Recommendation report on prioritisation of risk groups in Uganda

Following the advent of the second wave, UNITAG analysed epidemiological data from the second wave (April 1 to July 31, 2021) obtained from the Incident Management Team to assist the Ministry of Health in reprioritizing high-risk groups based on the latest epidemiological evidence.
However, several variables for which data was initially collected for all COVID-19 positive cases is no longer being collected. Although the committee could not perform a comparative analysis of some vital characteristics between the two waves due to missing data, the committee was able to complete a descriptive analysis of the available data to show how demographics and caseload distribution have shifted among sex and age groups.
Case distribution by sex and age group: The wide gender disparity seen in the first wave, in which men were much more likely to acquire the disease, has reversed with a percentage composition of women being 4% higher than men in the second wave. Also, the percentage of COVID-19 cases in the 20 years and lower age group has almost doubled.
Comparison of case-fatality rates between the 1st and 2nd waves: Evidence shows that the risk of death from severe disease has increased between the first and second waves.
Geographical Distribution of COVID-19 Cases across the country: the spread of disease is significantly higher in districts along the highways. Moreover, the top 5 high burden districts remain largely unchanged while eight (8) districts have joined the top 30 high burden districts, replacing the eight (8) districts whose numbers have fallen.

Key Recommendations
1. As more vaccines become available, and in areas where higher risk groups are not taking up the allocated vaccines, all people aged 30 years and above should be included in the vaccination drives. Also, all 20-year-olds and below should be monitored continually as the case load is most likely to grow in this age group.
2. Ministry of Health should establish sentinel sites where all or a systematic sample of people with a COVID positive test undergo a full epidemiological assessment. These sites should be supported with surveillance staff, and case-investigation forms that capture a minimum set of variables.
3. The Incident Management Team should strengthen Stewardship within the data collection team to closely monitor the variables of interest. Systematic and periodic epidemiological analyses should be conducted to understand the drivers for each new phase.