Papers by Alex Riolexus Ario
Effect of vector control on malaria incidence in Tororo: a case for focusing surveillance to sub-county levels
Pan African Medical Journal Conference Proceedings, 2018
Tororo is one of the highest malaria transmission districts in Uganda. Universal distribution of ... more Tororo is one of the highest malaria transmission districts in Uganda. Universal distribution of LLINs in 2013 and IRS in 2014 were introduced to control malaria transmission in the district, but their effect on the disease incidence is not known and the district has no documented malaria epidemic detection thresholds. The objectives of the analysis were to describe malaria trend, assess the effect of vector control interventions and to establish a district malaria surveillance thresholds for Tororo district. A descriptive analysis of aggregate surveillance data from 2013 to 2015 from DHIS2. Data were analyzed in Microsoft excel to make weekly, monthly and annual trend graphs of malaria incidence. The number of malaria cases reported included both the laboratory and clinically diagnosed. The percentage of malaria cases in Out Patient Department per year, malaria laboratory test positivity rates and incidence by sub-county were determined. We set the district malaria surveillance threshold using the five week moving mean. Universal distribution of LLINs in 2013 reduced malaria incidence in 2014 by 10%, but did not change the high endemic transmission. A combination of IRS and LLINs caused a greater reduction in malaria incidence from 59/1000 in April 2014 to 28/1000 in April 2015 and reduced the high transmission. Malaria incidence reduction by sub-county was not uniform and needs specific thresholds. Malaria incidence in Tororo has been reducing since introduction of vector control interventions. Malaria incidence varied by sub-county. Heterogeneity of malaria transmission needs sub-county specific surveillance thresholds for early detection of epidemics.
Role of National Public Health Institutes for a Stronger Health System in Africa
Fortune Journal of Health Sciences
Background: Functional National Public Health Institutes (NPHIs) are critical for effective surve... more Background: Functional National Public Health Institutes (NPHIs) are critical for effective surveillance, outbreak detection and response, provision of specialized diagnostic services, research and capacity building to guide health policies and strategies through science and data. Many countries in Africa lack fully functioning NPHIs and remain ill prepared to respond to public health threats with the required speed and agility. Objective: The main objective of this study was to map and generate information on the status of NPHI establishment in Africa, understand the legal frameworks used by the countries to establish NPHIs, and describe the different models of NPHIs on the continent. Methods: A semi-structured questionnaire was administered online by the Africa CDC between 18 July 2021 and 26 May 2022. Data were collated, filtered and analyzed using Microsoft Excel and Arc GIS for mapping of NPHI establishment status by country. Informed consent was obtained from all participating institutions. Result: Of the 55 African Union Member States, 40 (72.7%) responded to the online survey. Among the member states that responded, 12 reported being fully established, 17 indicated that they were at an advanced stage, six (6) had started the process, and five (5) reported not having a plan to develop an NPHI. Among the fully established and advanced-stage NPHIs, 17 (58.6%) are autonomous and semiautonomous, three (10.3%) are a network of institutions, and nine (31%) are structured as departments under the Ministries of Health. The most common functions of the NPHIs are research (26), surveillance and disease intelligence (24), epidemic preparedness and response (24), workforce development (19), public health informatics (15), and health promotion (10). Conclusion: Success in building strong health systems in Africa requires countries to have strong public health institutions. Thus, more efforts are required from the Africa CDC, African Union Member States and development partners to advocate and support the strengthening and establishment of new NPHIs.
Research Square (Research Square), Jul 20, 2023
Fine particulate matter (PM 2.5 ) is among the health damaging air pollutants; levels >15 µg/m 3 ... more Fine particulate matter (PM 2.5 ) is among the health damaging air pollutants; levels >15 µg/m 3 are associated with adverse health effects. We assessed spatio-temporal trends of air quality based on PM 2.5 concentration in Kampala City during January 2020-June 2022. We abstracted PM 2.5 concentrations generated by twenty-four Clarity© Node Solar-Powered monitors from January 1, 2020, to June 30, 2022, from the Clarity© dashboard. We computed 24-hour average PM 2.5 concentrations by combining data from all monitors. Average PM 2.5 concentrations per hour were compared by hour of the day. Seasonal Mann-Kendall statistical test was applied to assess signi cance of observed trends. Overall, the 24-hour average PM 2.5 concentration from January 1, 2020, to June 30, 2022, was 59 µg/m 3 (range: 18-182 µg/m 3 ). A statistically signi cant decline in PM 2.5 occurred throughout the assessment period from January 2020 to June 2022 (r = -0.27, p < 0.001). PM 2.5 increased from April to June each year [2020 (55 µg/m 3 , r=0.56, p=0.006), 2021 (45 µg/m 3 , r=0.26, p=0.030), and 2022 (37 µg/m 3 , r=0.37, p=0.030)] and declined from July to September in 2021 (57 µg/m 3 , r=-0.43, p=0.008) and January to March in 2022 (60 µg/m 3 , r=-0.41, p=0.011). PM 2.5 concentration peaked from 10am-midday (74-73 µg/m 3 ) and 8pm-9pm (73-77 µg/m 3 ). PM 2.5 concentrations exceeded targeted safe levels on all days in Kampala City during 2020-2022.
Loss to follow-up among people living with HIV on tuberculosis preventive treatment at four regional referral hospitals, Uganda, 2019–2021 , 2024
Introduction: Tuberculosis (TB) remains the leading cause of death among people living with HIV (... more Introduction: Tuberculosis (TB) remains the leading cause of death among people living with HIV (PLHIV). TB
preventive treatment (TPT) can prevent active TB infection in PLHIV for several years after it is completed.
During 2019–2021, the six-month course of TPT (using isoniazid) was the most readily available in Uganda;
however, program data indicated a TPT program loss to follow-up (LTFU) rate of 12 % during this period. We
evaluated factors associated with TPT LTFU among PLHIV in four regional referral hospitals (RRHs) in Uganda
from 2019 to 2021.
Methods: We abstracted program data from TPT registers on patient LTFU at Masaka, Mbale, Mubende, and Jinja
RRHs. Additional data collected included client demographics, duration on HIV antiretroviral therapy (ART),
year of TPT initiation, adherence, and point of entry. LTFU was defined as the failure to finish six consecutive
months of isoniazid without stopping for more than two months at a time. We conducted bivariate analysis using
the chi-square test for independence. Variables with p < 0.05 in bivariate analysis were included in a logistic
regression model to establish independent factors associated with LTFU.
Results: Overall, 24,206 clients were started on TPT in the four RRHs. Their median age was 40 years (range,
1–90 years), and 15,962 (66 %) were female. A total of 22,260 (92 %) had TPT adherence >95 %. Independent
factors associated with LTFU included being on ART for <3 months (AOR: 3.1, 95 % CI: 2.1–4.5) and 20–24 years
(AOR: 4.7, 95 % CI: 1.9–12) or 25–29 years (AOR: 3.3, 95 % CI: 1.3–8.2) compared to 15–19 years.
Conclusions: PLHIV just starting ART and young adults had higher odds of being LTFU from TPT during
2019–2021 in the four RRHs. Close follow-up of PLHIV aged 20–29 years and those newly initiated on ART could
improve TPT completion.
Epidemiology Research International, 2014
Objective: Directly observed treatment short course has been implemented as part of the national ... more Objective: Directly observed treatment short course has been implemented as part of the national tuberculosis control program in Ethiopia. The strategy, as evidenced by different studies, has improved the survival and treatment success rate of tuberculosis patients. However, some patients failed to complete their treatments and the factors for this failure were not assessed in the study area. We, therefore sought to identify factors associated with poor treatment outcome of tuberculosis in Debre Tabor, northwest Ethiopia. Results: We included 303 patients (173 males, 130 females) with mean age of 34.9 years in the study and 39 (12.9%) patients were with poor treatment outcome over the period of 5 years (2008-2013). Being male, urban residency, positive and unknown smear result at the 2nd month of treatment and patients in the age of 35-44 years were more likely to have poor treatment outcomes than their counterparts. Patients in the new treatment category were less likely to have poor treatment outcome compared to the retreated cases. Further studies are recommended to explore the association of poor treatment outcome with other important factors which are not investigated by this study.
Research Square (Research Square), Jun 2, 2020
Background: Measles is a highly infectious viral disease. In August 2017, Lyantonde District, Uga... more Background: Measles is a highly infectious viral disease. In August 2017, Lyantonde District, Uganda reported a measles outbreak to Uganda Ministry of Health. We investigated the outbreak to assess the scope, factors facilitating transmission, and recommend control measures. Methods: We de ned a probable case as sudden onset of fever and generalized rash in a resident of Lyantonde, Lwengo, or Rakai Districts from 1 June-30 September 2017, plus ≥1 of the following: coryza, conjunctivitis, or cough. A con rmed case was a probable case with serum positivity of measles-speci c IgM. We conducted a neighborhood-and age-matched case-control study to identi ed exposure factors, and used conditional logistic regression to analyze the data. We estimated vaccine effectiveness and vaccination coverage. Results: We identi ed 81 cases (75 probable, 6 con rmed); 4 patients (4.9%) died. In the case-control study, 47% of case-patients and 2.3% of controls were hospitalized at Lyantonde Hospital pediatric department for non-measles conditions 7-21 days before case-patient's onset (OR adj =34, 95%CI: 5.1-225). Estimated vaccine effectiveness was 95% (95%CI: 75-99%) and vaccination coverage was 76% (95%CI: 68-82%). During the outbreak, an "isolation" ward was established inside the general pediatric ward where there was mixing of both measles and non-measles patients. Conclusions: This outbreak was ampli ed by nosocomial transmission and facilitated by low vaccination coverage. We recommended moving the isolation ward outside of the building, supplemental vaccination, and vaccinating pediatric patients during measles outbreaks.
PLOS global public health, Aug 23, 2022
In April 2019, the District Health Office of Oyam District, Uganda reported an upsurge in malaria... more In April 2019, the District Health Office of Oyam District, Uganda reported an upsurge in malaria cases exceeding expected epidemic thresholds, requiring outbreak response. We investigated the scope of outbreak and identified exposures for transmission to inform control measures. A confirmed case was a positive malaria rapid diagnostic test or malaria microscopy from 1 January-30 June 2019 in a resident or visitor of Acaba Sub-county, Oyam District. We reviewed medical records at health facilities to get case-patients. We conducted entomological and environmental assessments to determine vector density, and identify aquatic Anopheles habitats, conducted a case-control study to determine exposures associated with illness. Of 9,235 case-patients (AR = 33%), females (AR = 38%) were more affected than males (AR = 20%) (p<0.001). Children <18 years were more affected (AR = 37%) than adults (p<0.001). Among 83 case-patients and 83 asymptomatic controls, 65 (78%) case-patients and 33 (40%) controls engaged in activities <500m from a swamp (OR MH = 12, 95%CI 3.6-38); 18 (22%) case-patients and four (5%) controls lived <500m from rice irrigation sites (OR MH = 8.2, 95%CI 1.8-36); and 23 (28%) case-patients and four (5%) controls had water pools <100m from household for 3-5 days after rainfall (OR MH = 7.3, 95%CI 2.2-25). Twenty three (28%) case-patients and four (5%) controls did not sleep under bed nets the previous night (OR MH = 20, 95%CI 2.7-149); 68 (82%) case-patients and 43(52%) controls did not wear long-sleeved clothes during evenings (OR MH = 9.3, 95% CI 2.8-31). Indoor resting vector density was 4.7 female mosquitoes/household/night. All Anopheles aquatic habitats had Anopheles larvae. Weekly rainfall in 2019 was heavier (6.0 ±7.2mm) than same period in 2018 (1.8±1.8mm) (p = 0.006). This outbreak was facilitated by Anopheles aquatic habitats near homes created by human activities, following increased rainfall compounded by inadequate use of individual preventive measures. We recommended awareness on use of insecticide-treated bed nets, protective clothing, and avoiding creation of Anopheles aquatic habitats.
Research Square (Research Square), Oct 6, 2020
Background: In March 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. Many... more Background: In March 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. Many countries in Sub Saharan Africa, Uganda inclusive, implemented lockdowns, curfew, banning of both private and public transport systems and mass gatherings to minimize spread. Media reports indicated that cases of violence and discrimination had increased in Uganda's communities following the lockdown. We estimated the incidence and factors associated with experiencing violence and discrimination among Ugandans during the COVID-19 lockdown to inform control and prevention measures. Methods: In April 2020, we conducted a cross-sectional study under the International Citizen Project (ICP) to assess adherence to public health measures and their impact on the COVID-19 outbreak in Uganda. We abstracted and analyzed data on violence and discrimination from the ICP study. We performed descriptive statistics for all the participants' characteristics and created a binary outcome variable called experiencing violence and/or discrimination. We performed logistic regression analysis to identify the factors associated with experiencing violence and discrimination. Results: Of the 1,726 ICP study participants, 1,051 (58.8%) were males, 841 (48.7%) were currently living with a spouse or partner, and 376 (21.8%) had physically attended work for more than 3 days in the past week. Overall, 145 (8.4%) experienced any form of violence and/or discrimination by any perpetrator, and 46 (31.7%) of the 145 reported that it was perpetrated by a law enforcement o cer. Factors associated
Uploads
Papers by Alex Riolexus Ario
preventive treatment (TPT) can prevent active TB infection in PLHIV for several years after it is completed.
During 2019–2021, the six-month course of TPT (using isoniazid) was the most readily available in Uganda;
however, program data indicated a TPT program loss to follow-up (LTFU) rate of 12 % during this period. We
evaluated factors associated with TPT LTFU among PLHIV in four regional referral hospitals (RRHs) in Uganda
from 2019 to 2021.
Methods: We abstracted program data from TPT registers on patient LTFU at Masaka, Mbale, Mubende, and Jinja
RRHs. Additional data collected included client demographics, duration on HIV antiretroviral therapy (ART),
year of TPT initiation, adherence, and point of entry. LTFU was defined as the failure to finish six consecutive
months of isoniazid without stopping for more than two months at a time. We conducted bivariate analysis using
the chi-square test for independence. Variables with p < 0.05 in bivariate analysis were included in a logistic
regression model to establish independent factors associated with LTFU.
Results: Overall, 24,206 clients were started on TPT in the four RRHs. Their median age was 40 years (range,
1–90 years), and 15,962 (66 %) were female. A total of 22,260 (92 %) had TPT adherence >95 %. Independent
factors associated with LTFU included being on ART for <3 months (AOR: 3.1, 95 % CI: 2.1–4.5) and 20–24 years
(AOR: 4.7, 95 % CI: 1.9–12) or 25–29 years (AOR: 3.3, 95 % CI: 1.3–8.2) compared to 15–19 years.
Conclusions: PLHIV just starting ART and young adults had higher odds of being LTFU from TPT during
2019–2021 in the four RRHs. Close follow-up of PLHIV aged 20–29 years and those newly initiated on ART could
improve TPT completion.