Original Research
Acute gastrointestinal illness in an African Indigenous population: the lived experience of Uganda’s Batwa
AUTHORS
Kaitlin Patterson1 MA, PhD Candidate *
Sierra Clark2 MSc, PhD candidate
Lea Berrang-Ford3 PhD, Associate Professor
Shuaib Lwasa4 PhD, Associate Professor
Didacus Bambaiha Namanya5 MPH, Health Geographer 
Fortunate Twebaze6 BSc, Masters Student
Sherilee L Harper8 PhD, Associate Professor
AFFILIATIONS
1 Dept of Population Medicine, University of Guelph, 50 Stone Rd E, Guelph, Ontario N1G 2W1, Canada
2 School of Public Health, Imperial College, London, UK
3 Priestley International Centre for Climate, University of Leeds, Leeds, UK
4, 6 Department of Geography, Makerere University, Kampala, Uganda
5 Ugandan Ministry of Health, Kampala, Uganda
7 Indigenous Health Adaptation to Climate Change (IHACC) Research Team: James Ford, Cesar Carcamo, Alejandro Llanos, Victoria Edge, Lea Berrang-Ford, Shuaib Lwasa, Didacus Namanya and Sherilee Harper, School of Public Health, University of Alberta, Edmonton, Alberta T6G 2R3, Canada
8 School of Public Health, University of Alberta, Edmonton, Alberta T6G 2R3, Canada
ACCEPTED: 19 November 2019
early abstract:
Introduction: Indigenous populations in low-income regions are often the most acutely affected by social gradients that impact health, including high burdens of infectious disease. Using a mixed methods approach, this study characterized the lived experience of acute gastrointestinal illness (AGI) in an Indigenous Batwa population in southwestern Uganda.
Methods: Quantitative data analyses were conducted on data from three cross-sectional census surveys of Batwa conducted in January 2013 (n=583), January 2014 (n=569), and April 2014 (n=540). Using a 14-day recall period, cases of AGI were defined as ≥3 loose stools or any vomiting in a 24hr period. These analyses were supplemented by qualitative data from key-informant interviews (n=11 interviews) and Batwa focus group discussions (n=61 participants).
Results: From the surveys, episodes of diarrhea and episodes of vomiting lasted on average 3.6 [95% CI 2.3-4.3] and 3.0 [95% CI 2.1-3.9] days, and cases experienced an average of 4.3 [95% CI 3.9-4.8] and 2.6 [95% CI 2.1-3.1] loose stools and vomiting episodes in 24 hours. Focus group participants and key informants indicated that episodes of AGI for Batwa were not limited to symptom-based consequences for the individual, but also had economic, social, and nutritional impacts.
Conclusions: Despite efforts to increase health literacy in disease transmission dynamics, risks, and prevention measures, the perceived barriers, and a lack of benefits still largely underscored adopting positive AGI prevention behaviors. This study moved beyond surveillance and provided information on the broader community-level burden of AGI and highlighted the current challenges and opportunities for improved uptake of AGI prevention measures for the Batwa