Background The COVID-19 pandemic overwhelmed the capacity of health facilities globally, emphasiz... more Background The COVID-19 pandemic overwhelmed the capacity of health facilities globally, emphasizing the need for readiness to respond to rapid increases in cases. The first wave of COVID-19 in Uganda peaked in late 2020 and demonstrated challenges with facility readiness to manage cases. The second wave began in May 2021. In June 2021, we assessed the readiness of health facilities in Uganda to manage the second wave of COVID-19. Methods Referral hospitals managed severe COVID-19 patients, while lower-level health facilities screened, isolated, and managed mild cases. We assessed 17 of 20 referral hospitals in Uganda and 71 of 3,107 lower-level health facilities, selected using multistage sampling. We interviewed health facility heads in person about case management, coordination and communication and reporting, and preparation for the surge of COVID-19 during first and the start of the second waves of COVID-19, inspected COVID-19 treatment units (CTUs) and other service delivery p...
Background: Uganda conducted its third mass Long-Lasting Insecticide-treated Net (LLIN) distribut... more Background: Uganda conducted its third mass Long-Lasting Insecticide-treated Net (LLIN) distribution campaign in 2021. The target of the campaign was to ensure that 100% of households own at least 1 LLIN per 2 persons and to achieve 85% use of distributed LLINs. We assessed LLIN ownership, use, and associated factors 3 months after the campaign.Methods: We conducted a cross-sectional household survey in 14 districts during April 13-30, 2021. We selected households using multistage sampling. We asked about LLIN ownership, use, duration since received until the time of interview, and visually verified the presence of LLINs. Outcomes were having at least one LLIN per 2 household members, and individual LLIN use. We used modified Poisson regression to assess associations between exposures and outcomes.Results: In total, 5,529 households with 27,585 residents and 15,426 LLINs were included in the analysis. Overall, 95% of households owned ≥1 LLIN, 92% of the households owned ≥1 LLIN <...
BackgroundCivil wars in the Great Lakes region resulted in massive displacement of people to neig... more BackgroundCivil wars in the Great Lakes region resulted in massive displacement of people to neighboring countries including Uganda, with associated humanitarian emergencies. Appropriate disease surveillance enables timely detection and response to outbreaks. We describe evaluation of the public health surveillance system in refugee settlements in Uganda and document lessons learnt.MethodsWe conducted a cross-sectional survey using the US CDC Updated Guidelines for Evaluating Public Health Surveillance Systems in four refugee settlements in Uganda i.e., Bidibidi, Adjumani, Kiryandongo and Rhino Camp. Using semi-structured questionnaires, key informant and focus group discussion guides, we interviewed health facility in-charges, key personnel and village health teams from 4 districts, 53 health facilities and 112 villages.ResultsAll health facilities assessed had key surveillance staff; 60% were trained on IDSR and most village health teams were trained on disease surveillance. Case ...
Background Compared to the general population in Uganda, fishing communities suffer greater burde... more Background Compared to the general population in Uganda, fishing communities suffer greater burden of HIV/AIDS. We determined the level of comprehensive knowledge on HIV prevention and its associated factors among fishing communities of Lake Kyoga. Methods We conducted secondary analysis of data from the Lake Kyoga Behavioral Survey, a population-based sample survey on behavioral risk factors for HIV, syphilis, and schistosomiasis among adults in fishing communities of Lake Kyoga in 2013. We defined comprehensive knowledge as having correct knowledge on HIV prevention (consistent condom use, faithfulness, a healthy-looking person can have HIV, and HIV cannot be transmitted through food-sharing, witchcraft or handshake). We used logistic regression to determined potential factors associated with comprehensive knowledge on HIV prevention and control for confounding. Results Of 1780 persons in the sample, 51% (911/1780) were females. The mean age was 32 (range: 15–97) years. Overall, 5...
On 20 June 2015, a cholera outbreak affecting more than 30 people was reported in a fishing villa... more On 20 June 2015, a cholera outbreak affecting more than 30 people was reported in a fishing village, Katwe, in Kasese District, south-western Uganda. We investigated this outbreak to identify the mode of transmission and to recommend control measures. We defined a suspected case as onset of acute watery diarrhoea between 1 June and 15 July 2015 in a resident of Katwe village; a confirmed case was a suspected case with Vibrio cholerae cultured from stool. For case finding, we reviewed medical records and actively searched for cases in the community. In a case-control investigation we compared exposure histories of 32 suspected case-persons and 128 age-matched controls. We also conducted an environmental assessment on how the exposures had occurred. We found 61 suspected cases (attack rate = 4.9/1000) during this outbreak, of which eight were confirmed. The primary case-person had onset on 16 June; afterwards cases sharply increased, peaked on 19 June, and rapidly declined afterwards....
ABSTRACT Rotavirus is consistently shown to be the leading cause of severe diarrhorea in children... more ABSTRACT Rotavirus is consistently shown to be the leading cause of severe diarrhorea in children worldwide. It is estimated to cause death of more than 2.5million young children annually, and approximately 85% of these deaths occur in developing countries in South Asia and sub-Saharan Africa. However, as many studies have concentrated in children under 5 years, there is limited information on the role of rotavirus infection in acute diarrhorea in HIV-1 immune-suppressed cases. We designed this study to investigate the prevalence and associated factors of Rotavirus infection in HIV/AIDS immune-suppressed children and adults at an urban AIDS treatment center. We collected 122 stool samples from consented HIV-1 infected patients presenting with non-bloody acute diarrhorea. Rotavirus genetic material Ribonucleic acid (RNA) was extracted from the viral genome region showing maximum sequence conservation and detection was done using immunochromatographic assay. Rotavirus prevalence was investigated using frequency tabulations and its association with each of the factors was analyzed using the Fisher&#39;s exact and chi-square statistical tests. Out of 122 samples investigated, 72 (59.0%) were from children and 50 (41.0%) from adults. Overall, 39(32.0%) samples were positive for Rotavirus infection. The prevalence in the HIV infected children 26 (21.3%) and that in HIV infected adults 13 (10.7 %) did not significantly differ chi-square p=0.239. The factors found to be associated with rotavirus infection are water source, p=0.002, duration of diarhorea, p=0.001, and history of vomiting, p=0.001. In HIV-1 immune-suppression, Rotavirus infection was found to be prevalent in both children and adults. Based on the findings, screening for rotavirus could be considered in HIV-infections particularly in cases where samples are negative for other common enteric pathogens. However, due to the smaller size of the study we recommend that a larger and well controlled study be conducted to generate stronger evidence.
The American journal of tropical medicine and hygiene, 2006
Knowledge of the baseline malaria transmission in a given environment is important to guide malar... more Knowledge of the baseline malaria transmission in a given environment is important to guide malaria control interventions. However, in Uganda, recent information on malaria transmission intensity is lacking. Therefore, a 1-year entomological study was conducted in seven ecologically different sites throughout the country to assess spatial and temporal patterns in malaria transmission intensity. Anopheles gambiae sensu stricto was the main vector in five of the seven study sites, and An. funestus was the most important vector in the two other sites. In a peri-urban village, An. arabiensis contributed substantially to malaria transmission. Clear differences in annual entomological inoculation rates (AEIR) were observed between the study sites, ranging from 4 infective bites per person per year in the southwestern part of the country to >1,500 infective bites per person per year in a swampy area near the Nile River. Between villages with parasite prevalences of >or= 80% in childr...
The American journal of tropical medicine and hygiene, 2007
Malaria transmission intensity has been proposed, based on theoretical models, as an important fa... more Malaria transmission intensity has been proposed, based on theoretical models, as an important factor for the spread of falciparum-resistant malaria, but the predictions obtained vary according to the assumptions inherent in the model used. We summarized the available field data on transmission intensity and the prevalence of malaria drug resistance. Resistance to chloroquine and sulphadoxine-pyrimethamine monotherapy was invariably higher where transmission was intense. Vector control interventions were associated with a better chloroquine and sulfadoxine-pyrimethamine efficacy. However, high resistance to chloroquine and also to combination therapy (chloroquine plus sulphadoxine-pyrimethamine and amodiaquine plus sulfadoxine-pyrimethamine) was also observed in very low transmission areas. Reducing transmission intensity is likely to slow the spread of drug resistance. Nevertheless, where transmission is extremely low, to limit the unnecessary use of antimalarials and a consequent ...
Background The COVID-19 pandemic overwhelmed the capacity of health facilities globally, emphasiz... more Background The COVID-19 pandemic overwhelmed the capacity of health facilities globally, emphasizing the need for readiness to respond to rapid increases in cases. The first wave of COVID-19 in Uganda peaked in late 2020 and demonstrated challenges with facility readiness to manage cases. The second wave began in May 2021. In June 2021, we assessed the readiness of health facilities in Uganda to manage the second wave of COVID-19. Methods Referral hospitals managed severe COVID-19 patients, while lower-level health facilities screened, isolated, and managed mild cases. We assessed 17 of 20 referral hospitals in Uganda and 71 of 3,107 lower-level health facilities, selected using multistage sampling. We interviewed health facility heads in person about case management, coordination and communication and reporting, and preparation for the surge of COVID-19 during first and the start of the second waves of COVID-19, inspected COVID-19 treatment units (CTUs) and other service delivery p...
Background: Uganda conducted its third mass Long-Lasting Insecticide-treated Net (LLIN) distribut... more Background: Uganda conducted its third mass Long-Lasting Insecticide-treated Net (LLIN) distribution campaign in 2021. The target of the campaign was to ensure that 100% of households own at least 1 LLIN per 2 persons and to achieve 85% use of distributed LLINs. We assessed LLIN ownership, use, and associated factors 3 months after the campaign.Methods: We conducted a cross-sectional household survey in 14 districts during April 13-30, 2021. We selected households using multistage sampling. We asked about LLIN ownership, use, duration since received until the time of interview, and visually verified the presence of LLINs. Outcomes were having at least one LLIN per 2 household members, and individual LLIN use. We used modified Poisson regression to assess associations between exposures and outcomes.Results: In total, 5,529 households with 27,585 residents and 15,426 LLINs were included in the analysis. Overall, 95% of households owned ≥1 LLIN, 92% of the households owned ≥1 LLIN <...
BackgroundCivil wars in the Great Lakes region resulted in massive displacement of people to neig... more BackgroundCivil wars in the Great Lakes region resulted in massive displacement of people to neighboring countries including Uganda, with associated humanitarian emergencies. Appropriate disease surveillance enables timely detection and response to outbreaks. We describe evaluation of the public health surveillance system in refugee settlements in Uganda and document lessons learnt.MethodsWe conducted a cross-sectional survey using the US CDC Updated Guidelines for Evaluating Public Health Surveillance Systems in four refugee settlements in Uganda i.e., Bidibidi, Adjumani, Kiryandongo and Rhino Camp. Using semi-structured questionnaires, key informant and focus group discussion guides, we interviewed health facility in-charges, key personnel and village health teams from 4 districts, 53 health facilities and 112 villages.ResultsAll health facilities assessed had key surveillance staff; 60% were trained on IDSR and most village health teams were trained on disease surveillance. Case ...
Background Compared to the general population in Uganda, fishing communities suffer greater burde... more Background Compared to the general population in Uganda, fishing communities suffer greater burden of HIV/AIDS. We determined the level of comprehensive knowledge on HIV prevention and its associated factors among fishing communities of Lake Kyoga. Methods We conducted secondary analysis of data from the Lake Kyoga Behavioral Survey, a population-based sample survey on behavioral risk factors for HIV, syphilis, and schistosomiasis among adults in fishing communities of Lake Kyoga in 2013. We defined comprehensive knowledge as having correct knowledge on HIV prevention (consistent condom use, faithfulness, a healthy-looking person can have HIV, and HIV cannot be transmitted through food-sharing, witchcraft or handshake). We used logistic regression to determined potential factors associated with comprehensive knowledge on HIV prevention and control for confounding. Results Of 1780 persons in the sample, 51% (911/1780) were females. The mean age was 32 (range: 15–97) years. Overall, 5...
On 20 June 2015, a cholera outbreak affecting more than 30 people was reported in a fishing villa... more On 20 June 2015, a cholera outbreak affecting more than 30 people was reported in a fishing village, Katwe, in Kasese District, south-western Uganda. We investigated this outbreak to identify the mode of transmission and to recommend control measures. We defined a suspected case as onset of acute watery diarrhoea between 1 June and 15 July 2015 in a resident of Katwe village; a confirmed case was a suspected case with Vibrio cholerae cultured from stool. For case finding, we reviewed medical records and actively searched for cases in the community. In a case-control investigation we compared exposure histories of 32 suspected case-persons and 128 age-matched controls. We also conducted an environmental assessment on how the exposures had occurred. We found 61 suspected cases (attack rate = 4.9/1000) during this outbreak, of which eight were confirmed. The primary case-person had onset on 16 June; afterwards cases sharply increased, peaked on 19 June, and rapidly declined afterwards....
ABSTRACT Rotavirus is consistently shown to be the leading cause of severe diarrhorea in children... more ABSTRACT Rotavirus is consistently shown to be the leading cause of severe diarrhorea in children worldwide. It is estimated to cause death of more than 2.5million young children annually, and approximately 85% of these deaths occur in developing countries in South Asia and sub-Saharan Africa. However, as many studies have concentrated in children under 5 years, there is limited information on the role of rotavirus infection in acute diarrhorea in HIV-1 immune-suppressed cases. We designed this study to investigate the prevalence and associated factors of Rotavirus infection in HIV/AIDS immune-suppressed children and adults at an urban AIDS treatment center. We collected 122 stool samples from consented HIV-1 infected patients presenting with non-bloody acute diarrhorea. Rotavirus genetic material Ribonucleic acid (RNA) was extracted from the viral genome region showing maximum sequence conservation and detection was done using immunochromatographic assay. Rotavirus prevalence was investigated using frequency tabulations and its association with each of the factors was analyzed using the Fisher&#39;s exact and chi-square statistical tests. Out of 122 samples investigated, 72 (59.0%) were from children and 50 (41.0%) from adults. Overall, 39(32.0%) samples were positive for Rotavirus infection. The prevalence in the HIV infected children 26 (21.3%) and that in HIV infected adults 13 (10.7 %) did not significantly differ chi-square p=0.239. The factors found to be associated with rotavirus infection are water source, p=0.002, duration of diarhorea, p=0.001, and history of vomiting, p=0.001. In HIV-1 immune-suppression, Rotavirus infection was found to be prevalent in both children and adults. Based on the findings, screening for rotavirus could be considered in HIV-infections particularly in cases where samples are negative for other common enteric pathogens. However, due to the smaller size of the study we recommend that a larger and well controlled study be conducted to generate stronger evidence.
The American journal of tropical medicine and hygiene, 2006
Knowledge of the baseline malaria transmission in a given environment is important to guide malar... more Knowledge of the baseline malaria transmission in a given environment is important to guide malaria control interventions. However, in Uganda, recent information on malaria transmission intensity is lacking. Therefore, a 1-year entomological study was conducted in seven ecologically different sites throughout the country to assess spatial and temporal patterns in malaria transmission intensity. Anopheles gambiae sensu stricto was the main vector in five of the seven study sites, and An. funestus was the most important vector in the two other sites. In a peri-urban village, An. arabiensis contributed substantially to malaria transmission. Clear differences in annual entomological inoculation rates (AEIR) were observed between the study sites, ranging from 4 infective bites per person per year in the southwestern part of the country to >1,500 infective bites per person per year in a swampy area near the Nile River. Between villages with parasite prevalences of >or= 80% in childr...
The American journal of tropical medicine and hygiene, 2007
Malaria transmission intensity has been proposed, based on theoretical models, as an important fa... more Malaria transmission intensity has been proposed, based on theoretical models, as an important factor for the spread of falciparum-resistant malaria, but the predictions obtained vary according to the assumptions inherent in the model used. We summarized the available field data on transmission intensity and the prevalence of malaria drug resistance. Resistance to chloroquine and sulphadoxine-pyrimethamine monotherapy was invariably higher where transmission was intense. Vector control interventions were associated with a better chloroquine and sulfadoxine-pyrimethamine efficacy. However, high resistance to chloroquine and also to combination therapy (chloroquine plus sulphadoxine-pyrimethamine and amodiaquine plus sulfadoxine-pyrimethamine) was also observed in very low transmission areas. Reducing transmission intensity is likely to slow the spread of drug resistance. Nevertheless, where transmission is extremely low, to limit the unnecessary use of antimalarials and a consequent ...
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Papers by Paul Okello