lowest timeliness (19% in both 2020 and 2021). Referral hospitals and private owned health facilities did not attain any of the targets, and had the poorest reporting rates throughout 2020 and 2021. Conclusion Weekly surveillance reporting on epidemic prone diseases improved modestly over time, but timeliness of reporting was poor. Further investigations to identify barriers to reporting timeliness for surveillance data are needed to address the variations in reporting.

Pathogenic fungi cause approximately 13 million infections and 1.5 million deaths worldwide each year, yet surveillance and diagnosis remain inadequate in resource-limited settings. In Uganda, fungal infections affect approximately 4,099,357 per 45 million people annually, resulting in severe invasive diseases if untreated. This study describes laboratory-confirmed pathogenic fungal isolates from clinical samples in Uganda from January 2020 to May 2024, and highlights gaps in diagnostic capacity. We abstracted data from the National Microbiology Reference Laboratory database, disaggregated pathogenic fungal isolates by the sex and age group of the patients, sample type, and isolated species, district, and year of isolation. Pathogenic fungal isolates were confirmed by culture and biochemical tests. Using Epi Info 7 software, we analyzed frequencies. Among 8,136 clinical samples tested, fungal pathogens were isolated from 744 (9%) samples. Of these, the majority were obtained from female (92%), persons aged 16-35 years (68%). Most fungal pathogens (93.7%) were isolated from superficial clinical samples, while 6.3% from deep samples. High-vaginal swabs accounted for 71% of the clinical samples, with most cases from Kampala (32%) and Mbarara (26%) districts. The pathogenic fungal species identified included C. albicans (65.4%), non-albicans Candida spp. (30.6%) and C. neoformans (3.9%). We observed a sharp decline of identified pathogenic fungi from 299 (40%) in 2020-39 (5%) in 2024, reflecting diagnostic disruptions during the COVID-19 pandemic. Candida spp. were the most commonly isolated pathogenic fungi, mainly among females and individuals aged 16-35 years from Kampala and Mbarara districts. There is need for targeted interventions against candidiasis in these groups and locations. This study also highlights the gaps in fungal diagnostic capacity in Uganda, as the national database was limited to Candida and Cryptococcus, emphasizing the need for improved diagnostic infrastructure, capacity-building and surveillance to enhance detection of pathogenic fungi.

Background Cholera is endemic in Uganda with cases reported annually. On July 19, 2023, the Uganda Ministry of Health declared a cholera outbreak in Kayunga District following death of four family members within eight days and confirmation of Vibrio cholerae by culture. We investigated the outbreak to determine the magnitude and its mode of transmission and generate evidence to inform interventions. Methods We defined a suspected case of cholera as onset of acute watery diarrhea in a resident of Kayunga District aged ≥ 2 years during June 24–August 29, 2023. A confirmed case was a suspected case with Vibrio cholerae cultured from stool. We described cases, conducted an environmental assessment and performed an un-matched case-control study in Lusenke Village which was the epicenter of the outbreak. We used logistic regression to identify factors associated with cholera infection. Results We identified 78 case-patients (34 suspected and 44 confirmed); 10 (13%) died. Males were more affected than females (attack rate (AR) = 2.4 vs. 1.6/1,000). Lusenke Village was most affected (AR = 41/1,000). The outbreak began following a funeral of the index case in Kayonjo, an inland village on July 1, 2024. Eleven days later, cases were reported in the distant Lusenke Village. We observed evidence of open defecation, bathing, and washing clothes along the river banks where water for drinking and domestic use was harvested. Using unboiled/untreated river water domestically (Adjusted Odds Ratio (aOR) = 4.5, CI = 1.2–17) increased the odds of cholera infection. Drinking the water in addition to using it domestically further increased the likelihood of cholera infection (aOR = 17, CI = 3.8–78). Conclusion This was likely a propagated outbreak triggered by a funeral of a suspected case whose source of infection was unknown and amplified through contamination of river water used and drank by village members. The outbreak ended within one week after a public health ban on drinking and use of River Nile water, community sensitization and providing prophylactic antibiotics.

Rift Valley fever, endemic or emerging throughout most of Africa, causes considerable risk to human and animal health. We report 7 confirmed Rift Valley fever cases, 1 fatal, in Kiruhura District, Uganda, during 2021. Our findings highlight the importance of continued viral hemorrhagic fever surveillance, despite challenges associated with the COVID-19 pandemic.

Although WHO recommends cotrimoxazole (CTX) discontinuation among HIV patients who have undergone immune recovery and are living in areas of low prevalence of malaria, some countries including Uganda recommend CTX discontinuation despite having a high malaria burden. We estimated the prevalence and factors associated with malaria parasitaemia among adults living with HIV attending hospital outpatient clinic before and after discontinuation of CTX prophylaxis. Between March and April 2019, 599 participants aged 18 years and above, and attending Kitgum hospital HIV clinic in Uganda were enrolled in a cross study. A standardized questionnaire was administered and physical examination conducted. A finger-prick blood sample was collected for identification of malaria parasites by microscopy. The prevalence of parasitaemia was estimated and compared among participants on and those who had discontinued CTX prophylaxis, and factors associated with malaria parasitaemia assessed. Of the enrolled participants, 27 (4.5%) had malaria parasites and 452 (75.5%) had stopped CTX prophylaxis. Prevalence of malaria parasitaemia was significantly higher in participants who had stopped CTX prophylaxis (5.5% versus 1.4% p = 0.03) and increased with increasing duration since the discontinuation of prophylaxis. Compared to participants taking CTX, those who discontinued prophylaxis for 3-5 months and >5 months were more likely to have malaria parasites (adjusted prevalence ratio (aPR) = 1.64, 95% CI 0.37-7.29, p = 0.51, and aPR = 6.06, 95% CI 1.34-27.3, P = 0.02). Low CD4 count (< 250cells/mm3) was also associated with increased risk of having parasites (aPR = 4.31, 95% CI 2.13-8.73, p <0.001). People from malaria endemic settings living with HIV have a higher prevalence of malaria parasitaemia following discontinuation of CTX compared to those still on prophylaxis. The risk increased with increasing duration since discontinuation of the prophylaxis. HIV patients should not discontinue CTX prophylaxis in areas of Uganda where the burden of malaria remains high. Other proven malaria control interventions may also be encouraged in HIV patients following discontinuation of CTX prophylaxis.

Background Early detection of outbreaks requires robust surveillance and reporting at both community and health facility levels. Uganda implements Integrated Disease Surveillance and Response (IDSR) for priority diseases and uses the national District Health Information System (DHIS2) for reporting. However, investigations after the first case in the 2022 Uganda Sudan virus outbreak was confirmed on September 20, 2022 revealed many community deaths among persons with Ebola-like symptoms as far back as August. Most had sought care at private facilities. We explored possible gaps in surveillance that may have resulted in late detection of the Sudan virus disease (SVD) outbreak in Uganda. Methods Using a standardized tool, we evaluated core surveillance capacities at public and private health facilities at the hospital level and below in three sub-counties reporting the earliest SVD cases in the outbreak. Key informant interviews (KIIs) were conducted with 12 purposively-selected participants from the district local government. Focus group discussions (FGDs) were conducted with community members from six villages where early probable SVD cases were identified. KIIs and FGDs focused on experiences with SVD and Viral Hemorrhagic Fever (VHF) surveillance in the district. Thematic data analysis was used for qualitative data. Results Forty-six (85%) of 54 health facilities surveyed were privately-owned, among which 42 (91%) did not report to DHIS2 and 39 (85%) had no health worker trained on IDSR; both metrics were 100% in the eight public facilities. Weak community-based surveillance, poor private facility engagement, low suspicion index for VHF among health workers, inability of facilities to analyze and utilize surveillance data, lack of knowledge about to whom to report, funding constraints for surveillance activities, lack of IDSR training, and lack of all-cause mortality surveillance were identified as gaps potentially contributing to delayed outbreak detection. Conclusion Both systemic and knowledge-related gaps in IDSR surveillance in SVD-affected districts contributed to the delayed detection of the 2022 Uganda SVD outbreak. Targeted interventions to address these gaps in both public and private facilities across Uganda could help avert similar situations in the future.

Background Postpartum family planning (PPFP) is important in reducing the risk of complications associated with closely spaced pregnancies. Family planning (FP) programmes usually promote the use of modern methods rather than traditional methods as the latter have a higher failure rate. However, only 28% of postpartum women in Uganda use modern FP. We identified determinants and barriers of modern FP uptake among postpartum mothers at selected regional referral hospitals (RRH) in Uganda in October 2023. Methods We conducted a cross-sectional study among 499 postpartum mothers aged 18–49 years, and attending immunization clinics in seven selected RRH in October 2023. We defined modern FP uptake as use of a contemporary contraception method: condoms, intrauterine devices (IUD), male or female sterilization, injectables, oral contraceptives and implants. We conducted interviews to collect data on sociodemographic characteristics, reproductive health and obstetric history and modern FP uptake. We summarized participant characteristics using frequency distributions, and identified determinants of uptake using modified Poisson regression. Results Among 499 postpartum mothers, most were aged 25–34 years (45%), unemployed (33%), and had attained secondary education (45%). The majority had heard about modern FP (85%), received counselling regarding PPFP (64%), and were using modern FP methods (46%). Mother being formally employed (aPR = 1.5, 95% CI: 1.1–2.1), having an employed partner (aPR = 4.14, 95% CI: 1.31–13.05), exclusive breastfeeding (aPR = 0.8, 95% CI: 0.65–0.99), receiving counselling on FP (aPR = 2.9, 95% CI: 2.1–4.02) were associated with modern FP uptake. Among 270 mothers who did not take up modern FP, spouse not being around (17%), fear of side effects (13%), and not being decided on method (10%) were the commonest reasons for non-uptake of modern FP. Conclusion Uptake of modern FP among postpartum mothers was suboptimal given that all postpartum mothers should be using FP. Mother being employed, partner employment, exclusive breastfeeding and receiving counselling on FP were associated with uptake of modern FP. Spouse not being around, fear of side effects and not being decided on FP method, were the commonest reasons for non-uptake of modern FP. We recommended intensifying FP counseling services in addition to health education for mothers and their partners on the benefits of using modern FP to improve modern FP uptake among postpartum mothers.

BackgroundOn October 8, 2022, Kampala, the capital city of Uganda, recorded its first Sudan virus disease (SVD) case. We described strategies utilized by Kampala Capital City Authority (KCCA) during SVD outbreak response in Kampala City from October 2022 − January 2023.MethodsWe reviewed daily situation reports submitted by KCCA incident management team to document strategies implemented throughout the SVD response. During SVD After Action Review (AAR), we convened consensus meetings with the Directorate of Public Health and Environment, incident management team, rapid response teams, and representatives from implementing partners. The AAR served as a structured platform for reflection and consensus-building through semi-structured group discussions among stakeholders. Findings were thematically synthesized to identify effective strategies and operational challenges encountered during SVD response in Kampala City.ResultsKCCA established an incident management system to coordinate the SVD response. Daily coordination meetings were held with rapid response teams and implementing partners to address emerging challenges. A centralized call and dispatch center served as the coordination hub for rapid response teams, facilitating timely verification of alerts and response to suspected SVD cases. Case investigation teams established epidemiological linkages among confirmed SVD cases and identified contacts for daily follow up. Designated ambulances were utilized to transport high-risk patients to isolation units, while confirmed cases were referred to Entebbe Ebola Treatment Unit. Infection prevention and control teams provided essential decontamination services and distributed IEC materials to affected health facilities and communities. KCCA also leveraged innovative strategies such as drones to disseminate public health messages, distributed placards with SVD symptoms and preventive measures, and actively engaged business communities, media outlets, and local leaders to enhance public awareness and risk communication.ConclusionKCCA’s response to the 2022 Sudan virus disease outbreak demonstrated effectiveness of leveraging existing coordination structures, adapting surveillance tools, and engaging communities in a complex city setting. The integration of emergency preparedness efforts and contextualized approaches such as mobile phone tracking, closed-circuit television (CCTV) footage, school-based interventions, and drone utilization contributed to timely containment. These strategies demonstrate valuable best practices for strengthening emergency preparedness and response capacities in high-risk urban settings.