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BackgroundUganda is currently implementing the International Health Regulations (IHR[2005]) within the context of Integrated Disease Surveillance and Response (IDSR). The IHR(2005) require countries to assess the ability of their national structures, capacities, and resources to meet the minimum requirements for surveillance and response. This report describes the results of the assessment undertaken in Uganda.MethodsWe conducted a descriptive cross-sectional assessment using the protocol developed by the World Health Organisation (WHO). The data collection tools were adapted locally and administered to a convenience sample of HR(2005) stakeholders, and frequency analyses were performed.ResultsUgandan national laws relevant to the IHR(2005) existed, but they did not adequately support the full implementation of the IHR(2005). Correspondingly, there was a designated IHR National Focal Point (NFP), but surveillance activities and operational communications were limited to the health sector. All the districts (13/13) had designated disease surveillance offices, most had IDSR technical guidelines (92%, or 12/13), and all (13/13) had case definitions for infectious and zoonotic diseases surveillance. Surveillance guidelines were available at 57% (35/61) of the health facilities, while case definitions were available at 66% (40/61) of the health facilities. The priority diseases list, surveillance guidelines, case definitions and reporting tools were based on the IDSR strategy and hence lacked information on the IHR(2005). The rapid response teams at national and district levels lacked food safety, chemical and radio-nuclear experts. Similarly, there were no guidelines on the outbreak response to food, chemical and radio-nuclear hazards. Comprehensive preparedness plans incorporating IHR(2005) were lacking at national and district levels. A national laboratory policy existed and the strategic plan was being drafted. However, there were critical gaps hampering the efficient functioning of the national laboratory network. Finally, the points of entry for IHR(2005) implementation had not been designated.ConclusionsThe assessment highlighted critical gaps to guide the IHR(2005) planning process. The IHR(2005) action plan should therefore be developed to foster national and international public health security.

Mycobacterium africanum is a member of the Mycobacterium tuberculosis complex, which also comprises the closely related species M. tuberculosis, M. bovis, M. microti, and M. canetti (21, 24). Since its first description in 1968 (3), M. africanum has been found in several regions of Africa, where it represents up to 60% of clinical strains obtained from patients with pulmonary tuberculosis (7,18,19,23).Recent surveys show highly variable prevalences of M. africanum in different African regions. For example, M. africanum was found in approximately 5% of patients with tuberculosis in the Ivory Coast and in at least 60% of patients in GuineaBissau (2, 10). Most of the studies presented so far have analyzed small numbers of strains from different regions, and systematic studies of prevalence and geographic distribution of M. africanum are still infrequent.In contrast to M. tuberculosis and M. bovis, M. africanum strains show a higher variability of phenotypic attributes, comprising characteristics common to both M. tuberculosis and M.bovis. This phenotypic heterogeneity of M. africanum complicates its unequivocal identification and may lead to misclassification of clinical strains. According to their biochemical characteristics, two major subgroups of M. africanum have been described, corresponding to their geographic origin in western (subtype I) or eastern (subtype II) Africa. Numerical analyses of biochemical characteristics revealed that M. africanum subtype I is more closely related to M. bovis, whereas subtype II more closely resembles M. tuberculosis (5).In our recent work, we determined diagnostic criteria, including phenotypic and biochemical characteristics as well as results of the molecular spoligotyping technique, that permit the accurate differentiation of M. africanum subtypes I and II (15). Spoligotyping is a rapid molecular test based on the detection of various nonrepetitive spacer sequences located between small repetitive units (direct repeats) in the direct repeat locus of M. tuberculosis complex strains. However, spoligotyping does not allow differentiation of M. africanum subtypes from M. tuberculosis without additional routine laboratory procedures. This drawback led us to evaluate the usefulness of gyrB DNA sequence polymorphisms as a further molecular marker for differentiation of the species of the M. tuberculosis complex (16).

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