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Epidemiological Study of Lightning Strikes in Uganda, July 2011
Stella Immaculate Akech, Benard Ngago, Ben Nsajju, Arthur Bagonza, Monday Busuulwa, Monica Musenero, Chima Ohuabunwo, Sheba Gitta
Nakacubo, David Mukanga
UMA-UVA International Conference
Background • Worldwide, lightning
strikes cause serious injuries in 1000-1500 individuals annually
• One of the most frequent causes of death due to natural phenomena
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•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
Background
• Raised public concern and prompted MPs to raise this matter in parliament
• High incidence and mortality rates indicated
probable gaps in knowledge and protective practices
• Information pertaining to the associated risks,
geographical distribution, population affected and
individual pattern was scanty
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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 4
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
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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
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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
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Known risk factors for lightning strikes
• Rain water harvesting (Meteorologist)
• 2/112 (1.8%) killed while harvesting rain water
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Known Risk factors for lightning strikes
• Sheltering under a tree when raining (Met-KI)• 18.8% (21/112) were struck while under tree shelter
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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
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Known Risk factors for lightning strikes
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• 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
Known Risk factors for lightning strikes
• Metallic clothes’ drying lines were associated with 4 deaths and 6 injuries from lightning strikes
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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
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Public health effects
Table 3: Injuries due to lightning strikesInjury Frequency (N=181) Percentage (%)Burns 86 47.5Paralysis 39 21.5 Shock 26 14.4Memory loss 6 3.3Weakness 9 5Headache 6 3.3Backache 4 2.2Sight loss 2 1.1Hearing loss 1 0.6Loss of teeth (after falling) 1 0.6Loss of limb (indirect) 1 0.6
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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
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Socio-economic effects of lightning
• Livestock loss
• School drop out
-orphans could not afford fees
• Property destruction
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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)25
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)26
Socio-cultural practices related to management of lightning strike victims
• Confiscating all properties from the affected
households (FGD,KI)
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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
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Public Health Actions
• Disseminated• Ministry of Health• Environmental Health Conference• Sensitized
• Next steps • Develop IEC materials• Sensitize and educate communities
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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
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