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

Conducted 16 focus group discussions (FGDs)

20 key informant interviews

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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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Results

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Number of Lightning Strike Victims by Time

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First notification

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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Distribution of Lightning strikes in Uganda-June to July 2011

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Number of lightning victims by district

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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

Teeth Damage in a male victim

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Burn injury in a female victim

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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Solar systems and class rooms destroyed by lightning

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House burnt by lightning strike

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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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Beliefs and practices

Burying the victims away from homes and at the river

banks

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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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Acknowledgements

• Ministry of Health Uganda• CDC• USAID Respond• AFENET• Meteorology School Uganda

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