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. 2024 Jul 30;24(1):754.
doi: 10.1186/s12879-024-09659-5.

Understanding the delay in identifying Sudan Virus Disease: gaps in integrated disease surveillance and response and community-based surveillance to detect viral hemorrhagic fever outbreaks in Uganda, September 2022

Jane Frances Zalwango  1 , Helen Nelly Naiga  2 , Edirisa Juniour Nsubuga  2 , Rebecca Akunzirwe  2 , Remmy Buhuguru  3 , Marie Gorreti Zalwango  2 , Brenda N Simbwa  2 , Saudah Namubiru Kizito  2 , Peter Chris Kawungezi  2 , Brian Agaba  2 , Mercy Wendy Wanyana  2 , Zainah Kabami  2 , Mackline Ninsiima  2 , Robert Zavuga  2 , Patrick King  2 , Thomas Kiggundu  2 , Hildah Tendo Nansikombi  2 , Doreen N Gonahasa  2 , Irene Byakatonda Kyamwine  2 , Lilian Bulage  2 , Benon Kwesiga  2 , Daniel Kadobera  2 , Richard Migisha  2 , Alex Riolexus Ario  2 , Julie R Harris  4
Affiliations

Understanding the delay in identifying Sudan Virus Disease: gaps in integrated disease surveillance and response and community-based surveillance to detect viral hemorrhagic fever outbreaks in Uganda, September 2022

Jane Frances Zalwango et al. BMC Infect Dis. .

Abstract

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.

Keywords: Ebola; Sudan Virus Disease; Surveillance; Uganda; Viral hemorrhagic fever.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Map of Uganda showing location of Mubende District and sub-counties from which the first SVD confirmed and probable cases were reported. Kiruma sub-county was carved out of Butoloogo sub-county
Fig. 2
Fig. 2
The surveillance structure at district level in Uganda
See this image and copyright information in PMC

References

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    1. World Health Organization. Uganda’s Disease Surveillance System Proves to be Effective in Detecting and Follow up Ebola Contacts Suspected Cases. 2019.
    1. Fall IS, et al. Integrated Disease Surveillance and Response (IDSR) strategy: current status, challenges and perspectives for the future in Africa. BMJ Global Health. 2019;4(4):e001427. - PMC - PubMed
    1. Uganda Ministry of Health. National Technical Guidelines for Integrated Disease Surveillance and Response, Third Edition. Kampala; 2021. p. iii.
    1. Byrne E, Sæbø JI. Routine use of DHIS2 data: a scoping review. BMC Health Serv Res. 2022;22(1):1234. - PMC - PubMed

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