Evelyn Lirri
23 April 2008
opinion
It has been centuries since diseases like malaria, tuberculosis, sleeping sickness and leprosy among others were first discovered. Yet it has taken more centuries to battle - with not much success - these ancient diseases which are treatable, curable and preventable and whose means of prevention is usually cheap and available.
For years now, malaria has been Uganda's most threatening and leading killer, claiming the lives of between 70,000 to 110,000 people every year.
According to the Ministry of Health statistics, 95 percent of the country has perennial malaria transmission and only 5 percent seasonal transmission. Perennial transmission emerges when a disease becomes persistent in an area recurrently for a long period of time.
The ministry also says that 25 to 40 percent of all outpatient visits at health facilities and 20 percent of hospital admissions are as a result of malaria. Another 9-14 percent of in-patient deaths, according to the Ministry of Health, are as a result of malaria.
Majority of its victims are children. This is because malaria usually kills children in combination with other ailments like childhood anaemia, reduced growth and mental retardation. As a result, malaria is said to account for more than a quarter of all causes of death among children in Uganda, the rest of the burden being contributed by diarrhoeal illnesses and pneumonia.
In total, Uganda loses about 200,000 children every year to preventable and treatable yet often severe diseases like malaria, diarrhoea and pneumonia.
Out of the 200,000, for example, over 40,000 die of diarrhoeal diseases alone, according to Commissioner for Clinical and Community health in the ministry of health, Dr Kenya Mugisha. Dr Mugisha attributes this to low coverage of pit latrines, safe water and poor hygiene at house-hold level. Uganda's current latrine coverage is about 50 percent.
"People don't deposit all faecal matter in the latrines, they don't wash hands after visiting the toilet or when they are going to serve food and end up consuming faeces," he said.
To be able to combat diarrhoea, the ministry recently launched a newly formulated Oral Rehydration Salts (ORS) that will be jointly used with Zinc tablets (Zinkid) to treat children under the age of five.
The new ORS formula and Zinc is being promoted by the Ministry of Health in collaboration with the World Health Organisation, UNICEF, and USAID and AFFORD, the Health Marketing Initiative as a new child survival strategy. Like malaria, more than a century after the discovery of Mycobacterium tuberculosis, the bacillus that causes Tuberculosis, and a half a century after the discovery of antibiotics to treat the disease, TB is still taking its toll on the population.
In Uganda, with 80,000 new cases occurring annually, TB contributes a large proportion of the country's high disease burden and death.
Uganda also ranks at number 15 among 22 countries with the highest TB cases worldwide.
The absence of a fast and simpler drug regimen that would shorten treatment is escalating the disease. In fact the World Health Organisation in its latest report released in February 2008 says that multi drug resistant TB is on the increase across the world.
"WHO estimates there are nearly half a million new cases of multi drug resistant TB-about 5% of the total nine million new TB cases worldwide each year," the report says.
Multi drug resistant TB which is untreatable, according to the report has been recorded in 45 countries across the world including Uganda.
Though efforts are in place to fight the epidemic, Uganda still lags behind on the global TB targets set to be able to contain the disease.
The Global Strategy to stop TB requires countries to detect at least 70 percent of the infectious cases of TB and also treat and cure 85 percent of the patients annually.
For the case of malaria, while early diagnosis and treatment can help control the disease, recent years have seen that a rapid spread of anti malarial drug resistance continues to undermine malaria control efforts.
At the moment, Coartem is the most effective malaria treatment especially in areas with high resistance to conventional anti malaria treatment.
The government's proposal in 2005 to combat malaria with the controversial insecticide DDT sparked a heated debate, with advocates of the use of DDT to eradicate malaria arguing that it is a cost-effective measure that tackles the cause of the disease, rather than simply reacting to its effects.
Uganda's high maternal mortality, even if it has reduced from 505 to 434 deaths for every 100,000 births has remained high over the last 15 years.
Yet target four of the UN Millennium Development Goals (MDG) which seeks to reduce by two thirds, maternal deaths, is far from being achieved. According to the MDG, it is projected that Uganda's maternal mortality would be at 132 deaths for every 100,000 live births by 2015.
But as long as women do not seek treatment from skilled health personnel, coupled with high fertility rate, increased teenage pregnancies and low contraceptive use, more women will continue to die in child birth.
Even if these diseases remain the biggest and oldest threat to the country, the already overburdened and underfunded health sector cannot effectively address the problem.
Uganda's share of the national budget to the health sector which stands at 8.3 percent is still below what was agreed on in Abuja, Nigeria in 2001 during a summit of health ministers called to specifically address challenges of HIV/Aids, TB, malaria and other infectious diseases.
African leaders at this conference agreed to increase the health budget of their respective countries to at least 15 percent. The Abuja declaration also includes a commitment by government leaders to take all the necessary measures to ensure that resources like infrastructure and equipment are made available.
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