Epidemiological Study of Lightning Strikes in Uganda, July 2011

1. Epidemiological Study of Lightning Strikes in Uganda, July 2011 UMA-UVA International Conference Stella Immaculate Akech, BenardNgago, Ben Nsajju, Arthur Bagonza, Monday Busuulwa, Monica Musenero, Chima Ohuabunwo, ShebaGittaNakacubo, David Mukanga

2. Background • Worldwide, lightning strikes cause serious injuries in 1000-1500 individuals annually • One of the most frequent causes of death due to natural phenomena • In June and July 2011, Uganda experienced an apparent outbreak of lightning strikes • Estimated 45 deaths and 155 injuries reported • Killed 19 pupils from a single school

3. Background • Raised public concern and prompted MPs to raise this matter in parliament • High incidenceand mortality ratesindicated probable gaps in knowledge and protective practices • Information pertaining to the associated risks, geographical distribution, population affected and individual pattern was scanty

4. Study Objectives • Describe the distribution of lightning strikes by place, person and time • Identify presence/contribution of known risk factors for lightning strikes • Assess the effects of lightning strikes on affected communities • Determine community beliefs and practices related to lightning strikes

5. Methods Study design and setting • Cross sectional descriptive community survey • Constituted two multidisciplinary teams; Epidemiologists, Social Scientists, Meteorologists, Environmental Health Specialists, Medical Workers • Purposively selected 9 districts in Central, Eastern and Northern Uganda

6. Methods: Data Collection Conducted 16 focus group discussions (FGDs) 20 key informant interviews

7. Methods: Data Collection • Directly observed community practices • Reviewed medical and school records • Developed a case definition and generated line list • Conducted active community case search • Conducted environmental assessment • GPS for mapping, altitude measurement • Observation of physical damages • Administered semi-structured questionnaires

8. Results

9. Number of Lightning Strike Victims by Time First notification

10. Distribution of lightning strikes among victims • Of the 112 cases identified, 57 (51%) were males • The most affected age group was 10 – 19 years • Primary school children were mostly affected

11. Distribution of Lightning strikes in Uganda-June to July 2011

12. Number of lightning victims by district

13. Known risk factors for lightning strikes • Rain water harvesting (Meteorologist) • 2/112 (1.8%) killed while harvesting rain water

14. Known Risk factors for lightning strikes • Sheltering under a tree when raining (Met-KI) • 18.8% (21/112) were struck while under tree shelter

15. Known Risk factors for lightning strikes • Overcrowding (Met) • 55/112 (59.1%) were struck while in classrooms • Buildings without lightning arrestors are at risk of being struck by lightning (KIs, Meteorologists) • 39/40 (97.5%) did not have lightning arresters

16. Known Risk factors for lightning strikes • Other factors as pointed out by the meteorologists were; • cutting down trees which lead to • Other factors as pointed out by the meteorologists were; • cutting down trees which lead to exposure of the buildings • 32/40 (80%) places struck had little or no tree cover

17. Known Risk factors for lightning strikes • Metallic clothes’ drying lines were associated with 4 deaths and 6 injuries from lightning strikes

18. Public health effects • Lightning strikes caused 32 deaths (CFR-17.2%) in the nine districts (June 14th to July 3rd) • Multiple (181) injuries among 112 victims

19. Public health effects

20. Public health effects Teeth Damage in a male victim Burn injury in a female victim

21. Public health effects • Induced anxiety in the population, with a resultant • decrease in attendance at school and • other social events reported by 80% of the respondents

22. Socio-economic effects of lightning • Livestock loss • School drop out -orphans could not afford fees • Property destruction

23. Solar systems and class rooms destroyed by lightning

24. House burnt by lightning strike

25. Beliefs and misconceptions Perceived cause: • An angel from heaven • Punishment due to false swearing “Lightning strikes are spirits of the dead which strike people if they swear falsely. It is like a cock in rainbow colour.” ( KI- Traditional healer)

26. Socio-cultural practices related to management of lightning strike victims • Smearing victims with human feces as treatment (FGD,KI) “They delayed to smear them with faeces so we lost them.”(Male FGD) • Victims not supposed to be taken to health facilities (FGD,KI) “People struck by lightning die if taken to the hospital and injected. “ (FGD)

27. Socio-cultural practices related to management of lightning strike victims • Confiscating all properties from the affected households (FGD,KI)

28. Beliefs and practices Burying the victims away from homes and at the river banks

29. Conclusion • Incidence of lightning strikes and its case fatality was high for the period affecting buildings with no lightning arresters • Known risk factors identified include but not limited to sheltering under trees and rain water harvesting • Hazardous socio-cultural practices were common due to lack of knowledge • The socio-economic and health impacts on households and communities were enormous

30. Public Health Actions • Disseminated • Ministry of Health • Environmental Health Conference • Sensitized • Next steps • Develop IEC materials • Sensitize and educate communities

31. Recommendations Government should: • Promote community awareness and education on the risks of lightning strikes • Enforce installation of lightning arresters on public buildings • Traditional beliefs and myths needs to be addressed through sensitization

32. Acknowledgements • Ministry of Health Uganda • CDC • USAID Respond • AFENET • Meteorology School Uganda