Uganda’s ministry of health declared today the end of the country’s recent Ebola outbreak, which started on September 20, 2022 and affected nine districts. In total, 142 people were confirmed to have the disease, including 87 people who recovered and 55 people who died. The Case Fatality Rate (CFR) among confirmed cases was 39 percent.
During this Ebola outbreak—the country’s seventh—Doctors Without Borders/Médecins Sans Frontières (MSF) provided support to the ministry of health to help reduce deaths through direct patient care, as well as prevent further spread through community outreach projects and contact tracing. In total, MSF had 330 Ugandan and 74 international staff responding in five districts: Mubende, Kassanda, Kampala, Masaka, and Jinja.
The outbreak can be declared over because 42 days have now passed without any confirmed Ebola patients in the country—a number that corresponds with twice the incubation period of the virus. No new confirmed cases have been reported since November 17, 2022, and the last four patients were discharged on November 30, 2022.
Caring for people with Ebola
Over the course of the outbreak, MSF provided and supported the clinical care of 107 people with Ebola and 1,125 people suspected to have the disease in two Ebola Treatment Centers (ETC) that the organization built in the city of Mubende—the initial epicenter of the outbreak—and the Ugandan capital of Kampala. MSF also assisted in the treatment of 11 confirmed Ebola patients and 91 people suspected to have the disease at the country’s Mulago National Isolation Center. Overall, 83 percent of people who contracted Ebola during this outbreak were treated in MSF-supported facilities.
In addition to these facilities where MSF provided direct care, the organization led and financed the construction of six ETCs and Ebola Treatment Units (ETU) to help facilitate a decentralized approach that ensured people could be diagnosed and cared for earlier and closer to their homes. One 48-bed ETC and another 39-bed ETC were constructed in Mubende, two 8-bed treatment units were constructed next to existing health care centers in Madudu and Bweyongedde, a 40-bed ETC was constructed in Kassanda, and a 32-bed, semi-permanent ETC was built in Kampala next to the Mulago National Referral Hospital.
In addition to physical care, MSF provided mental health support during the outbreak. In Mubende and Kassanda, 319 patients benefitted from mental health care and psychosocial support. MSF is both helping people who had Ebola reintegrate into their communities, as well as providing support for the survivors’ follow-up program.
In addition to Ebola care, MSF supported the continuity of non-Ebola care in 17 health facilities in Uganda as it is common for other illnesses to be neglected during outbreaks.
Working with the community
MSF’s health education teams reached 15,568 people in Mubende and Kassanda during community meetings on Ebola symptoms, proper hygiene, when and how to seek care, and stigmatization related to the disease. MSF teams also interacted with 19,530 people in schools, trading centers, markets, churches, and mosques as part of mass gathering sensitizations to inform people about Ebola and protective measures. In addition, 891 people were contacted in and around health facilities. When a new confirmed case was identified, MSF teams also educated people within the communities of high-risk contacts—reaching 7,778 more people that way.
In Kampala, MSF conducted 4,666 door-to-door sessions, which educated more than 22,000 people. Additionally, seven community meetings were organized with local stakeholders.
MSF also donated items like medical supplies, drugs, infection prevention and control (IPC) supplies, and water, sanitation, and hygiene (WASH) materials in all of the districts where MSF was present, as well as offered IPC and WASH trainings to the staff working in the ETCs. MSF carried out IPC donations and trainings in 212 health facilities in Mubende and Kassanda and in eight schools. Seven health facilities in Maska and Jinja’s neighboring districts of Kamuli and Luuka were provided a comprehensive package of IPC support from MSF, which included set up of entry screening points, set up of holding areas for suspect cases, active case finding among admitted patients, medical and hygiene material donations, and medical and WASH training.
Prevention practices like these were critical during this outbreak as there were no approved vaccines or treatments for this particular strain of Ebola, the Sudan strain.
Providing epidemiological support
Throughout the Ebola outbreak, MSF participated in case investigation and contact tracing. The teams were also involved in several aspects of information research and innovation such as data collection, monitoring, and evaluation. The data tools and the data collection system and sharing will be one of the subjects of in-depth work with the ministry of health—even in the post-epidemic period—to ensure better preparation for future public health responses.
MSF also supported laboratories in Mubende through biochemistry and equipment donations, as well as in Kassanda through the construction of a lab space in the ETC there.
Preparing for future outbreaks
Following this outbreak, MSF remains committed to building the capacity of Ugandan emergency response teams to ensure strong preparedness and skills for future response efforts. To accomplish this, MSF is working with the ministry of health to determine how best to collaborate, especially in regards to training and capacity building of Ugandan staff at the new ETC training facility in Kampala. This will better prepare health staff for future viral hemorrhagic fever outbreaks like Ebola. From December 20 to 23, 2022, MSF trained a team of 45 heath workers and hygienists from the ministry of health on how to operate an ETC.