title: Managing Ebola from rural to urban slum settings: experiences from Uganda.
abstract: BACKGROUND
  Five outbreaks of ebola occurred in Uganda between 2000-2012. The outbreaks were quickly contained in rural areas. However, the Gulu outbreak in 2000 was the largest and complex due to insurgency. It invaded Gulu municipality and the slum- like camps of the internally displaced persons (IDPs). The Bundigugyo district outbreak followed but was detected late as a new virus. The subsequent outbreaks in the districts of Luwero district (2011, 2012) and Kibaale (2012) were limited to rural areas.
  
  
  METHODS
  Detailed records of the outbreak presentation, cases, and outcomes were reviewed and analyzed. Each outbreak was described and the outcomes examined for the different scenarios.
  
  
  RESULTS
  Early detection and action provided the best outcomes and results. The ideal scenario occurred in the Luwero outbreak during which only a single case was observed. Rural outbreaks were easier to contain. The community imposed quarantine prevented the spread of ebola following introduction into Masindi district. The outbreak was confined to the extended family of the index case and only one case developed in the general population. However, the outbreak invasion of the town slum areas escalated the spread of infection in Gulu municipality. Community mobilization and leadership was vital in supporting early case detection and isolations well as contact tracing and public education.
  
  
  CONCLUSIONS
  Palliative care improved survival. Focusing on treatment and not just quarantine should be emphasized as it also enhanced public trust and health seeking behavior. Early detection and action provided the best scenario for outbreak containment. Community mobilization and leadership was vital in supporting outbreak control. International collaboration was essential in supporting and augmenting the national efforts.
authors.affiliation: Uganda National Health Research Organisation, Entebbe, Uganda.
authors.forename: Sam I
authors.initials: SI
authors.lastname: Okware
authors.affiliation: African Centre for Health and Social Transformation, Kampala.
authors.forename: Francis
authors.initials: F
authors.lastname: Omaswa
authors.affiliation: Public Health and Health Systems Research, University of Oxford- KEMRI Welcome Trust Program, Nairobi, Kenya.
authors.forename: Ambrose
authors.initials: A
authors.lastname: Talisuna
authors.affiliation: Curative Services, Ministry of Health,, Kampala, Uganda.
authors.forename: Jacinto
authors.initials: J
authors.lastname: Amandua
authors.affiliation: Curative Services, Ministry of Health,, Kampala, Uganda.
authors.forename: Jackson
authors.initials: J
authors.lastname: Amone
authors.affiliation: District Director Health Services, Gulu district, Uganda.
authors.forename: Paul
authors.initials: P
authors.lastname: Onek
authors.affiliation: Department disease Control, Ministry of Health, Kampala, Uganda.
authors.forename: Alex
authors.initials: A
authors.lastname: Opio
authors.affiliation: Division of Epidemiology and Disease Control, Ministry of Health, Uganda.
authors.forename: Joseph
authors.initials: J
authors.lastname: Wamala
authors.affiliation: Uganda Virus Institute, Entebbe, Uganda.
authors.forename: Julius
authors.initials: J
authors.lastname: Lubwama
authors.affiliation: Division of Epidemiology and Disease Control, Ministry of Health, Uganda.
authors.forename: Lukwago
authors.initials: L
authors.lastname: Luswa
authors.affiliation: Health Education Division, Ministry of Health, Uganda.
authors.forename: Paul
authors.initials: P
authors.lastname: Kagwa
authors.affiliation: Centre for International Health, University of Bergen, Norway.
authors.forename: Thorkild
authors.initials: T
authors.lastname: Tylleskar
mesh_terms: D000328:Adult; D003140:Communicable Disease Control / Q000379:methods*; D019468:Disease Management; D004196:Disease Outbreaks; D005260:Female; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D006801:Humans; D008297:Male; D011159:Population Surveillance; D011204:Poverty Areas; D012111:Residence Characteristics; D012424:Rural Population; D014454:Uganda / Q000453:epidemiology
keywords: Ebola; Uganda
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