Bwindi Community Hospital was founded in 2003 by Scott and Carol Kellermann. It began as an outreach clinic under a tree, and has grown into a 112-bed hospital providing health care and health education services to a population of over 100,000 people in Uganda. The hospital began with a special mission to help the Batwa pygmies who were displaced from the Bwindi Impenetrable Forest after it was made a National Park in 1991. Since leaving the forest many Batwa have lived in extreme poverty and are affected by the health issues that poverty brings.While the hospital was started particularly to provide health care to the Twa, it quickly found itself treating all people living in the area. The hospital serves the population in 3 sub-counties of Kayonza, Mpungu and Kanyantorogo in Kanungu District.There are few other decent health services in this extremely remote area and people sometimes walk for more than a day to get to the hospital. Its status was upgraded from health centre to hospital in 2008 after a new operating theater was built.
BACKGROUND:Anthrax is a recurrent zoonosis in Uganda, with 11 outbreaks reported in 2024. On September 17, 2024, the Ministry of Health received reports of two human deaths in Kanungu District, later confirmed as anthrax-the district's first recorded outbreak. We investigated to determine its scope, risk factors, and recommend control measures. METHODS:We defined a suspected cutaneous anthrax case as an acute onset of skin lesions (papule, vesicle, or eschar) with ≥2 of itching, reddening, lymphadenopathy, fever, or malaise. Suspected gastrointestinal anthrax was onset of abdominal pain with ≥2 of vomiting, diarrhea, fever, or loss of appetite in a Kanungu resident from June-November 2024. Confirmation required Polymerase Chain Reaction (PCR) detection of Bacillus anthracis. In a 1:2 unmatched case-control study, we enrolled all cases and controls from neighboring asymptomatic households in the two most affected sub-counties. Logistic regression was used to identify risk factors for infection. RESULTS:We identified 90 cases (86 suspected and 4 confirmed); 80% had cutaneous, 11% gastrointestinal, and 9% both forms. Males were more affected (attack rate [AR]=48/100,000) than females (AR = 15/100,000); case fatality rate was 6.7% (6/90). Overall, 10/27 sub-counties were affected, with Bugongi (AR = 257/100,000) being the most affected. Consuming meat from suddenly dead livestock (adjusted odds ratio [aOR]=5.5, 95% CI: 2.7-11), handling carcasses (aOR=8.2, 95% CI: 3.8-18), having a low education level (aOR=6.0, 95% CI: 2.6-14), and being male (aOR=2.3, 95%CI = 1.03-4.9) increased the odds of infection. Notably, 90% of the case-patients purchased the contaminated meat from a single dealer. CONCLUSION:The outbreak was linked to consuming and handling meat from livestock that died suddenly, underscoring gaps in veterinary inspection and carcass management. Strengthening inspections, enforcing carcass disposal, and targeted community education are essential for prevention.
Background Anthrax is a recurrent zoonosis in Uganda, with 11 outbreaks reported in 2024. On September 17, 2024, the Ministry of Health received reports of two human deaths in Kanungu District, which were subsequently confirmed as anthrax, marking the district’s first recorded outbreak. We investigated to determine the scope of the outbreak, identify risk factors, and recommend evidence-based control and prevention measures. Methods We defined a suspected cutaneous anthrax case as an acute onset of skin lesions (papule, vesicle, or eschar) with ≥ 2 of skin itching, reddening, lymphadenopathy, fever, or malaise. Suspected gastrointestinal anthrax was the onset of abdominal pain with ≥ 2 of vomiting, diarrhea, fever, or loss of appetite in a resident of Kanungu District, from June 1 to November 4, 2024. Confirmation required PCR detection of Bacillus anthracis. For the case–control study (1:2 unmatched), we enrolled all confirmed and suspected cases, and selected controls from neighbouring households in the two most affected sub-counties, who remained asymptomatic during the same period. Logistic regression was used to identify risk factors for infection. Results We identified 90 cases (86 suspected and 4 confirmed); 80% had cutaneous anthrax, 11% had gastrointestinal anthrax, and 9% had both forms. Males were more affected (attack rate [AR] = 48/100,000) than females (AR = 15/100,000). The case fatality rate was 6.7% (6/90). Overall, 10/27 sub-counties were affected, with Bugongi (AR = 257/100,000) and Katete (AR = 224/100,000) being the most affected. Consuming meat from suddenly dead animals (adjusted odds ratio [aOR] = 5.8, 95% CI: 2.7–12.0), handling their carcasses (aOR = 9.3, 95% CI: 2.5–15.0), and having only primary or no formal education (aOR = 6.2, 95% CI: 2.5–15.0) significantly increased odds of anthrax. Notably, 90% of the case-patients reported buying meat from a single butcher who sourced animals that died suddenly. Conclusion This anthrax outbreak resulted from the consumption and handling of meat from livestock that died suddenly, underscoring gaps in veterinary inspection and carcass management. To prevent future similar outbreaks, we recommend instituting mandatory pre-slaughter veterinary inspections, enforcing hygienic carcass disposal practices, and implementing targeted community education on the risks associated with handling or consuming meat from animals of unknown cause of death. Clinical trial number: Not applicable
Background/Aims Despite the relative ease of prevention, the incidence of cervical cancer in Uganda is increasing and there is low uptake of screening services. One of the main contributing factors to low uptake is a lack of awareness. Targeting this barrier may help increase uptake and reduce the burden of cervical cancer. This study evaluated the effect of an educational intervention on knowledge, perception, intent to use and use of cervical cancer screening among women in rural southwestern Uganda. Methods This pre-test, post-test study was conducted with 150 women from a village in southwest Uganda, selected for its low uptake of cervical screening services. The home-based educational intervention consisted of a lecture and a discussion on cervical cancer and screening services. Data on women's knowledge, perceptions and use of screening services were captured at baseline and 7 weeks after the intervention, using a questionnaire. Chi-squared tests and paired sample t-tests were used to assess differences in participants' knowledge, perception and use of screening services. Results At baseline, participants had low scores for awareness, attitude and use of cervical screening. The intervention significantly improved knowledge (P<0.001), perception (P<0.001) and screening rate (P<0.001). Some participants' unwillingness to screen after the intervention was associated with marital status or religion. Conclusions The home-based health education intervention was effective in improving knowledge and perception of cervical cancer, and use of screening services. Use of this education intervention in rural regions of Uganda could be an effective strategy to increase use of screening services and thus improve early detection and prevention of cervical cancer.
Background Mental, neurological, and substance-use disorders cause medium to long term disability in all countries. They are amenable to treatment but often treatment is only available in hospitals, as few staff feel competent to give treatment. The WHO developed the “Mental Health GAP” (mhGAP) course to train non-specialist clinical staff in basic diagnosis and treatment. At Bwindi Community Hospital, in south-west Uganda, mental health care was initially only provided at the hospital. It was extended outside the hospital in two implementation phases, initially by establishing 17 clinics in the community, run by qualified mental health staff from the hospital. In the second implementation phase staff in 12 health centers were trained using mhGAP and ran their own clinics under supervision. Methods Using routine data the defined data variables for the individuals attending the clinics was extracted. Results A total of 2,617 people attended a mental health care clinic in the study period between January 2016 and March 2020. Of these 1,051 people attended more than once. The number of patients attending clinics increased from 288 during the baseline to 693 in the first implementation phase then to 839 patients in the second implementation phase. After mhGAP training, about 30% of patients were seen locally by mhGAP trained healthcare personnel. The average number of mental health patients seen each month increased from 12 to 65 over the time of the study. The number of patients living >20 km from the hospital increased from 69 in the baseline to 693 in the second implementation phase. The proportion of patients seen at the hospital clinic dropped from 100% to 27%. Conclusions Providing mental health care in the community at a distance from the hospital substantially increased the number of people accessing mental health care. Training health center-based staff in mhGAP contributed to this. Not all patients could appropriately be managed by non-specialist clinical staff, who only had the five-day training in mhGAP. Supplies of basic medicines were not always adequate, which probably contributed to patients being lost to follow-up. About 50% of patients only attend the clinic once. Further work is required to understand the reasons.
Background: There is a paucity of literature on the effectiveness of drama or documentary films in changing knowledge, beliefs, attitudes, and behavior of people towards family planning. This study aimed to compare and assess the acceptability of health promotion films based on documentary or drama, and their effect on knowledge, attitudes, and intention to use family planning. Methods: We developed short documentary and drama films about contraceptive implants, using the person-based approach. Their acceptability was assessed in focus group discussions with younger women below 23 years, women over 23 years, men of reproductive age, and health workers in four different areas of Uganda (Bwindi/Kanungu, Walukuba/Jinja, Kampala, and Mbarara). Transcripts of the focus group discussions were analyzed using thematic analysis, to generate themes and examine the key issues. We assessed changes in knowledge, attitudes, and intentions to use family planning after watching the films. Results: Sixteen focus groups with 150 participants were carried out. Participants said that the documentary improved their knowledge and addressed their fears about side effects, myths, and implant insertion. The drama improved their attitudes towards the implant and encouraged them to discuss family planning with their partner. The final versions of the documentary and the drama films were equally liked. Conclusions: Viewing a short documentary on the contraceptive implant led to positive changes in knowledge, while a short drama improved attitudes and intentions to discuss the implant with their partner. The drama and documentary have complementary features, and most participants wanted to see both.
