Cyril Mugyenyi
5 November 2008
opinion
There is a saying that health is made at home and only repaired in health units. Whether this is real in the Uganda context is still a matter of debate. The health system emphasises curative approaches and management of health units without removing the root cause of ill health.
With mere effective washing of hands and mosquito bed nets we can reduce mortality by a sizable margin. Lack of clean water and poor sanitation is the second most important risk factor in terms of the global disease burden after malnutrition.
According to Plan International, an NGO, access to safe water and environmental sanitation are vital for the dignity and health of all people, and it is especially important in ensuring the healthy development of children.
Every year around 2.2 million children die from diarrhoeal related diseases (one child dying every 15 seconds). Many more are left underweight, stunted mentally and physically, vulnerable to other deadly diseases, and too debilitated to go to school.
About 2.4 billion people globally live under highly unsanitary conditions and have such poor hygiene behaviours that their exposure to incidence and spread of infectious diseases, are enormous. This situation in today's world is both humiliating and morally wrong.
Our national water and sanitation records reveal that latrine coverage is 59 per cent and hand-washing with soap after visiting a latrine is 14 per cent, safe water coverage is 63 per cent.
This implies that 41 per cent of the population dispose of their human waste in the open. As a result, faeces get into the domestic water sources we use and the food we eat through various path ways. Contaminated water and soils have roundworm and hookworm ova and other disease pathogens that cause dysentery, typhoid and cholera which remain in a sick population where disease is cyclic.
On our day-to-day business a person may shake hands with about 10 people many of whom never washed their hands after visiting a latrine, touched the door lock of a car, held bank notes or coins, touched the door of a house etc. The dirt full of pathogens collected from every object is alive in the hands.
How much money can we save if we just invested in teaching our people to wash hands with soap before and after eating? What about teaching about hand-washing after visiting and covering latrines? What about oral hygiene; teaching everybody to clean their teeth after every meal instead of only after waking up in the morning which is the common practice?
To appreciate the gravity of the sanitation problem in our society, try to be observant each time you attend a party. At meal time more than 80 per cent of the guests eat without washing their hands only to do it after. The majority just wet their hands with water (which activates the germs) and then begin eating. Soap is used after eating to remove fat and not germs.
According to WHO intestinal worms infect more than 10 per cent of the population of the developing world, and can lead to malnutrition, anaemia and retarded growth, even where food is sufficient young children will continue to have malnutrition as long as people continue ingesting food contaminated with worm ova and cysts. Worms once inside the intestines are known to inhibit digestion of food protein.
Suppose we consider use of treated mosquito bed nets an essential sanitation requirement for every person. The moment we cut off human-mosquito contact the results would be overwhelming, malaria cases would be reduced by over 80 per cent and we will save almost the entire health budget and increase on the hours spent caring for the sick.
If those pools of water seen in and around our urban and semi urban areas were drained to deny the mosquito breeding grounds, results would be interesting.
The aim of sanitation is to block all these pathways of disease spread analogous to immunisation.
We need to prioritise environmental sanitation compared to curative services. Common sense should prevail that environmental sanitation is supported by curative services.
Mr Mugyenyi is an environment specialist and a member of the Daily Monitor Panel of Experts
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