Surveillance and response: Integrated indigenous health systems-based sentinel detection of human plague in a plague endemic West Nile region of Uganda (2008-2013)

Abstract

Background: Bacterial plague, caused by Yersinia pestis, is a zoonotic disease predominantly rodent flea-borne. Approximately 2000 suspected cases of plague were reported from the plague endemic West Nile region of Uganda through the past decade. Case mortality rates were high due to delays in seeking appropriate medical treatment. Community health workers (CHWs), private for profit (PFP) clinics and drug-shops provide immediate alternative source of health care to those suffering from illness. Besides, an estimated 40-60% of the study population seeks the service of traditional healers (THs). This study piloted an innovative one heath tailored community-based surveillance aimed at enabling the indigenous health care providers to recognize primary symptoms of plague among their clients and refer suspects to the nearest health center (HC); and to determine the number of patients referred by the participating THs, the proportion that actually arrive in the HCs, and the diagnostic outcome of referred patients. Methods & Materials: Participating THs were provided with easy to use patient referral kits whilst the catchment HCs received rapid diagnostic tests (RDT) for on-spot detection of Y. pestis F1 antigen. Samples that tested positive by RDT at the HCs or negative but presented with clinical signs suggestive of Y. pestis infection were re-subjected to serial testing by RDTs direct fluorescent assay (DFA), bacterial culture and serology. Results: Out of 562 patients referred to HCs by THs, 1 patient (0.18%) was confirmed with Y. pestis infection whilst a significant proportion tested positive to other febrile infections such as malaria (51.0%), pneumonia (18.9%), tuberculosis (4.3%) and others (25.8%). We summerized in table below human plague incidance and case mortality (2008-2012) in the study area.Tabled 1YearConfirmedNo. of deaths due to Y. pestis20085825200921201011201122201296 Open table in a new tab Conclusion: Although the proportion of referred patients confirmed with Y. pestis is minimal, it's clearly evident that the involving THs has saved many lives from several illnesses. The integration of CHWs, clinics and drug-shops increased sensitivity of the surveillance system. Such community-based surveillance one health models that innovatively integrate indigenous health systems and scientific research are likely to have significant impact on mitigating public health crises in report settings.