Kampala — The First Lady, Janet Museveni, is the new minister for Karamoja Affairs. A lot has been said about what she can do for this most socio-economically marginalised region.

One would propose electrification and the provision of a robust and efficient transport infrastructure as the pillars for developing Karamoja. However, as a public health professional working in this region, I beg to differ.

A baseline survey by the International Rescue Committee (IRC) reveals that hygiene conditions of homesteads is appalling, with 61.1% households littered with faeces, while the latrine coverage stands at 0.3%. United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA) puts the figure at 9%, but I would attribute this to institutional latrines.

Knowledge on hand washing is lacking, with people knowing two critical hand washing events - before eating food and before preparing it. There is little knowledge of the other three critical and important events - after visiting the latrine or bush, after handling children's faeces and before feeding infants.

Poor sanitation and hygiene lead to diarrhoea. The incidence of diarrhoea is at 46.5%; loose stool in children below five can be seen in almost every Manyatta.

On a World Food Programme (WFP) organised dinner in Nakapiripirit, the resident district commissioner (RDC) thanked WFP for being a development partner to the region since 1964. This is a remarkable period of work, yet according to a 2008 report by UNOCHA, global acute malnutrition rate in this region stands at 11% and is rising, whereas the average for the rest of the country is 6%.

The motarlity rate in children under five is reported at 174 children per every 1,000 live births. These are staggering statistics, yet decades of development work have been dedicated to this region.

Speaking during the participatory hygiene and sanitation transformation training of government extension staff by the IRC, the deputy RDC expressed fears that poor sanitation had become the biggest threat in the region, next to insecurity.

Whereas relief food can be given to vulnerable children, it cannot achieve its end. In an article, titled: What is killing children?, published by www.nowpublic.com/health, diarrhoea and undernutrition (not malaria and AIDS) are the leading causes of mortality and morbidity among children under five in Africa.

This scenario would be avoided through proper excreta disposal and handwashing at the five critical times.

A boarding school in Kangole with 1,005 pupils has one five-stance latrine, never mind its condition. Considering the patchy nature of health facilities in the region, these children are sitting on a time bomb.

Elsewhere, myths such as a Karimojong elder should "never mix" his feaces with those of an in-law still loom, thereby making the idea of owning a latrine so alien.

Eradication of poverty, hunger, child mortality, achievement of universal primary education, gender equality and empowerment of women are the key aspects of the millenium development goals. We can set a right environment for their attainment by streamlining sanitation in all aspects of development programmes to improve the sanitation ladder of the people of Karamoja.

The writer is a public health officer of the International Rescue Committee, Karamoja region