Think of Uganda Private HealthCare Providers as Partners

Grace Kiwanuka Ssali, the Executive Director of Uganda Healthcare Federation (UHF) an umbrella body for private health providers wants Uganda private healthcare providers to be treated as a partners and not profit centres. 

But this will require a mindset shift perception by the public, development partners and the government. 

Speaking to Health Journalists Network members during a boot camp held in Kampala,  Kiwanuka Ssali,  said the private health sector providers need more support from development partners and the government. 

"I know that development partners say we are putting money into government and supporting Private-not-for-profits (PNFPS) but it is not as easy as saying ... I am going to support these three people the rest of you will figure it out," Kiwanuka told HEJNU journalists. 

"We need to shift the perception about the private sector health providers to be partners and not profit centres." 

Kiwanuka said the private sector health providers are waiting for the government to allow them to officially offer COVID-19 vaccination services. 

Right now the a pilot project to do this was started in Kampala, because it a unique district in terms of healthcare - 98 percent of the healthcare facilities are privately owned. 

The Uganda private health providers resolved to dialogue with the government and have the Ministry of Health (MOH) draft a policy that’s now in very early stages to allow private health providers officially offer COVID-19 vaccination when it became practically impossible to do it on their own.

At the height of the pandemic, Kiwanuka says members of the Federation went directly to COVID-19 vaccine manufacturers with proposals but they needed up to US$500,000 to make the smallest acceptable import order because companies were prioritizing the COVAX facility. The providers couldn’t afford this. 

While a number of private facilities are now offering vaccine services, according to the federation, these are being offered in a pilot mode. The accredited facilities went through a tight verification process where they gave priority to those that had been engaging in routine immunization prior to the pandemic and those that had the equipment and expressed capacity to arrest the adverse reactions from the vaccine in a timely manner case they happen.

Noteworthy, MOH had early last year drafted guidelines for private pharmacies and importers of pharmaceutical products to start dealing in vaccines, a move that was immediately shot down by critics including public health experts who expressed worries about fakes infiltrating the market.

Now, Kiwanuka says over the last two years, they have been in back and forth meetings with the policymakers to ensure that they are engaged early to participate in health emergencies. 

For her, it’s now clear that government cannot handle it on its own with lessons taken from COVID-19 interventions where they were overwhelmed when private hospitals started filling with critical COVID-19 patients and yet they were not involved in the preparations.

Because of this, she says all the solutions so far reached with the government on vaccine provision so far are not feasible for private providers. For instance, MOH had allowed them to use the National Medical Stores (NMS) to manage the vaccines logistics for them.

 

Insecurity heightens spread of Tuberculosis in Karamoja region

 A bad cough that lasts 3 weeks or longer, pain in the chest, coughing up blood or sputum (phlegm from deep inside the lungs) are some of the symptoms of Tuberculosis. 

In Napak district, Karamoja region coughing loudly and persistently without stopping resulted in a bullet shot for a TB patient and death. 

Now, patients suffering from Tuberculosis in Karamoja, one of the high burden regions with a TB prevalence rate ten times higher than the national average, are scared and want to run away from their villages due to insecurity and their TB treatment is being interrupted. 

The Karamoja region is also home to the U.S. government's Accelerated Control of TB in Karamoja program or PACT Karamoja supported by the United States Agency for International Development (USAID) launched 2018. 

USAID's PACT Karamoja program is a $7.5 million agreement (2020-2025) that aims to address the Karamoja Region’s high TB prevalence and low treatment success rates by supporting locally generated solutions to mobilize health facilities, village health teams, and community members for accelerated screening, testing, identification, and successful treatment and prevention of TB.

Paul Losiru was in his hut sleeping at night and he started coughing because he is a TB patient but on medication. Outside the “Manyatta” were he resided cattle rustlers were passing by and they heard him coughing persistently. 

They ordered him to get out of his house because his coughing and the noise irritated the warriors and alerted the security.

‘’I had them saying that each time we pass by your home, you are seriously coughing, it’s like you are cursing us or if not you are signalling to the security that we are around. This is intolorable. I immediately heard gunshots,’’ Daniel Kedi his neighbour narrated.  

This is terrible because the Karamoja region in North Eastern Uganda is one of the high burden regions with a TB prevalence rate ten times higher than the national average. The treatment success rate in the Karamoja region was below 50% until an emergency response was declared in 2019. 

TB is the world's deadliest infectious disease, infecting about 10 million people and killing 1.5 million globally each year. Uganda is among the 30 high burden TB and HIV countries in the world. 

As dangerous as TB is, it is treatable and curable but in Uganda TB disease still causes illness in about 90,000 Ugandans annually including 1,500 people who get infected with drug-resistant TB. And in Uganda, about 15,600 people died from TB in Uganda in 2019.

In 2019, of the estimated 1,500 drug-resistant TB (DR-TB) cases, only 559 were diagnosed and notified to the National TB and Leprosy Program (NTLP) 

After killing Losiru, the warriors picked his phone and they used it to call the relatives inquiring about the mood of people since the incident happened. Now TB patients in Karamoja are scared of what will happen to them too. 

Maria Nakoru, a TB patient and a resident of Iriiri trading center, says coughing is a must for TB patients and there’s nothing they can do to stop it. They are turning to God for protection.

Its not only the warriors that are scaring TB patients in Karamoja but patients are also grappling with a food crisis and yet the medicines require them to feed well. She fears that if insecurity is not addressed in the region, time will come when they will be slaughtered like chicken. 

Losiru and Nakoru both live in Napak district, which records a high number of Tuberculosis cases ranging between 500 and 600 annually. 

James Lemukol the district Health Officer Napak says that the TB patients are now traumatized because the insecurity is affecting their treatment cycle. Lemukol said when patients fail to follow the treatment series, they are at increased risks of morbidity, drug resistance, transmission and mortality.

However, without security even with the USAID Accelerated Control of TB project home based in the district, the prevalence will increase and success rate will continue to decline. 

An Integrated approach of cervical cancer and Schistosomiasis treatment and care present opportunities towards elimination

By Esther Nakkazi

Initiating an integrated approach for cervical cancer and Female Genital Schistosomiasis (FGS) for affected women and girls presents an opportunity towards the World Health Organization (WHO) elimination target over the next decade.

The WHO targets to eliminate transmission of cervical cancer by 2030 and its policy brief on deworming adolescent girls and women of reproductive age aims to control schistosomiasis in the same time frame. 

Dr Tedros Adhanom Ghebreyesus, Director-General, WHO, has stated that “FGS is a silent and neglected epidemic, affecting the same people who carry a disproportionate global burden of HIV and cervical cancer”.

Now, scientists say there is an increased probability to achieve the WHO target by 2030 if an integrated approach for FGS and cervical cancer into routine sexual and reproductive health care services where affected women and girls most likely seek prevention, treatment and care is implemented.

“We want to support, develop and implement worldwide evidence based initiatives to improve on three spheres; first HPV and cervical cancer prevention. 

Secondly, FGS diagnosis and patient information and thirdly, quality of treatment which has to be tailored to the needs through research and policy initiatives,” says Eyrun Flörecke Kjetland a professor at Oslo University Hospital.

Scientists led by Dr Julie Jacobson, a global health leader who serves as Managing Partner for the global health non-profit Bridges to Development published in January in the Nature Reproductive Health Journal  says the skills necessary for FGS management is a critical step to prepare for proper diagnosis and treatment of women and girls in sub-Saharan Africa by trained health professionals. 

The suggested competencies can now serve as the foundation to create educative tools and curricula to better train health care workers on the prevention, diagnosis, and management of FGS, says the research.

Kjetland says right now there is an enormous thrust in the cervical cancer community to push forward to eliminate it is an opportunity for FGS to piggyback as the little sister in the system on a disease (FGS) that is life threatening with less much less funding, much less push. “It’s an excellent opportunity to try to wedge our way in and join with the big systems program.”

FGS is a chronic disease caused by parasitic worms, schistosomes, transmitted by contact with infested fresh water. An estimated 56 million women may have FGS in Africa, but almost none are diagnosed or treated. 

FGS like cervical cancer can be life threatening and life altering. They are both dangerous conditions for sexual reproductive health in endemic areas. They both cause physical pain and discomfort to women who also have to contend with stigma and isolation.

FGS as a common gynaecological lesion could be confused to be cancer or an STI. “When we looked at the implications of FGS on HPV and HIV, we found an association between the high risk of HPV which causes cancer and the FGS lesions,” says Kjetland.

“To me the most dangerous situation would be that you are misdiagnosing something as cervical cancer when it is genital schistosomiasis, removing parts of the cervix, unnecessarily creating problems for the women, fertility wise and vice versa as well,” says Kjetland.

As the overlap of the incidence of cervical cancer and the prevalence of schistosomiasis presents itself in Africa, coupling the two diseases using an integrated approach through opportunities in screening, early treatment and awareness creation would maximise cost effectiveness from limited resources available, says Teresa Norris a sexual health specialist and HPV expert, the founder and president of HPV global action.

Scientists also have an opportunity through a screening method that can be used for both diseases, the Automated Visual Evaluation (AVE), a deep learning computer application.

A typical country programme would first target HPV and cervical cancer prevention by combining screening simultaneously girls aged nine to 14 and then screening and treatment for women 25 to 45 years, scientists say.

“We would first of all do screening for cervical cancer lesions using AVE while simultaneously screening for FGS lesions using this same tool and then providing treatment,” said Norris.

Secondly, the program can look at the country wide HPV vaccination programs that run through GAVI while simultaneously providing Praziquantel through GAVI to supplement the mass Drug Administration programs. Many GAVI countries also have an objective of eliminating Schistosomiasis transmission.

The scientists say they need to consider the country’s specific resources, needs and attitudes to ensure this will work.“This will give us an opportunity to be mapping for FGS and cervical cancer via a pilot project proof of concept studies in Africa in several places,” says Norris. “These initiatives in individual countries will be able to assess the accessibility and feasibility and then we can move towards scaling it up for population control in many African countries.”

Both diseases also require early treatment for better outcomes. “The diagnosis and management strategies for the two need to be hand in hand. For the young girls we know that this can be prevented if you treat it early, so they don’t have to walk into their first sexual intercourses with damaged genitals,” says Kjetland.

Cervical cancer and FGS also need more awareness creation among populations, academics and professionals. But more work is required for FGS which is hardly known. “Currently, no women are diagnosed with FGS or informed that they have this disease and FGS is not mentioned in any prevention programs,” says Kjetland.

“To many of us, learning about the prominence of FGS is new for us and then also further to that is adding that opportunity to have a deworming strategy in a lot of our projects is something that’s new in our in our community,” says Norris.

Sierra Leone has managed to make remarkable progress to control Schistosomiasis. “And the most important lesson I think we’ve learned over the last 10 years certainly is the power of integration,”says Mary Hodges, Adjunct professor, Njala University, Sierra Leone.

“Transitioning from mass campaigns for preschoolers into an integrated service delivery that included family planning for their caregivers, was a real success. And going forward, I would recommend that further integration channels for adolescents, women of reproductive age, should take a careful look at the opportunities to ride on,” says Hodges.

Kakuuto Health Centre IV alarming birth deliveries

 You have got to give it up for women in Kyotera district. The fertility rate is over the top. At Kakuuto Health Centre IV in Kyotera district baby deliveries are about six per day which now averages 180 deliveries per month.

In 2020 the population of Kyotera district was recorded to be 261,000 people. With the current additions you can do the maths. The issues may be lack of access to contraception or boredom – I don’t know.

The health officers at Kakuuto HCIV say they are overwhelmed. A health centre IV is a mini hospital with wards for men, women, and children and should be able to admit patients. It should have a senior medical officer and another doctor as well as a theatre for carrying out emergency operations.

At Kakuuto HCIV, they have an acute shortage of beds now. Of the 6 baby deliveries done everyday at least two are caesarian, which takes away time and resources for other pregnancy or antenatal related cases that are not delivering babies.

Dr. Aloysious Musoke, the Medical Officer in charge of Kakuuto HCIV, said they have a 15-bed capacity which is not enough for the increasing number of patients at the maternity ward. As a result, Musoke says they are forced to improvise with mattresses so that the patients can get maternity care from the floor.

A non-governmental organisation Brick By Brick Uganda, through its Babies And Mothers Alive (BAMA) project, built a neonatal unit to save premature babies in the congested ward but this is not enough.

Due to increased numbers, Dr. Musoke further noted that the insufficient drug supply at the health center is also worsening the situation since the drugs run out of stock before the next cycle. 

He explains that this nature of the health center is meant to be supplied drugs worth over Ugx30, 000,000 but the National Medical Stores provides drugs worth Ugx11,000,000 which is not enough considering the performance of the Health center and the numbers of patients.

Kate Nalwadda, a caregiver of a caesarian patient, says they do not have space to sleep in because the floor is being occupied by the expecting mothers.

Edward Muwanga, the Kyotera District Health Officer, he is aware of the challenge and he attributed it to lack of financial resources to purchase more beds for the maternity and other wards at the health centre.

Agnes Namusiitwa, the Kakuuto Female Councilor, and Kyotera LC5 Vice-chairperson, says that different patients and caregivers have expressed the same concern on different occasions but there is nothing to do in the meantime but to improvise. She adds that they are still lobbying some beds from good Samaritans and Non-governmental Organisations.

Frog limbs regrown - research study

US scientists have regrown the legs of frogs after a brief drug treatment, marking a significant advance for regenerative medicine.

The team at Tufts University, in collaboration with colleagues at Harvard University,  both Massachusetts, used a combination of five drugs applied in a wearable silicone cap that was placed over the stump of the frog leg, that previously had been amputated.

Each drug had a different purpose, including reducing inflammation, promoting growth of blood vessels and muscle, and stopping scar tissue.

The findings, in Science Advances, showed that after an 18-month period of regrowth, frogs restored a functional leg able to respond to stimuli such as touch.

“The fact that it required only a brief exposure to the drugs to set in motion a months-long regeneration process suggests that frogs and perhaps other animals may have dormant regenerative capabilities that can be triggered into action,” said Nirosha Murugan, first author of the paper.

Source: EARA News Digest

Gene-environment interactions that drives autism evidence revealed for the first time

Scientists have provided the first evidence of the close interactions between genes and the environment in the social dysfunctions typical of autistic disorders.

For the first time a team from the University of Geneva (UNIGE), Switzerland, within the framework of the Synapsy National Centre of Competence in Research, has deciphered how a change in cell environment triggers the onset of autistic symptoms in mice with a genetic vulnerability. 

While a link between the inflammatory process and autism was suspected, an imbalance in the expression of a series of genes caused by a massive inflammation — resulting from an immune response to the administration of a pharmacological product —leads to the hyperexcitability of neurons of the reward system" says a press release from the University of Geneva (UNIGE), Switzerland.

The results of the research are published this month in the journal Molecular Psychiatry.

The research team led by Camilla Bellone, a professor in the Department of Basic Neurosciences at the UNIGE Faculty of Medicine and director of the Synapsy National Centre of Competence in Research, had already demonstrated the role of the reward system in the social interaction deficit in autistic mice. 

Indeed, the motivation that drives individuals to interact with their peers is closely linked to the reward system, through the activation of the neuronal networks that make it up. 

But what are the cellular and molecular mechanisms at the origin of the deficits in social interaction? To understand this process and thus decipher how the symptoms appear, the scientists studied so-called heterozygous mice, i.e. mice carrying a deletion of only one of the two copies of the SHANK3 gene, but not showing social behavioural disorders. With 1-2% of all autism cases, this is indeed one of the most common monogenic causes of the disease.

“Humans carry a mutation in only one of the two copies of SHANK3, a gene that is essential for the functioning of synapses and communication between neurons,” points out Camilla Bellone. 

“In animal models of the disease, however, mutation of a single copy of SHANK3 only slightly affects the behaviour of mice, which explains why the behavioural phenotypes observed are not homogeneous”.

The role of neuronal hyperexcitability

The researchers first inhibited the expression of SHANK3 in the neural networks of the reward system in order to identify the other genes whose expression was modified. Several genes related to the inflammatory system were detected, including one of them, Trpv4, which is also involved in the functioning of communication channels between neurons. 

“By inducing massive inflammation, we observed an overexpression of Trpv4, which then led to a neuronal hyperexcitability concomitant to the onset of social avoidance behaviours that our mice did not exhibit until now,” stresses Camilla Bellone. Moreover, by inhibiting Trpv4, the scientists were able to
restore normal social behaviour.

“This provides evidence that autistic disorders are indeed the result of an interaction between a genetic susceptibility and an external trigger - in this case, massive inflammation. Neuronal hyperexcitability disrupts communication channels, thereby altering the brain circuits governing social behaviour.”

This would also explain why the same genetic predisposition can lead, depending on the environmental factors encountered and the type of inflammation they trigger, to a diversity of symptoms of equally variable severity.

Irreversible damage during development?

In this study, the inflammation was induced in adult animals. The resulting deficit in social behaviour was not only reversible, but also disappeared naturally after a few days. “We now need to replicate our research during the critical phases of neurodevelopment — i.e. during gestation and immediately after birth — in order to observe the impact of hyperexcitability on the developing neural networks.

This could damage the construction of neural networks beyond repairs,” says Camilla Bellone. This study constitutes a proof-of-principle of a direct causality between inflammation and the appearance of behavioural symptoms in the presence of genetic vulnerability, and highlights the importance of environmental factors, which have been largely underestimated until now. 

It also highlights the fact that the understanding of the mechanisms behind autistic disorders still needs to be refined in order to intervene effectively. Indeed, depending on the gene-environment interactions and inflammatory mechanisms specific to each patient, it would be possible to identify a treatment that would correspond exactly to the cellular and molecular modification at stake in the brain circuits.

People with autism spectrum disorders all have characteristic behavioural difficulties. Nevertheless, the important heterogeneity of their symptoms remains one of the major questions for scientists and physicians.

DOI: 10.1038/s41380-021-01427-0

Uganda Polio mass vaccination roll out: vaccine carriers, cults and health workers

About 270 health workers were trained to roll out the vaccination against Polio for six days in Arua City.

The Wild Polio 2 virus was detected from two samples last year at two sewage treatment sites. This type of polio can lead to permanent paralysis or even death in some cases.

Uganda was named free of Wild Polio 2 virus in 2015 and it was removed from the routine immunization schedule in 2016. As such the country doesn't store vaccines for it anymore. 

As a result the government through the Ministry of Health decided to roll out mass vaccination for children below five years targeting to vaccinate at least 8.7 million children, countrywide scheduled three days.

7.2 million children were targeted to be vaccinated by Monday 17, leaving a deficit of 1.5 million children yet to receive the vaccine. But due to limited vaccine carriers the Ministry of Health extended the date for the mass polio vaccination to Wednesday, 19th.

Vaccine carriers are insulated containers where vaccines are kept cold during transportation.

In Arua, City Health officials extended days for Polio vaccination over a shortage of vaccine carriers forcing health officials to conduct the campaign in two phases from Monday up to Wednesday.

According to Peter Aziku the Deputy Health Officer Arua City, they needed 890 cold boxes but they received 469. 

Aziku said they have decided to divide the health staff into two with the first one starting vaccination in the areas of Pajulu, Adumi, and Ayivuni all in Ayivu West while the second group of health workers will resume on Monday in the areas of Arua Hill, Oli Division, Oluko Dadamu, Manibe, and Aroi.

Pader district had a target of 50,777 children under five to be vaccinated but only 45,780 received the vaccine.

Justine Ocen the LCV Vice-Chairperson, said that the district received fewer vaccines because the Ministry of Health relied on the district report about the target population, yet the figure is now different. 

Ocen said the district is liaising with other neighboring districts to get vaccines and vaccinate the remaining children.

In Mukono district, the lack of medical workers stalled the polio vaccination campaign. The district dispatched 108 medical workers to carry out the exercise in the entire district with each parish receiving one medical worker. Mukono district target was to vaccinate 147, 000 children. 

Sarah Nassaka, a health worker said that during the previous mass vaccination exercises, four medical workers were allocated to Bagala zone but this time round only one was assigned for the polio vaccination.

Stephen Mulindwa, the District Health Officer-DHO advised parents with busy schedules to take their children to the district general hospital and health center IVs where were designated immunization centers and enough staff.

The issue of lack of vaccine carriers:

As the government rolled out the national mass polio vaccination, vaccine carriers stalled the process. The exercise which was slated to commence on Thursday January 13th, 2022, and end on Sunday, 16th January was extended for three more days. 

According to a Ministry of health survey carried out prior to commencement of the exercise only 24,000 cold chain carriers were available in the country. Hence, about 56,000 out of the 80,000 teams deployed to conduct the polio vaccination exercise nationwide didn’t get carriers to safely carry the vaccines. 

The ministry then used a staggered approach, where vaccination teams shared the carriers. Dr. Immaculate Ampaire, the deputy program manager of the Uganda National Expanded Programme on Immunization (UNEPI) said the campaign exposed the need of investing in door-to-door cold storage equipment. 

"When it comes to other cold storage equipment we are okay but we do not have enough vaccine carriers. In this ongoing campaign, we had a shortfall of over 50,000 and that is why districts were asked to do passed implementation," Ampaire said.

Extension of the campaign was a necessity and the Ministry of Health also halted COVID-19 vaccination from taking place to free up cold chain boxes that would otherwise have been used to store COVID-19 vaccines. 

The Health Ministry Spokesperson, Emmanuel Ainebyoona, said that the ministry is in the long term working towards increasing the capacity of cold chain storage equipment in the country. Recently the health ministry received equipment worth US$ 8.3million. 

Using the sub-country approach: 

As a means to reach all the children the government changed to a sub-county approach from the district approach. The door to door also consists of teams visiting each household and school which will achieve the target of reaching every child. 

On Friday, Luwero district embarked on the door-to-door immunization campaign against polio among children aged five years and below.  The district targeted to immunize 106,000 children within six days and 65 centers were gazetted to coordinate the campaign.

The health workers kicked off by immunizing children in daycare and nursery schools before they move door to do together with LCI Chairpersons.

According to preliminary data released by the immunization program, Busoga has emerged as the best performing region in this campaign with 484,809 children vaccinated followed by South Central with 450,260 children. 

Ampaire attributes Busoga's excellent performance to a change in the models used. Figures from the health ministry show that the region normally scores less than 50 percent vaccine coverage on average when it comes to routine immunization. 

“This time around we had a plan that catered for all parishes. We used village teams to move from one village to another and parish to parish. This helped us plan for all hard-to-reach areas like mountains, islands, and even some cities," she said.

"We are urging parents and school administrators to go and get children under five vaccinated. This vaccine was removed from the routine immunization schedule. We got resources from the Global Polio Eradication Initiative to carry out this campaign and parents must take up this opportunity," Ampaire said.

The health officials have also involved the cultural, religious, and local council leaders in addition to the VHTs to popularize the vaccination campaign. 

Hellen Alimo a Village Health Team-VHT Officer in Luwero said parents responded positively to the exercise although there was a challenge of inadequate health workers.

Ismail Tuku the Prime Minister of Lugbara Cultural Institution said the government should consider sharing polio vaccines with the Neighboring DRC and South Sudan because of the eminent polio risk in these countries.

Cult culture inhibit uptake of polio vaccines;

Luwero district health officials are facing a challenge to reach children of cult members that are against any form of immunization. Over 50 children could be affected.

When Luwero district embarked on the door-to-door immunization campaign, parents of children who belong to the Abajiri Christian cult in Luwero rejected it.  The families are spread at villages of Kakoola, Makokonyigo, Kikandwa, and Nakasejjere village in Kamira sub-county.

Local Leaders say the cult believes that the immunization campaign is satanic and a plan to enforce the new world order.

Abdullatif Serugo the LCI Chairman of Makokonyigo village said that during the registration of families whose children are eligible for immunization, 10 families that follow the cult in his area indicated that they won’t participate in the campaign and hence refused to volunteer any information.

He said that in the past parents have been arrested and jailed for rejecting government programs but this has not deterred their beliefs.

Ronald Mulumba the LCI Chairman of Nakasejjere village said that whenever cult followers learn about such campaigns, the children are hidden in makeshift houses in the swamps until the exercise ends.

Ponsiano Kabaale the LC 1 Chairperson of Kakoola village said he was secretly gathering information about the total number of children in the families and they intend to round them for immunization during their prayers on Saturday.

The Chairpersons have since asked the District Leadership to take up the matter and force the parents to surrender the children for immunization.

Doctor Innocent Nkonwa the Luwero District Health Officer said they were privy to information on the existence of the group and they intend to use security personnel to ensure they access children for immunization.

Erastus Kibirango the LCV Chairperson of Luwero said they would visit the villages to persuade and sensitize communities to participate in the campaign.

Sheikh Ramadhan Mulindwa the Chairperson of Inter-Religious Council in Luwero district said that immunization is not against religious faiths and parents should embrace it. It's believed that the followers of the cult have also shunned COVID 19 vaccination exercise.

In 2014, more than 300 followers of Abajiri cult in Luwero and Nakasongola districts fled their homes to evade arrest after rejecting the national population and housing census.

In 2010, the same cult followers were arrested and jailed for blocking their children from attending school but their attitude didn’t change. It is believed that they're over 500 followers of Bajiri cult in Luwero and Nakasongola districts. 

Polio hit Uganda hard in 1983 and left many children who are now aged 30 years plus maimed with its scars. Since then vaccines have been rolled out to eliminate the disease. 

Uganda had already excluded the vaccines for Wild Polio 2 virus from its immunization routine programs in 2016, following the WHO declaration in 2006 that Uganda was Polio free since it had not reported a case of polio for a decade. But porous borders continue to derail these efforts.