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Review
. 2022 Sep 6:43:10.
doi: 10.11604/pamj.2022.43.10.33598. eCollection 2022.

Investigation of a COVID-19 outbreak at a regional prison, Northern Uganda, September 2020

Richard Migisha  1 , Job Morukileng  1 , Claire Biribawa  1 , Daniel Kadobera  1 , James Kisambu  2 , Lilian Bulage  1 , Alex Ndyabakira  1 , Elizabeth Katana  1 , Lisa A Mills  3 , Alex Riolexus Ario  1   4 , Julie R Harris  3   5
Affiliations
Review

Investigation of a COVID-19 outbreak at a regional prison, Northern Uganda, September 2020

Richard Migisha et al. Pan Afr Med J. .

Abstract

Despite implementing measures to prevent introduction of COVID-19 in prisons, a COVID-19 outbreak occurred at Moroto Prison, northern Uganda in September 2020. We investigated factors associated with the introduction and spread of COVID-19 in the prison. A case was PCR-confirmed SARS-CoV-2 infection in a prisoner/staff at Moroto Prison during August-September 2020. We reviewed prison medical records to identify case-patients and interviewed prison and hospital staff to understand possible infection mechanisms for the index case-patient and opportunities for spread. In a retrospective cohort study, we interviewed all prisoners and available staff to identify risk factors. Data were analyzed using log-binomial regression. On September 1, 2020, a recently-hospitalized prisoner with unrecognized SARS-CoV-2 infection was admitted to Moroto Prison quarantine. He had become infected while sharing a hospital ward with a subsequently-diagnosed COVID-19 patient. A sample taken from the hospitalized prisoner on August 20 tested positive on September 3. Mass reactive testing at the prison on September 6, 14, and 15 revealed infection among 202/692 prisoners and 8/90 staff (overall attack rate=27%). One prison staff and one prisoner who cared for the sick prisoner while at the hospital re-entered the main prison without quarantining. Both tested positive on September 6. Food and cleaning service providers also regularly transited between quarantine and unrestricted prison areas. Using facemasks >50% of the time (adjusted risk ratio [aRR]=0.26; 95%CI: 0.13-0.54), or in combination with handwashing after touching surfaces (aRR=0.25; 95%CI: 0.14-0.46) were protective. Prisoners recently transferred from other facilities to Moroto Prison had an increased risk of infection (aRR=1.50; 95%CI: 1.02-2.22). COVID-19 was likely introduced into Moroto Prison quarantine by a prisoner with hospital-acquired infection and delayed test results, and/or by caretakers who were not quarantined after hospital exposures. The outbreak may have amplified via shared food/cleaning service providers who transited between quarantined and non-quarantined prisoners. Facemasks and handwashing were protective. Reduced test turnaround time for the hospitalized prisoner could have averted this outbreak. Testing incoming prisoners for SARS-CoV-2 before quarantine, providing unrestricted soap/water for handwashing, and universal facemask use in prisons could mitigate risk of future outbreaks.

Keywords: COVID-19; SARS-CoV-2; Uganda; disease outbreaks; prison.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
timeline of events in Moroto Prison and Moroto Regional Referral Hospital (MRRH) in Uganda during August-September 2020
Figure 2
Figure 2
flow diagram for the inclusion and exclusion of prisoners and staff of Moroto Prison into the retrospective cohort study analysis, Moroto Prison COVID-19 outbreak, September 2020
Figure 3
Figure 3
SARS-CoV-2 infection among prisoners and staff, Moroto Prison, Uganda, by date of symptom onset during September 2020 (n=130)
Figure 4
Figure 4
diagram of the setup of Moroto Prison, Uganda, as of September 2020; ward refers to a prison unit that acts as a dormitory
See this image and copyright information in PMC

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