Original Research

Acute gastrointestinal illness in an African Indigenous population: the lived experience of Uganda’s Batwa

AUTHORS

name here
Kaitlin Patterson1
MA, PhD Candidate *

name here
Sierra Clark2
MSc, PhD candidate

name here
Lea Berrang-Ford3
PhD, Associate Professor

name here
Shuaib Lwasa4
PhD, Associate Professor

name here
Didacus Namanya5
MPH, Health Geographer

name here
Fortunate Twebaze6
BSc, Masters Student

name here
IHACC Research Team7

name here
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