Publications by authors named "Julie R Harris"

Background: Seasonal malaria chemoprevention (SMC) refers to monthly administration of full treatment courses of anti-malarial medicine to children <5 years during high malaria transmission seasons. SMC has demonstrated effectiveness in Sahel and sub-Sahel countries in Africa. However, it was not implemented in Uganda until April 2021, when the country began SMC in the highly malaria-endemic Kotido and Moroto Districts.

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Ebola disease survivors often experience stigma in multiple forms, including felt (perceived) stigma, enacted (action-based) stigma, and institutional stigma. On September 20, 2022, Uganda declared a Sudan Virus Disease (species orthoebolavirus sudanense) outbreak after a patient with confirmed Sudan virus (SUDV) infection was identified in Mubende District. The outbreak led to 142 confirmed and 22 probable cases over the next two months.

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Background: In September 2022, Uganda experienced an outbreak of Sudan virus disease (SVD), mainly in central Uganda. As a result of enhanced surveillance activities for Ebola disease, samples from several patients with suspected viral hemorrhagic fever (VHF) were sent to the VHF Program at Uganda Virus Research Institute (UVRI), Entebbe, Uganda, and identified with infections caused by other viral etiologies. Herein, we report the epidemiologic and laboratory findings of Crimean-Congo hemorrhagic fever (CCHF) cases that were detected during the SVD outbreak response.

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Article Synopsis
  • Uganda faced a Sudan Virus Disease outbreak starting September 2022, spreading to multiple districts and prompting a study on community beliefs that contributed to its spread.
  • A qualitative study in February 2023 involved focus groups and interviews, revealing that local beliefs often attributed deaths to witchcraft or poisoning, leading patients to seek traditional healing before formal medical care.
  • The analysis indicated that cultural practices, such as hiding patients and unsafe burial customs, facilitated transmission, suggesting that integrating traditional healers and religious leaders into public health strategies could enhance control measures.
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Background: Uganda has had seven Ebola disease outbreaks, between 2000 and 2022. On Sept 20, 2022, the Ministry of Health declared a Sudan virus disease outbreak in Mubende District, Central Uganda. We describe the epidemiological characteristics and transmission dynamics.

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  • Uganda's Integrated Disease Surveillance and Response (IDSR) system aims for early outbreak detection, but the Sudan virus outbreak in 2022 highlighted gaps in community and health facility reporting.* -
  • A study evaluated surveillance capacities in public and private health facilities, revealing that 85% of surveyed private facilities failed to report to the national system, and many lacked trained staff.* -
  • Identified gaps included weak community surveillance, poor engagement of private facilities, low awareness of Viral Hemorrhagic Fever, and insufficient funding and training for effective reporting.*
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  • Uganda's yellow fever (YF) surveillance system monitored outbreaks from 2017-2022 at seven high-risk sites, assessing attributes like timeliness and data completeness.
  • A total of 3,073 suspected and 15 confirmed YF cases were reported, with significant delays in case confirmation noted (37 days median lag) and varying completeness (76% external, 65% internal).
  • Stakeholders found the system simple and acceptable, contributing to detecting 71% of previous outbreak cases and guiding vaccination efforts, but issues with delays and incomplete data limited its overall efficacy.
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Introduction: on March 21, 2020, the first case of COVID-19 was confirmed in Uganda. A total lockdown was initiated on March 30 which was gradually lifted May 5-June 30. On March 25, a toll-free call center was organized at the Kampala Capital City Authority to respond to public concerns about COVID-19 and the lockdown.

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Background: In 2022, an Ebola disease outbreak caused by Sudan virus (SUDV) occurred in Uganda, primarily affecting Mubende and Kassanda districts. We determined risk factors for SUDV infection among household members (HHM) of cases.

Methods: We conducted a case-control and retrospective cohort study in January 2023.

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Background: Individuals living in communities with poor access to healthcare may be unaware of their high blood pressure (BP). While the use of community health workers (CHWs) can address gaps in human resources for health, CHWs in Uganda have not been used previously for BP screening and management. We report the results of an initiative to train CHWs to evaluate BP and to administer group-based education in Kalangala and Buvuma Island Districts of Lake Victoria, Uganda.

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Background: On 20 September 2022, Uganda declared its fifth Sudan virus disease (SVD) outbreak, culminating in 142 confirmed and 22 probable cases. The reproductive rate (R) of this outbreak was 1.25.

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  • Uganda's Ministry of Health introduced point-of-care HIV testing for early infant diagnosis (EID) to improve the speed of test result returns and access to antiretroviral therapy (ART) for HIV-exposed infants (HEI).* -
  • The study analyzed EID data from 10 health facilities, comparing the time to sample collection, results receipt, and ART initiation before and after the rollout of point-of-care testing from 2018 to 2021.* -
  • Results showed significant improvements in turnaround times for receiving results and starting ART, with 33% of HIV-positive infants starting treatment on the same day during point-of-care testing compared to only 4% before.*
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  • Early isolation of Ebola patients at Treatment Units is crucial to control outbreaks, and a study was conducted to assess the timing of ETU entry during the 2022 Sudan virus disease outbreak in Uganda.
  • Among 118 confirmed cases, delays in ETU entry were significant, with 43% experiencing long delays of six days or more, particularly those whose symptoms started later in the outbreak.
  • Factors such as awareness of symptoms and contact status helped improve early care-seeking, while fear of the ETUs and transportation issues were common reasons for delayed isolation.
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Background: Contact tracing (CT) is critical for ebolavirus outbreak response. Ideally, all new cases after the index case should be previously-known contacts (PKC) before their onset, and spend minimal time ill in the community. We assessed the impact of CT during the 2022 Sudan Virus Disease (SVD) outbreak in Uganda.

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Article Synopsis
  • - HIV infection negatively impacts maternal health, leading to higher risks of death and complications during childbirth, with the study showing an increased maternal mortality ratio (MMR) for HIV-positive women compared to those who are HIV-negative.
  • - The "Saving Mothers, Giving Life" initiative managed to lower maternal and neonatal mortality rates in Uganda during its implementation, with data from 116,066 births revealing that while HIV-positive women experienced more severe risks, antiretroviral drug (ARV) use significantly improved outcomes.
  • - Non-use of ARVs among HIV-positive women drastically raised the chances of maternal and perinatal death, highlighting the importance of antiretroviral treatment in improving health outcomes for mothers and their infants.
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Background: Malaria outbreaks are detected by applying the World Health Organization (WHO)-recommended thresholds (the less sensitive 75th percentile or mean + 2 standard deviations [2SD] for medium-to high-transmission areas, and the more sensitive cumulative sum [C-SUM] method for low and very low-transmission areas). During 2022, > 50% of districts in Uganda were in an epidemic mode according to the 75th percentile method used, resulting in a need to restrict national response to districts with the highest rates of complicated malaria. The three threshold approaches were evaluated to compare their outbreak-signaling outputs and help identify prioritization approaches and method appropriateness across Uganda.

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  • Rift Valley Fever (RVF) is a serious viral illness affecting both humans and livestock, characterized by high mortality and severe symptoms; the outbreak was highlighted by a confirmed human case in Uganda in December 2020.
  • The investigation involved defining suspect and confirmed cases through symptoms and testing methodologies (RT-PCR for humans and ELISA for livestock) to monitor the situation and gather data on exposure risks.
  • Results indicated that while the index case consumed raw cow milk and had a positive connection to the virus, most herdsmen and surrounding individuals remained asymptomatic; however, potential contact with infected animal fluids raised concerns about broader transmission.
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Ebola disease (EBOD) is a public health threat with a high case fatality rate. Most EBOD outbreaks have occurred in remote locations, but the 2013-2016 Western Africa outbreak demonstrated how devastating EBOD can be when it reaches an urban population. Here, the 2022 Sudan virus disease (SVD) outbreak in Mubende District, Uganda, is summarized, and the genetic relatedness of the new variant is evaluated.

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  • A study in Western Uganda assessed the impact of community dialogue meetings led by local leaders on COVID-19 vaccine perceptions among participants.
  • Results showed a significant increase in leaders' COVID-19 risk perception and a decrease in concerns about the vaccine after the meetings.
  • Participants also reported a greater belief in the benefits and accessibility of the COVID-19 vaccine, reflecting a positive shift in attitude toward vaccination.
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  • The COVID-19 pandemic highlighted the weaknesses in healthcare facility readiness, particularly in Uganda during the first and second waves of cases in 2020 and 2021.
  • A study evaluated the readiness of 17 referral hospitals and 71 lower-level facilities in Uganda by assessing their management capabilities, resource availability, and preparedness for surges in COVID-19 cases.
  • Results showed that overall readiness was low, with a median score of 39% across all facilities; referral hospitals had a better score (63%), but most lower-level facilities were poorly equipped, lacking critical supplies like medicines and oxygen.
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Background: High blood pressure (HBP), including hypertension (HTN), is a predictor of cardiovascular events, and is an emerging challenge in young persons. The risk of cardiovascular events may be further amplified among people living with HIV (PLHIV). We determined the prevalence of HBP and associated factors among PLHIV aged 13 to 25 years in Rwenzori region, western Uganda.

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Uganda has implemented several interventions that have contributed to prevention, early detection, and effective response to Public Health Emergencies (PHEs). However, there are gaps in collecting and documenting data on the overall response to these PHEs. We set out to establish a comprehensive electronic database of PHEs that occurred in Uganda since 2000.

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Fumonisin exposure is common in populations where maize is a dietary staple, such as in Guatemala, and has been associated with negative health outcomes including neural tube defects. The objective of this study was to estimate fumonisin B1 (FB1) exposure among Guatemalan reproductive-age women and develop a better understanding of the dietary and sociodemographic risk factors for exposure. A cross-sectional study in 18 municipalities in Guatemala was conducted.

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