12 April 2018

Uganda: Kagadi, Hoima Health Workers Grapple With Cholera Outbreak

Kagadi — The rapid outbreak of cholera, a highly contagious and deadly communicable disease, has strained healthcare workers in Kagadi and Hoima districts in Bunyoro Sub- region.

The outbreak was first reported in Kyangwali refugees' settlement camp and Buhuka landing site on Lake Albert in Hoima District in February and so far, it has claimed 44 lives.

Most victims are refugees fleeing tribal clashes in Eastern DR Congo, according to health workers.

Medical officers say the health systems in the two districts have been stretched given a scarcity of resource, limiting the care that should have been extended to the patients.

About 2,086 cholera cases have so far been reported in the two districts.

As the government and other aid workers battle the outbreak in Hoima District, the neighbouring Kagadi District is also facing similar challenges, particularly in Ndaiaga Sub-county on the Lake Albert shores.

The Kagadi cholera outbreak was confirmed mid last week by the Kagadi District health officer, Dr James Olwo.

The Kagadi District health inspector, Mr Peter Situma, says the outbreak, which was first reported on March 29, with only seven cases recorded, had escalated to 27 by Sunday evening.

The most affected landing sites are Kitebere, Kabukanga and Rwebigongoro in Ndaiga Sub-county.

He expressed that the disease would spread since most of the patients are being treated from their homes.

The district was by the end of last week yet to put up an isolation centre where the victims can access treatment.

Congolese refugees

A temporally isolation centre was only set up over the weekend at Kitebere Health Centre with the help from the World Health Organisation (WHO).

"We have so far registered 27 cases and three of them tested positive. Other suspected patients are being treated in their homes. It is dangerous but it is because we didn't have the requirements or logistics to handle the situation" Mr Situma said.

"We are pushing on but the numbers are increasing. When they reported on March, 29, we had seven cases but the numbers have been escalating... There are no fatalities recorded yet," Mr Situma says.

The understaffed health department of the district is strained by the outbreak.

Mr Situma says the district health staff in charge of handling the outbreak has been joined by other health workers from WHO operating from Kyangwali refugee settlement camp where another outbreak has occured.

The Hoima District Health Inspector, Dr Nicholas Magambo Kwikiriza, says the district receives refugees from the DR Congo, some of whom cross over with the disease and spread it to surrounding communities.

Mr Mugenyi Mulindambura, the Hoima District secretary for health and education, says: "The coming of thousands of refugees in the district has strained the social services such as water and medicine.

This is because by the time the 2017/2018 budget was approved, Hoima had less than 40,000 refugees. From December last year to date, the district has received over 50,000 new refugees who the district had not planned for."

Dr Kwikiriza blames the outbreak on poor sanitation. He says the district is working with other partners to contain the disease.

Measures taken

He says: "We have now put up measures like latrine construction, hand washing, access to safe water and social mobilisation and establishment of case management committees".

Dr Kwikiriza adds: "Health workers handling other ailments have been diverted to handle the outbreak. We also have other players like World Health Organisation, Unicef and Medicines Sans Frontiers International who are helping us in the provision of aid like emergency vehicles to transport the sick to hospitals".

The hard hit area are Kyangwali refugee settlement camp in Kyangwali Sub-county, Buhuka landing site and Senjojo Island, all in Hoima District.

Dr Kwikiriza mentions the health facilities handling most cholera cases as Kituuti and Sebagoro health centres.

"In our structure, we had 19 staff at each health centre III. However, the cholera epidemic required us to boost manpower at those centres. We transferred some staff from health centres that are in other sub-counties to the affected areas," Dr Kwikiriza said.

Ten additional health worker workers were sent to each of the health centre III handling the cholera cases.

He said they are working in two shifts per day. "Each shift has 1 doctor, at least three clinical officers, and four nurses" he added.

He said each day, health workers are sent to the communities to sensitise people.

Dr Bwire Godfrey, the principal medical officer at the Ministry of Health said cholera treatment centres were established at Kasonga, Buhuka and Sebagoro to bring services nearer to the people.

The nature and location of the landing sites had made the work of health workers difficult because of inaccessibility of the hard-hit landing sites and islands on Lake Albert.

Dr Kwikiriza said the cost of managing the cholera outbreak is likely to skyrocket, putting the estimated cost at Shs500m.

He cited Senjojo Island in Buhuka Parish, Kyangwali Sub-county where health workers are supposed to use boats to access cholera patients.

"Given the nature of topography, some places are difficult to access, such as islands, we need boats. The outbreak may take over Shs500 million to contain," he said.

The same challenge is being battled by Kagadi District.

The Kagadi District vice chairman, Mr John Alibankoha, says the district has to meet the cost of transporting and accommodating health workers at Kitebera landing site.

"Most of the affected areas are hard to reach. From Ndaiga to Kitebera it is about 15 kilometres and no vehicle can access this epicentre of the disease. Shs40, 000 is needed to transport only one health worker to the landing site and we need at least five (health workers per outreach)" he says.

He added: "The area has no accommodation and the health workers are supposed to stay there. We have written to the Health ministry over this issue."

Poor pit-latrine coverage

Pit-latrine coverage in Ndaiga Sub-county is below one per cent, thereby leaving residents with an option of either disposing human waste in the open on land or in the lake.

Whenever it rains, all waste and other unhygienic materials are washed away and dumped into the lake where people fetch water for drinking and domestic use without any form of chemical treatment or boiling.

The cycle continues, leaving the area at risk of contracting hygiene-related diseases.

Kagadi District leaders and health workers are preparing to hold a sensitisation campaign in Ndaiga Sub-county to raise public awareness on sanitation and hygiene.

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