Background Accurate and affordable laboratory testing is key for timely diagnosis and appropriate... more Background Accurate and affordable laboratory testing is key for timely diagnosis and appropriate management of COVID-19 patients. As such, robust evidence regarding diagnostic accuracy and costs of available tests would inform policy and practice especially in resource-limited settings. We aimed to determine the diagnostic test accuracy, costs and utility of laboratory test strategies for COVID-19 in LMICs. Methods This was a multi-staged protocol-driven systematic review conducted in line with PRISMA guidelines for diagnostic test accuracy studies (PRISMA-DTA). We searched for relevant literature in six databases including: PubMed, Google Scholar, MEDLINE, SCOPUS, Web of Science, and the WHO Global Index Medicus. Studies were screened and coded in pairs. We conducted a structured narrative and quantitative synthesis of the results guided by Fryback and Thornbury framework. The primary outcome was COVID-19 diagnostic test accuracy. The results were reported following the PRISMA-DTA...
Background Uganda is prone to Emerging Infectious Diseases (EIDs) which can cause serious epidemi... more Background Uganda is prone to Emerging Infectious Diseases (EIDs) which can cause serious epidemics and pandemics. Uganda’s capacity for EID research, surveillance and control is improving but still low partly due to inadequate highly knowledgeable and skilled human and animal health workers. To inform the design of training programs that can address Uganda’s health workforce capacity gaps, we conducted a training needs assessment. Methods A qualitative study involving a desk review, 25 key informant interviews and a 1-day consultative workshop to review study findings. Results The majority of infectious disease research, surveillance and control in Uganda focuses on HIV/AIDS, Tuberculosis, Malaria and viral hemorrhagic fevers e.g., Ebola and Marburg. Health workforce capacity for surveillance and control is robust compared to many other resource-constrained settings but research capacity and output are relatively low, especially for EIDs. Public and private tertiary institutions in...
Globally, even though improvements have been made to effective surveillance and response, communi... more Globally, even though improvements have been made to effective surveillance and response, communicable diseases such as cholera remain high priorities for national health programs, especially in Africa. High-quality surveillance information coupled with adequate laboratory facilities are effective in curbing outbreaks from such diseases, ultimately reducing morbidity and mortality. One way of building this capacity is through simulation of response to such health events. This case study based on a cholera outbreak investigated by FETP trainees in October 2015 in Uganda can be used to reinforce skills of frontline FETP trainees and other novice public health practitioners through a practical simulation approach. This activity should be completed in 2.5 hours.
In 2012, Tororo District had the highest malaria burden in Uganda with community Plasmodium preva... more In 2012, Tororo District had the highest malaria burden in Uganda with community Plasmodium prevalence of 48%. To control malaria in the district, the Ministry of Health introduced universal distribution of long lasting insecticide-treated nets (LLINs) in 2013 and added indoor residual spraying (IRS) in 2014. This study assessed malaria incidence, test positivity rates and outpatient (OPD) attendance due to malaria before and after vector control interventions. This study was based on analysis of Health Management Information System (HMIS) secondary malaria surveillance data of 2,727,850 patient records in OPD registers of 61 health facilities from 2012 to 2015. The analysis estimated monthly malaria incidence for the entire population and also separately for <5- and ≥5-year-olds before and after introduction of vector control interventions; determined laboratory test positivity rates and annual percentage of malaria cases in OPD. Chi square for trends was used to analyse annual ...
In June 2015, a malaria epidemic was confirmed in ten districts of Northern Uganda; after cessati... more In June 2015, a malaria epidemic was confirmed in ten districts of Northern Uganda; after cessation of indoor residual spraying (IRS). Epidemic was defined as an increase in incidence per month beyond one standard deviation above mean incidence of previous 5 years. Trends in malaria incidence among children-under-5-years were analysed so as to describe the extent of change in incidence prior to and after cessation of IRS. Secondary data on out-patient malaria case numbers for children-under-5-years July 2012 to June 2015 was electronically extracted from the district health management information software2 (DHIS2) for ten districts that had IRS and ten control districts that didn't have IRS. Data was adjusted by reporting rates, cleaned by smoothing and interpolation and incidence of malaria per 1000 population derived. Population data obtained from 2002 and 2014 census reports. Data on interventions obtained from malaria programme reports, rainfall data obtained from Uganda Nat...
Additional file 1 A .pdf file providing additional details on the Methods and Supplementary Table... more Additional file 1 A .pdf file providing additional details on the Methods and Supplementary Tables and Figures. Methods: 1) Study population and clinical management of severe malaria. 2) Neurologic, cognitive and behavioral assessment. 3) Enrollment in the Iron study. Supplementary Tables and Figures: Table S1. Characteristics of severe malaria study participants by choice of in-hospital antimalarial administered. Table S2. Primary cognitive and behavioral outcomes in children over 24-month follow up, according to antimalarial treatment (quinine vs. parenteral artemisinin), and severe malaria group at presentation (cerebral malaria or severe malarial anemia). Table S3. Primary cognitive and behavioral outcomes in children over 24-month follow up, according to specific antimalarial drug treatment, and severe malaria group at presentation (cerebral malaria or severe malarial anemia).
The questionnaire that was used in the collection of information from cases and controls is avail... more The questionnaire that was used in the collection of information from cases and controls is available as a supplementary file called Typhoid questionnaire. It provides details on which questions were asked about food and water exposures. (DOC 87 kb)
Background In 2011, the World Health Organization recommended injectable artesunate as the first-... more Background In 2011, the World Health Organization recommended injectable artesunate as the first-line therapy for severe malaria (SM) due to its superiority in reducing mortality compared to quinine. There are limited data on long-term clinical and neurobehavioral outcomes after artemisinin use for treatment of SM. Methods From 2008 to 2013, 502 Ugandan children with two common forms of SM, cerebral malaria and severe malarial anemia, were enrolled in a prospective observational study assessing long-term neurobehavioral and cognitive outcomes following SM. Children were evaluated a week after hospital discharge, and 6, 12, and 24 months of follow-up, and returned to hospital for any illness. In this study, we evaluated the impact of artemisinin derivatives on survival, post-discharge hospital readmission or death, and neurocognitive and behavioral outcomes over 2 years of follow-up. Results 346 children received quinine and 156 received parenteral artemisinin therapy (artemether or ...
IntroductionAccurate and affordable laboratory testing is key to timely diagnosis and appropriate... more IntroductionAccurate and affordable laboratory testing is key to timely diagnosis and appropriate management of patients with COVID-19. New laboratory test protocols are released into the market under emergency use authorisation with limited evidence on diagnostic test accuracy. As such, robust evidence on the diagnostic accuracy and the costs of available tests is urgently needed to inform policy and practice especially in resource-limited settings. We aim to determine the diagnostic test accuracy, cost-effectiveness and utility of laboratory test strategies for COVID-19 in low-income and middle-income countries.Methods and analysisThis will be a multistaged, protocol-driven systematic review conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for diagnostic test accuracy studies. We will search for relevant literature in at least six public health databases, including PubMed, Google Scholar, MEDLINE, Scopus, Web of Scie...
Background: Globally, health care workers continue to be infected, fall ill and die at the frontl... more Background: Globally, health care workers continue to be infected, fall ill and die at the frontline of the Coronavirus disease 2019 (COVID-19) fight, an indicator of inadequate safety in health facilities. This rapid evidence synthesis aims to highlight the impacts of COVID-19 on healthcare workers in low-and middle-income countries (LMICs) in terms of infections, illnesses and deaths. Methods: A systematic review will be done. Article search will be performed by an experienced librarian in PubMed, MEDLINE Ovid, Google Scholar, COVID-END, Cochrane library and targeted search from other relevant sources. MeSH terms and Boolean operators “AND” and “OR” will be used in the article search. Independent reviewers will screen the retrieved articles using a priori criteria. Data abstraction will be done using an excel based abstraction tool and synthesized using structured narratives and summary of findings tables. Discussion and anticipated use of results: This evidence synthesis seeks to...
Pan African Medical Journal Conference Proceedings, 2018
Introduction : in September 2015, a cholera outbreak occurred in a village in Hoima District, wes... more Introduction : in September 2015, a cholera outbreak occurred in a village in Hoima District, western Uganda. The Ministry of Health assembled a rapid response team, with support by CDC, UNICEF and WHO, to investigate the outbreak, establish the Kaiso Cholera Treatment Center (KCTC), and implement control measures. The team identified 120 cholera cases (with 5 deaths) and determined that drinking contaminated water from the lakeshore caused this outbreak. We sought to determine the cost of investigating and controlling this outbreak, and compare it to a would-be simple preventive measure, constructing deep wells to provide cleaner water. Methods : we collected cost data, including personnel and material costs at KCTC, health facilities, Hoima District Health Office, Uganda Public Health Fellowship Program, UNICEF, CDC, and WHO. We defined direct cost of responding to this outbreak as expenditure on medications, medical equipment and supplies, utilities, and allowances and transport for responders; indirect cost included salary and other compensations for responders. We did not include difficult-to-measure costs such as vehicle depreciation, building maintenance, and loss of productivity to case-persons due to illness and deaths. The cost of constructing deep wells was quoted by a U.S.-based NGO. Results : the total cost incurred in investigating and controlling this outbreak was $71,769, including $21,059 in direct cost ($19,225 for allowances and transportation, $1,774 for medical equipment and supplies, and $60 for utilities), and $50,620 in indirect cost (74,484 person-hours of salary and other compensations for responders). Conversely, constructing a deep well to provide cleaner water would cost approximately $2500. Essentially, the total cost incurred in this outbreak would have been enough to construct 28 (=71769/2500) deep wells; even the direct cost only would have been enough to construct 8 (=21059/2500) deep wells. One such deep well would have prevented this outbreak and averted future waterborne outbreaks. Conclusion : a simple prevention measure such as constructing deep wells for village residents can be substantially cost-effective for preventing waterborne diseases such as cholera. We recommend that the government should proactively implement prevention measures for waterborne outbreaks whenever possible, instead of passively responding to these outbreaks.
Background: In June 2015, a malaria epidemic was confirmed in ten districts of Northern Uganda; a... more Background: In June 2015, a malaria epidemic was confirmed in ten districts of Northern Uganda; after cessation of indoor residual spraying (IRS). Epidemic was defined as an increase in incidence per month beyond one standard deviation above mean incidence of previous 5 years. Trends in malaria incidence among children-under-5-years were analysed so as to describe the extent of change in incidence prior to and after cessation of IRS. Methods: Secondary data on outpatient malaria case numbers for children-under-5-years July 2012 to June 2015 was electronically extracted from the district health management information software2 (DHIS2) for ten districts that had IRS and ten control districts that didn't have IRS. Data was adjusted by reporting rates, cleaned by smoothing and interpolation and incidence of malaria per 1000 population derived. Population data obtained from 2002 and 2014 census reports. Data on interventions obtained from malaria programme reports, rainfall data obtained from Uganda National Meteorological Authority. Three groups of districts were created; two based on when IRS ended, the third not having IRS. Line graphs were plotted showing malaria incidence vis-à-vis implementation of IRS, mass net distribution and rainfall. Changes in incidence after withdrawal of IRS were obtained using incidence rate ratios (IRR). IRR was calculated as incidence for each month after the last IRS divided by incidence of the IRS month. Poisson regression was used to test statistical significance. Results: Incidence of malaria declined between spray activities in districts that had IRS. Decline in IRR for 4 months after last IRS month was greater in the sprayed than control districts. On the seventh month following cessation of IRS, incidence in sprayed districts rose above that of the last spray month [
Background: In June 2015, a malaria epidemic was confirmed in ten districts of Northern Uganda; a... more Background: In June 2015, a malaria epidemic was confirmed in ten districts of Northern Uganda; after cessation of indoor residual spraying (IRS). Epidemic was defined as an increase in incidence per month beyond one standard deviation above mean incidence of previous 5 years. Trends in malaria incidence among children-under-5-years were analysed so as to describe the extent of change in incidence prior to and after cessation of IRS. Methods: Secondary data on outpatient malaria case numbers for children-under-5-years July 2012 to June 2015 was electronically extracted from the district health management information software2 (DHIS2) for ten districts that had IRS and ten control districts that didn't have IRS. Data was adjusted by reporting rates, cleaned by smoothing and interpolation and incidence of malaria per 1000 population derived. Population data obtained from 2002 and 2014 census reports. Data on interventions obtained from malaria programme reports, rainfall data obtained from Uganda National Meteorological Authority. Three groups of districts were created; two based on when IRS ended, the third not having IRS. Line graphs were plotted showing malaria incidence vis-à-vis implementation of IRS, mass net distribution and rainfall. Changes in incidence after withdrawal of IRS were obtained using incidence rate ratios (IRR). IRR was calculated as incidence for each month after the last IRS divided by incidence of the IRS month. Poisson regression was used to test statistical significance. Results: Incidence of malaria declined between spray activities in districts that had IRS. Decline in IRR for 4 months after last IRS month was greater in the sprayed than control districts. On the seventh month following cessation of IRS, incidence in sprayed districts rose above that of the last spray month [
Background Accurate and affordable laboratory testing is key for timely diagnosis and appropriate... more Background Accurate and affordable laboratory testing is key for timely diagnosis and appropriate management of COVID-19 patients. As such, robust evidence regarding diagnostic accuracy and costs of available tests would inform policy and practice especially in resource-limited settings. We aimed to determine the diagnostic test accuracy, costs and utility of laboratory test strategies for COVID-19 in LMICs. Methods This was a multi-staged protocol-driven systematic review conducted in line with PRISMA guidelines for diagnostic test accuracy studies (PRISMA-DTA). We searched for relevant literature in six databases including: PubMed, Google Scholar, MEDLINE, SCOPUS, Web of Science, and the WHO Global Index Medicus. Studies were screened and coded in pairs. We conducted a structured narrative and quantitative synthesis of the results guided by Fryback and Thornbury framework. The primary outcome was COVID-19 diagnostic test accuracy. The results were reported following the PRISMA-DTA...
Background Uganda is prone to Emerging Infectious Diseases (EIDs) which can cause serious epidemi... more Background Uganda is prone to Emerging Infectious Diseases (EIDs) which can cause serious epidemics and pandemics. Uganda’s capacity for EID research, surveillance and control is improving but still low partly due to inadequate highly knowledgeable and skilled human and animal health workers. To inform the design of training programs that can address Uganda’s health workforce capacity gaps, we conducted a training needs assessment. Methods A qualitative study involving a desk review, 25 key informant interviews and a 1-day consultative workshop to review study findings. Results The majority of infectious disease research, surveillance and control in Uganda focuses on HIV/AIDS, Tuberculosis, Malaria and viral hemorrhagic fevers e.g., Ebola and Marburg. Health workforce capacity for surveillance and control is robust compared to many other resource-constrained settings but research capacity and output are relatively low, especially for EIDs. Public and private tertiary institutions in...
Globally, even though improvements have been made to effective surveillance and response, communi... more Globally, even though improvements have been made to effective surveillance and response, communicable diseases such as cholera remain high priorities for national health programs, especially in Africa. High-quality surveillance information coupled with adequate laboratory facilities are effective in curbing outbreaks from such diseases, ultimately reducing morbidity and mortality. One way of building this capacity is through simulation of response to such health events. This case study based on a cholera outbreak investigated by FETP trainees in October 2015 in Uganda can be used to reinforce skills of frontline FETP trainees and other novice public health practitioners through a practical simulation approach. This activity should be completed in 2.5 hours.
In 2012, Tororo District had the highest malaria burden in Uganda with community Plasmodium preva... more In 2012, Tororo District had the highest malaria burden in Uganda with community Plasmodium prevalence of 48%. To control malaria in the district, the Ministry of Health introduced universal distribution of long lasting insecticide-treated nets (LLINs) in 2013 and added indoor residual spraying (IRS) in 2014. This study assessed malaria incidence, test positivity rates and outpatient (OPD) attendance due to malaria before and after vector control interventions. This study was based on analysis of Health Management Information System (HMIS) secondary malaria surveillance data of 2,727,850 patient records in OPD registers of 61 health facilities from 2012 to 2015. The analysis estimated monthly malaria incidence for the entire population and also separately for <5- and ≥5-year-olds before and after introduction of vector control interventions; determined laboratory test positivity rates and annual percentage of malaria cases in OPD. Chi square for trends was used to analyse annual ...
In June 2015, a malaria epidemic was confirmed in ten districts of Northern Uganda; after cessati... more In June 2015, a malaria epidemic was confirmed in ten districts of Northern Uganda; after cessation of indoor residual spraying (IRS). Epidemic was defined as an increase in incidence per month beyond one standard deviation above mean incidence of previous 5 years. Trends in malaria incidence among children-under-5-years were analysed so as to describe the extent of change in incidence prior to and after cessation of IRS. Secondary data on out-patient malaria case numbers for children-under-5-years July 2012 to June 2015 was electronically extracted from the district health management information software2 (DHIS2) for ten districts that had IRS and ten control districts that didn't have IRS. Data was adjusted by reporting rates, cleaned by smoothing and interpolation and incidence of malaria per 1000 population derived. Population data obtained from 2002 and 2014 census reports. Data on interventions obtained from malaria programme reports, rainfall data obtained from Uganda Nat...
Additional file 1 A .pdf file providing additional details on the Methods and Supplementary Table... more Additional file 1 A .pdf file providing additional details on the Methods and Supplementary Tables and Figures. Methods: 1) Study population and clinical management of severe malaria. 2) Neurologic, cognitive and behavioral assessment. 3) Enrollment in the Iron study. Supplementary Tables and Figures: Table S1. Characteristics of severe malaria study participants by choice of in-hospital antimalarial administered. Table S2. Primary cognitive and behavioral outcomes in children over 24-month follow up, according to antimalarial treatment (quinine vs. parenteral artemisinin), and severe malaria group at presentation (cerebral malaria or severe malarial anemia). Table S3. Primary cognitive and behavioral outcomes in children over 24-month follow up, according to specific antimalarial drug treatment, and severe malaria group at presentation (cerebral malaria or severe malarial anemia).
The questionnaire that was used in the collection of information from cases and controls is avail... more The questionnaire that was used in the collection of information from cases and controls is available as a supplementary file called Typhoid questionnaire. It provides details on which questions were asked about food and water exposures. (DOC 87 kb)
Background In 2011, the World Health Organization recommended injectable artesunate as the first-... more Background In 2011, the World Health Organization recommended injectable artesunate as the first-line therapy for severe malaria (SM) due to its superiority in reducing mortality compared to quinine. There are limited data on long-term clinical and neurobehavioral outcomes after artemisinin use for treatment of SM. Methods From 2008 to 2013, 502 Ugandan children with two common forms of SM, cerebral malaria and severe malarial anemia, were enrolled in a prospective observational study assessing long-term neurobehavioral and cognitive outcomes following SM. Children were evaluated a week after hospital discharge, and 6, 12, and 24 months of follow-up, and returned to hospital for any illness. In this study, we evaluated the impact of artemisinin derivatives on survival, post-discharge hospital readmission or death, and neurocognitive and behavioral outcomes over 2 years of follow-up. Results 346 children received quinine and 156 received parenteral artemisinin therapy (artemether or ...
IntroductionAccurate and affordable laboratory testing is key to timely diagnosis and appropriate... more IntroductionAccurate and affordable laboratory testing is key to timely diagnosis and appropriate management of patients with COVID-19. New laboratory test protocols are released into the market under emergency use authorisation with limited evidence on diagnostic test accuracy. As such, robust evidence on the diagnostic accuracy and the costs of available tests is urgently needed to inform policy and practice especially in resource-limited settings. We aim to determine the diagnostic test accuracy, cost-effectiveness and utility of laboratory test strategies for COVID-19 in low-income and middle-income countries.Methods and analysisThis will be a multistaged, protocol-driven systematic review conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for diagnostic test accuracy studies. We will search for relevant literature in at least six public health databases, including PubMed, Google Scholar, MEDLINE, Scopus, Web of Scie...
Background: Globally, health care workers continue to be infected, fall ill and die at the frontl... more Background: Globally, health care workers continue to be infected, fall ill and die at the frontline of the Coronavirus disease 2019 (COVID-19) fight, an indicator of inadequate safety in health facilities. This rapid evidence synthesis aims to highlight the impacts of COVID-19 on healthcare workers in low-and middle-income countries (LMICs) in terms of infections, illnesses and deaths. Methods: A systematic review will be done. Article search will be performed by an experienced librarian in PubMed, MEDLINE Ovid, Google Scholar, COVID-END, Cochrane library and targeted search from other relevant sources. MeSH terms and Boolean operators “AND” and “OR” will be used in the article search. Independent reviewers will screen the retrieved articles using a priori criteria. Data abstraction will be done using an excel based abstraction tool and synthesized using structured narratives and summary of findings tables. Discussion and anticipated use of results: This evidence synthesis seeks to...
Pan African Medical Journal Conference Proceedings, 2018
Introduction : in September 2015, a cholera outbreak occurred in a village in Hoima District, wes... more Introduction : in September 2015, a cholera outbreak occurred in a village in Hoima District, western Uganda. The Ministry of Health assembled a rapid response team, with support by CDC, UNICEF and WHO, to investigate the outbreak, establish the Kaiso Cholera Treatment Center (KCTC), and implement control measures. The team identified 120 cholera cases (with 5 deaths) and determined that drinking contaminated water from the lakeshore caused this outbreak. We sought to determine the cost of investigating and controlling this outbreak, and compare it to a would-be simple preventive measure, constructing deep wells to provide cleaner water. Methods : we collected cost data, including personnel and material costs at KCTC, health facilities, Hoima District Health Office, Uganda Public Health Fellowship Program, UNICEF, CDC, and WHO. We defined direct cost of responding to this outbreak as expenditure on medications, medical equipment and supplies, utilities, and allowances and transport for responders; indirect cost included salary and other compensations for responders. We did not include difficult-to-measure costs such as vehicle depreciation, building maintenance, and loss of productivity to case-persons due to illness and deaths. The cost of constructing deep wells was quoted by a U.S.-based NGO. Results : the total cost incurred in investigating and controlling this outbreak was $71,769, including $21,059 in direct cost ($19,225 for allowances and transportation, $1,774 for medical equipment and supplies, and $60 for utilities), and $50,620 in indirect cost (74,484 person-hours of salary and other compensations for responders). Conversely, constructing a deep well to provide cleaner water would cost approximately $2500. Essentially, the total cost incurred in this outbreak would have been enough to construct 28 (=71769/2500) deep wells; even the direct cost only would have been enough to construct 8 (=21059/2500) deep wells. One such deep well would have prevented this outbreak and averted future waterborne outbreaks. Conclusion : a simple prevention measure such as constructing deep wells for village residents can be substantially cost-effective for preventing waterborne diseases such as cholera. We recommend that the government should proactively implement prevention measures for waterborne outbreaks whenever possible, instead of passively responding to these outbreaks.
Background: In June 2015, a malaria epidemic was confirmed in ten districts of Northern Uganda; a... more Background: In June 2015, a malaria epidemic was confirmed in ten districts of Northern Uganda; after cessation of indoor residual spraying (IRS). Epidemic was defined as an increase in incidence per month beyond one standard deviation above mean incidence of previous 5 years. Trends in malaria incidence among children-under-5-years were analysed so as to describe the extent of change in incidence prior to and after cessation of IRS. Methods: Secondary data on outpatient malaria case numbers for children-under-5-years July 2012 to June 2015 was electronically extracted from the district health management information software2 (DHIS2) for ten districts that had IRS and ten control districts that didn't have IRS. Data was adjusted by reporting rates, cleaned by smoothing and interpolation and incidence of malaria per 1000 population derived. Population data obtained from 2002 and 2014 census reports. Data on interventions obtained from malaria programme reports, rainfall data obtained from Uganda National Meteorological Authority. Three groups of districts were created; two based on when IRS ended, the third not having IRS. Line graphs were plotted showing malaria incidence vis-à-vis implementation of IRS, mass net distribution and rainfall. Changes in incidence after withdrawal of IRS were obtained using incidence rate ratios (IRR). IRR was calculated as incidence for each month after the last IRS divided by incidence of the IRS month. Poisson regression was used to test statistical significance. Results: Incidence of malaria declined between spray activities in districts that had IRS. Decline in IRR for 4 months after last IRS month was greater in the sprayed than control districts. On the seventh month following cessation of IRS, incidence in sprayed districts rose above that of the last spray month [
Background: In June 2015, a malaria epidemic was confirmed in ten districts of Northern Uganda; a... more Background: In June 2015, a malaria epidemic was confirmed in ten districts of Northern Uganda; after cessation of indoor residual spraying (IRS). Epidemic was defined as an increase in incidence per month beyond one standard deviation above mean incidence of previous 5 years. Trends in malaria incidence among children-under-5-years were analysed so as to describe the extent of change in incidence prior to and after cessation of IRS. Methods: Secondary data on outpatient malaria case numbers for children-under-5-years July 2012 to June 2015 was electronically extracted from the district health management information software2 (DHIS2) for ten districts that had IRS and ten control districts that didn't have IRS. Data was adjusted by reporting rates, cleaned by smoothing and interpolation and incidence of malaria per 1000 population derived. Population data obtained from 2002 and 2014 census reports. Data on interventions obtained from malaria programme reports, rainfall data obtained from Uganda National Meteorological Authority. Three groups of districts were created; two based on when IRS ended, the third not having IRS. Line graphs were plotted showing malaria incidence vis-à-vis implementation of IRS, mass net distribution and rainfall. Changes in incidence after withdrawal of IRS were obtained using incidence rate ratios (IRR). IRR was calculated as incidence for each month after the last IRS divided by incidence of the IRS month. Poisson regression was used to test statistical significance. Results: Incidence of malaria declined between spray activities in districts that had IRS. Decline in IRR for 4 months after last IRS month was greater in the sprayed than control districts. On the seventh month following cessation of IRS, incidence in sprayed districts rose above that of the last spray month [
Uploads