Managing ebola in low-resource settings:

Abstract

Five outbreaks of Ebola virus disease of the Sudan Ebola virus and the Bundibugyo Ebola virus occurred in Uganda from 2000 to 2012. The attack rates and the case fatality rates were much higher for the former than the later. Fever and bleeding manifesta‐ tions associated with the clustering of cases were typical clinical features. Close contact with infected person was probably the major route of spread. Apparent asymptomat‐ ic and atypical Ebola infection was demonstrated in some close contacts, suggesting past unrecognised exposure or cross-reacting antibodies. A zoonotic connection was apparent in monkeys and asymptomatic villagers. The Ministry of Health together with its partners contained the outbreaks, sometimes with delays, but at least once prompt‐ ly. Early detection and communication yielded the best ideal outcomes. A communitybased

response ensured timely case search and contact tracing for the isolation and management of patients. The syndrome-based EVD case definition and the laboratory screening tests for Ebola were used to detect cases. However, their unknown specifici‐ ty and sensitivity and their low positive predictive values were a major weakness in the screening process. Validation of the criteria and the tests at the local level was essential. There were gaps in isolation procedures as 64% of the health care workers were infected after the isolation units were established. Palliative treatment was an important part of management as it improved survival and public confidence. Therefore, survival and not just quarantine must be emphasized and be a critical component of EVD manage‐ ment. Substantial investment in human resource for health is needed to attract, reward, retain and compensate health workers. Collaboration and partnerships at national and international level is vital in building health systems for early surveillance and management of emerging infections. The Uganda experience provides opportunities for further research on some of these strategies that could improve the management and control of Ebola in low resource countries. Keywords: Ebola, outbreaks, detection, management, resources