Abstract
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Abstract; Background: Globally, approximately 11–21 million people get typhoid fever annually. The disease is characterized by prolonged fever, headache, nausea, loss of appetite, and constipation or diarrhoea and the transmission is oral-faecal. In early 2015, the Uganda Ministry of Health, confirmed typhoid fever outbreak in Kampala city which quickly spread to the neighbouring districts. Strategies including preventive and curative measures were put in place to control the disease although the outbreak persisted and spread quickly. In response, this study was commissioned to identify risk factors that propagated the outbreak in Kampala and the surrounding districts, and to establish innovative ways of communicating risk and behavioural change messages to the populations at risk. Methods: This was a qualitative study among residents working in major food markets of Kampala, Mukono and Wakiso districts. Data was collected using 14 focus group discussions (FGDs), 25 Key Informant Interviews (KIIs), 10 In-depth Interviews (IDIs), and environmental observations within communities including major markets. A total of 10 FGDs from Kampala district were stratified by sex while the 4 FGDs conducted in Mukono and Wakiso districts were mixed by sex. Data was analysed employing the thematic approach using open codding. Results: Behavioural practices, environmental, health system and policy related factors propagated the outbreak. We established that poor personal and food hygiene, contaminated water sources, consumption of unsafe beverages, the prolonged dry season, inadequate disease surveillance and delay in diagnosis and treatment of cases were main factors that led to the outbreak. Our study established that the behaviour change approaches were electronic, media, print and face to face communication. These strategies created an understanding of the presence of the outbreak but had some limitations. The study highlighted major recommendations for future control of typhoid outbreak included innovative use of technology and intersectoral collaborations. Conclusion: Typhoid outbreak was spread through individual behavioural, environmental and health system factors. Innovative communication strategies including use of mobile technologies, school children as messengers, strengthened face to face communication by community leaders and expressing messages in terms of economic losses and gains were recommended.