17 April 2018

Uganda: Districts On High Alert Over Cholera Outbreak

The rainy season is often associated with various challenges such as floods and cholera outbreaks.

Recently, cholera, a highly contagious and deadly communicable disease, claimed 44 lives in Kagadi and Hoima districts in Bunyoro Sub-region.

The cholera outbreak was first reported in Kyangwali refugees' settlement camp and Buhuka Landing Site on Lake Albert in Hoima District in February. About 2,086 cholera cases have so far been reported in the two districts.

The lingering questions are: Is it ignorance of the people to improve their personal hygiene? What really is the problem?

Many districts in eastern Uganda have always experienced an overwhelming number of cholera cases during rainy seasons.

Between two and three months last year, a number of districts such as Busia, Manafwa, Sironko, Bulambuli, Mbale, Kibuku, Namayingo and Butaleja were hit by the epidemic, recording about 40 deaths and affecting more than 200 people.

"The challenge is that many communities in various districts lack pit-latrines and end up defecating in open spaces. If nature calls, definitely one has to move into the nearby bush," one of the victims says.

Mr Willaim Kwiri, a resident of Bunyoro Village in Kadama Sub-county, Kibuku District, was among those who were hit by cholera epidemic.

He narrowly survived death recovering at Nabiganda Health Centre where he was admitted at an isolation centre.

The cholera outbreak reportedly struck Nandere Parish in Kadama Sub-county On April 17, 2017, and later spread to various sub-counties in Kibuku.

The Victims

According to the Kibuku District health officer, Dr Ahamed Bumba, the cholera epidemic reportedly left one person dead and a total of 15 people infected and admitted to Kadama health isolation centre under severe condition.

According to Dr Bumba, the poor sanitation and hygiene practices in various communities has exposed residents to contradicting the epidemic.

District health authorities say many communities in the district are being affected by the epidemic due to a number of factors, including inadequate safe water supply and lack of sufficient pit-latrine facilities.

The communities that have been hit by the epidemic are constrained to access safe drinking water, and eventually resort to using contaminated water from unprotected springs for domestic use.

Cholera characterised by severe acute diarrhoea coupled with vomiting and general body weakness. The outbreak of the disease in the few districts is attributed to the state of hygiene that remains wanting.

Dr Bumba says strategies have been put up to avoid further spread of the disease.

The health workers, mainly those handling patients suspected to be having cholera signs are normally availed with protective gears and logistical requirements. The necessary emergency drugs have been supplied to the health centres.

Also, district leaders have been sensitising communities on control strategies, use of safe water chain, proper hygiene and sanitation practices. Control measures, include restrictions of sale of food stuffs on the roadside and in unhygienic places.

Residents have been encouraged to boil water before drinking, eat warn food, wash hands before and after eating, avoid fetching water from swamps/rivers, avoid eating foods or drinking juices sold on roadsides, embrace good pit-latrines practices.

"All the suspected cholera cases that were received are currently confined at an isolation unit at Kadama Health Centre. Others patients have been barred from visiting the ward as a control measure to prevent more people from getting infected," Dr Bumba says.

"The situation will be put under control and some of them are responding positively as health workers continue to monitor the few isolated cases that are still undergoing treatment," he adds.

Pit-latrine coverage in the district remains at 78 per cent, implying that 22 per cent residents do not pit-latrines, which poses great risk.

Kibuku District has safe water coverage of 75 per cent but areas on River Namatala, have a lesser safe water coverage.

Supplementary funding

To address the water stress in these communities, leaders recommend the need for the district to get supplementary funding from central government and other development partners to improve the water coverage.

According to various recent health surveys, many communities in some areas have no-pit-latrines facilities. The district has embarked on making ordinances to deal firmly with those who do not have pit-latrines.

In Mbale District, the district health officer, Dr Jonathan Wangisi, says since the outbreak of the epidemic on December 7, 2015, the district has recorded 110 cases with four deaths.

The most affected areas with high levels of people affected with the disease were found to be in Bunghokho-Mutoto where at least three people died, which he attributes to use of contaminated water and lack of pit-latrines.

"The cumulative figures of cholera have jumped from 110 cases, which is worrying because on average, the health department registers four new cases every day. This worrying figure is compounded with many factors and among them is lack of clean water," he says.

Dr Wangisi says all the suspected cholera cases were confined in two cholera treatment centres, which were set up at Namanyonyi HC11 and Namatala HC1V, which in the Industrial Division.

In Butaleja District, the district health officer, Dr John Matovu, says more than eight people have succumbed to the epidemic and a dozen hospitalised at Nabiganda Health Centre for treatment.

In Busia District, the acting district health officer, Ms Lilly Achayo, says two people died due to cholera epidemic and 10 others were infected last year. She says five sub-counties; Eastern Division, Western Division, Busitema, Ikuda and Dabani were affected. The victims were confined at Busia Health Centre 1V.

In Bulambuli District, Dr Mohammed Mulongo, the district health officer, notes that three people died and 234 were infected. Similarly, in Manafwa and Sironko districts where the government prison facility was hit with the disease.

"Cases of cholera are registered during the rainy season. People should observe proper hygiene and sanitation to avert any possible outbreak," he says.

Measures

Strategies. Kibuku District health officer, Dr Ahamed Bumba says strategies have been put up to avoid further spread of the cholera. He says health workers, mainly those handling patients suspected to be having cholera, are normally availed with protective gears and logistical requirements.

Drugs. The necessary emergency drugs have been supplied to the health centres.

Education. Leaders have been sensitising communities on control strategies, use of safe water chain, proper hygiene and sanitation practices. Control measures, include restrictions of sale of food stuffs on the roadside and in unhygienic places.

Safe practices. Residents have been encouraged to boil water before drinking, eat warn food, wash hands before and after eating, avoid fetching water from swamps/rivers, avoid eating foods or drinking juices sold on roadsides, embrace good pit-latrines practices.

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