A Cross-Cutting Approach to Surveillance and Laboratory Capacity as a Platform to Improve Health Security in Uganda

Mohammed Lamorde¹, Arthur Mpimbaza², Richard Walwema³, Moses Kamya⁴, James Kapisi⁵, Henry Kajumbula⁶, Asadu Sserwanga⁷, Jane Frances Namuganga⁸, Abel Kusemererwa⁹, Hannington Tasimwa¹⁰, Issa Makumbi¹¹, John Kayiwa¹², Julius Lutwama¹³, Prosper Behumbiize¹⁴, Abner Tagoola¹⁵, Jane Frances Nanteza¹⁶, Gilbert Aniku¹⁷, Meklit Workneh¹⁸, Yukari Manabe¹⁹, Jeff N Borchert²⁰, Vance Brown²¹, Grace D Appiah²², Eric D Mintz²³, Jaco Homsy²⁴, George S Odongo²⁵, Raymond L Ransom²⁶, Molly M Freeman²⁷, Robyn A Stoddard²⁸, Renee Galloway²⁹, Matthew Mikoleit³⁰, Cecilia Kato³¹, Ronald Rosenberg³², Eric C Mossel³³, Paul S Mead³⁴, Kiersten J Kugeler³⁵

Affiliations

¹ Mohammed Lamorde, PhD, FRCP, is Head of the Department of Prevention, Care and Treatment, Infectious Diseases Institute, Kampala, Uganda. Co-senior author.
² Arthur Mpimbaza, MBChB, MMed, MSc, is Project Coordinator, Infectious Diseases Research Collaboration, Kampala, and Lecturer, Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala. Co-senior author.
³ Richard Walwema, MBA, is with the Infectious Diseases Institute, Kampala.
⁴ Moses Kamya, MBChB, MMed, MPH, PhD, is Professor and Chair, Makerere University School of Medicine, Kampala. Dr. Kamya is also with the Infectious Diseases Research Collaboration, Kampala.
⁵ James Kapisi, MBChB, MMed, MSc Epid, Infectious Diseases Research Collaboration, Kampala.
⁶ Henry Kajumbula, MBChB, MMed, Department of Medical Microbiology, Makerere University School of Medicine, Kampala.
⁷ Asadu Sserwanga, MBChB, MPH, Infectious Diseases Research Collaboration, Kampala.
⁸ Jane Frances Namuganga, MPH, Infectious Diseases Research Collaboration, Kampala.
⁹ Abel Kusemererwa, Infectious Diseases Research Collaboration, Kampala.
¹⁰ Hannington Tasimwa, Department of Medical Microbiology, Makerere University School of Medicine, Kampala.
¹¹ Issa Makumbi, MBChB, is with the Uganda Ministry of Health Public Health Emergency Operations Centre, Kampala.
¹² John Kayiwa, Uganda Virus Research Institute, Entebbe, Wakiso, Uganda.
¹³ Julius Lutwama, PhD, Uganda Virus Research Institute, Entebbe, Wakiso, Uganda.
¹⁴ Prosper Behumbiize is with the Health Information Systems Program, Kampala.
¹⁵ Abner Tagoola, MBChB, MMed, MSc, is with the Jinja Regional Referral Hospital Republic of Uganda Ministry of Health, Jinja, Uganda.
¹⁶ Jane Frances Nanteza, MBChB, MMed, is with the Mubende Regional Referral Hospital, Republic of Uganda Ministry of Health, Mubende, Uganda.
¹⁷ Gilbert Aniku, MBChB, MMed, is with Arua Regional Referral Hospital, Republic of Uganda Ministry of Health, Arua, Uganda.
¹⁸ Meklit Workneh, MD, MPH, is a Medical Microbiology Fellow, Johns Hopkins School of Medicine, Baltimore, Maryland.
¹⁹ Yukari Manabe, MD, is Associate Director of Global Health Research and Innovation, Johns Hopkins School of Medicine, Baltimore, Maryland.
²⁰ Jeff N. Borchert, MS, is a Public Health Analyst, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado.
²¹ Vance Brown, MA, is Deputy Program Director, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala, Uganda.
²² Grace D. Appiah, MD, MS, is a Medical Epidemiologist, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
²³ Eric D. Mintz, MD, MPH, is a Medical Epidemiologist, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
²⁴ Jaco Homsy, MD, MPH, is Program Director, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala, Uganda.
²⁵ George S. Odongo, MPH, is a Public Health Informatics Fellow, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia.
²⁶ Raymond L. Ransom is Associate Director for Informatics, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia.
²⁷ Molly M. Freeman, PhD, is a Microbiologist, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
²⁸ Robyn A. Stoddard, DVM, PhD, Microbiologists, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
²⁹ Renee Galloway, MLS, MPH, Microbiologists, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
³⁰ Matthew Mikoleit, MS, is a Microbiologist, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia.
³¹ Cecilia Kato, PhD, is a Biologist, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia .
³² Ronald Rosenberg, ScD, is Associate Director for Science, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado.
³³ Eric C. Mossel, PhD, is a Microbiologist, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado.
³⁴ Paul S. Mead, MD, MPH, is a Medical Officer, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado.
³⁵ Kiersten Kugeler, PhD, MPH, is an Epidemiologist, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO.

PMID: 30480504
PMCID: PMC11898800
DOI: 10.1089/hs.2018.0051

A Cross-Cutting Approach to Surveillance and Laboratory Capacity as a Platform to Improve Health Security in Uganda

Mohammed Lamorde et al. Health Secur. 2018 Fall.

. 2018 Fall;16(S1):S76-S86.

doi: 10.1089/hs.2018.0051.

Authors

Affiliations

¹ Mohammed Lamorde, PhD, FRCP, is Head of the Department of Prevention, Care and Treatment, Infectious Diseases Institute, Kampala, Uganda. Co-senior author.
² Arthur Mpimbaza, MBChB, MMed, MSc, is Project Coordinator, Infectious Diseases Research Collaboration, Kampala, and Lecturer, Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala. Co-senior author.
³ Richard Walwema, MBA, is with the Infectious Diseases Institute, Kampala.
⁴ Moses Kamya, MBChB, MMed, MPH, PhD, is Professor and Chair, Makerere University School of Medicine, Kampala. Dr. Kamya is also with the Infectious Diseases Research Collaboration, Kampala.
⁵ James Kapisi, MBChB, MMed, MSc Epid, Infectious Diseases Research Collaboration, Kampala.
⁶ Henry Kajumbula, MBChB, MMed, Department of Medical Microbiology, Makerere University School of Medicine, Kampala.
⁷ Asadu Sserwanga, MBChB, MPH, Infectious Diseases Research Collaboration, Kampala.
⁸ Jane Frances Namuganga, MPH, Infectious Diseases Research Collaboration, Kampala.
⁹ Abel Kusemererwa, Infectious Diseases Research Collaboration, Kampala.
¹⁰ Hannington Tasimwa, Department of Medical Microbiology, Makerere University School of Medicine, Kampala.
¹¹ Issa Makumbi, MBChB, is with the Uganda Ministry of Health Public Health Emergency Operations Centre, Kampala.
¹² John Kayiwa, Uganda Virus Research Institute, Entebbe, Wakiso, Uganda.
¹³ Julius Lutwama, PhD, Uganda Virus Research Institute, Entebbe, Wakiso, Uganda.
¹⁴ Prosper Behumbiize is with the Health Information Systems Program, Kampala.
¹⁵ Abner Tagoola, MBChB, MMed, MSc, is with the Jinja Regional Referral Hospital Republic of Uganda Ministry of Health, Jinja, Uganda.
¹⁶ Jane Frances Nanteza, MBChB, MMed, is with the Mubende Regional Referral Hospital, Republic of Uganda Ministry of Health, Mubende, Uganda.
¹⁷ Gilbert Aniku, MBChB, MMed, is with Arua Regional Referral Hospital, Republic of Uganda Ministry of Health, Arua, Uganda.
¹⁸ Meklit Workneh, MD, MPH, is a Medical Microbiology Fellow, Johns Hopkins School of Medicine, Baltimore, Maryland.
¹⁹ Yukari Manabe, MD, is Associate Director of Global Health Research and Innovation, Johns Hopkins School of Medicine, Baltimore, Maryland.
²⁰ Jeff N. Borchert, MS, is a Public Health Analyst, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado.
²¹ Vance Brown, MA, is Deputy Program Director, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala, Uganda.
²² Grace D. Appiah, MD, MS, is a Medical Epidemiologist, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
²³ Eric D. Mintz, MD, MPH, is a Medical Epidemiologist, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
²⁴ Jaco Homsy, MD, MPH, is Program Director, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala, Uganda.
²⁵ George S. Odongo, MPH, is a Public Health Informatics Fellow, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia.
²⁶ Raymond L. Ransom is Associate Director for Informatics, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia.
²⁷ Molly M. Freeman, PhD, is a Microbiologist, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
²⁸ Robyn A. Stoddard, DVM, PhD, Microbiologists, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
²⁹ Renee Galloway, MLS, MPH, Microbiologists, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
³⁰ Matthew Mikoleit, MS, is a Microbiologist, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia.
³¹ Cecilia Kato, PhD, is a Biologist, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia .
³² Ronald Rosenberg, ScD, is Associate Director for Science, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado.
³³ Eric C. Mossel, PhD, is a Microbiologist, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado.
³⁴ Paul S. Mead, MD, MPH, is a Medical Officer, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado.
³⁵ Kiersten Kugeler, PhD, MPH, is an Epidemiologist, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO.

PMID: 30480504
PMCID: PMC11898800
DOI: 10.1089/hs.2018.0051

Abstract

Global health security depends on effective surveillance for infectious diseases. In Uganda, resources are inadequate to support collection and reporting of data necessary for an effective and responsive surveillance system. We used a cross-cutting approach to improve surveillance and laboratory capacity in Uganda by leveraging an existing pediatric inpatient malaria sentinel surveillance system to collect data on expanded causes of illness, facilitate development of real-time surveillance, and provide data on antimicrobial resistance. Capacity for blood culture collection was established, along with options for serologic testing for select zoonotic conditions, including arboviral infection, brucellosis, and leptospirosis. Detailed demographic, clinical, and laboratory data for all admissions were captured through a web-based system accessible at participating hospitals, laboratories, and the Uganda Public Health Emergency Operations Center. Between July 2016 and December 2017, the expanded system was activated in pediatric wards of 6 regional government hospitals. During that time, patient data were collected from 30,500 pediatric admissions, half of whom were febrile but lacked evidence of malaria. More than 5,000 blood cultures were performed; 4% yielded bacterial pathogens, and another 4% yielded likely contaminants. Several WHO antimicrobial resistance priority pathogens were identified, some with multidrug-resistant phenotypes, including Acinetobacter spp., Citrobacter spp., Escherichia coli, Staphylococcus aureus, and typhoidal and nontyphoidal Salmonella spp. Leptospirosis and arboviral infections (alphaviruses and flaviviruses) were documented. The lessons learned and early results from the development of this multisectoral surveillance system provide the knowledge, infrastructure, and workforce capacity to serve as a foundation to enhance the capacity to detect, report, and rapidly respond to wide-ranging public health concerns in Uganda.

Keywords: Global health security; Surveillance; Uganda.

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Figures

**Figure 1.**
Geographic location of 6 sentinel site hospitals engaged in case-based surveillance and laboratory capacity-building efforts in Uganda

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References

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A Cross-Cutting Approach to Surveillance and Laboratory Capacity as a Platform to Improve Health Security in Uganda

Affiliations

A Cross-Cutting Approach to Surveillance and Laboratory Capacity as a Platform to Improve Health Security in Uganda

Authors

Affiliations

Abstract

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous