5th April 2016
UNHCO: A fresh outbreak of cholera has been reported in Eastern Uganda. The Monitor newspaper reported that at least one person has been confirmed dead and more than 25 others hospitalised following a cholera outbreak in Butaleja District. Out of 25 suspect cases at Nabiganda Health Centre IV; the district health Office confirmed one dead. In Uganda, sporadic cholera cases are reported throughout the year, especially during the rainy season, when waste is often carried into rivers and lakes where people continue to collect drinking water. The major outbreaks are associated with changing weather patterns due to the occurrence of El Nino in the country. The cholera situation in Uganda is worsened by overcrowding in some areas due to influx of refugees from neighbouring countries, poor sanitation and waste disposal.
Butaleja case follows Cholera outbreak in Mbale and Sironko districts early this year, which left many hospitalized and over 10 people dead. The outbreak was first reported on Easter Monday at Nabiganda trading centre in Kachonga Sub-county. The Health department has since opened up an isolation centre at Nabiganda Health Centre IV to manage the cases. Presently the most affected areas are Kachonga and Mazimasa. It is suspected that the epidemic could have spread to Butaleja from the neighbouring districts of Busia, Tororo, Mbale, Sironko and Bulambuli where cases of the deadly disease have been confirmed between 2015 and2016. Cholera is very contagious as Dr. Jonathan Wangisi the Acting district health officer –Mbale confirms; “Since the epidemic broke out in December, cases have shot up from 56 to 110 while five people died; at least four new cases are registered every day.”
Heavy rains vs. disease outbreaks: Cholera, Malaria and Typhoid
The Executive Director Uganda National Health Consumers’ Organisation (UNHCO)-Robinah Kaitiritimba calls on local leaders to increase Community vigilance as heavy rains start. She said; “There is need for increased vigilance now that the rainy season has started.” A rise in cholera, Malaria and typhoid cases and deaths in Uganda is predicted beyond the cases so far reported in the various districts across the country due to their mode of transmission. She said government pays a lot of remuneration to community leaders as such civil society expects that at a time like this Local leaders are focused on managing and supervising environmental health: safe food, water and sanitation facilities and providing information to communities. Community leaders should be focusing on most at-risk population, in addition to community outreach and awareness campaigns that stress the importance of personal hygiene, especially hand-washing; safe water, adequate sanitation and proper hygiene are critical to good health. Without water, sanitation and proper hygiene, health interventions would not succeed. Leaders therefore need to be focused on the underlying causes of water-and-sanitation-related disease outbreaks, follow up cases and report deaths. Water availability, water quality, waste management, and community hygiene, community monitoring and awareness would best protect at-risk populations from cholera and similar illnesses.
Robinah Kaitiritimba noted that being a crowded area Kampala District is likely to be more affected by a cholera, malaria or typhoid outbreak. She appreciated work done by the Kampala Capital City Authority (KCCA) in promoting cleanliness, maintaining and constructing drainages, removing unsafe/unhealthy structures, constructing markets and others. Robinah is calling upon community leaders to support KCCA with monitoring and maintenance of general cleanliness-keeping drainages open and clean, clearing bushes around homes, remove empty containers, ensuring that households do proper food, faecal, water waste disposal within the communities. These she said the leaders should do along with teaching the population about their health responsibilities which should not be left to the Ministry of Health and its agents. Robinah recommended that households need to return to “bulungi bwansi” where local leaders spearhead households in collective environment health management and maintenance. She said this includes cleaning around
homes and public places, clearing roads and bushes, cleaning around water sources and boiling drinking water, ensuring every household has a pit latrine, homes are swept and well kept, safe food preparation places are set up, in villages or slums households use drying rack-katandalo to keep food utensils clean and the sick are reported or taken to hospitals for management.
Robinah said if people are prepared, the cases and possibly the death toll will not spiral. That is why the public needs to be warned about the rainy season. Leaders need to adopt hygiene and sanitation sensitization as a crucial component of the strategy to control the 3 disease outbreaks. The public is further urged to be vigilant and report all suspected cholera, malaria, typhoid, dysentery cases and other strange deaths to the nearest health facility.
Risk of malaria
The public should always sleep in a mosquito net to avoid mosquito bites that could cause malaria. “The rainy season usually comes with a rise in malaria cases from a female anopheles mosquito. When stagnant water is left in our neighbourhoods in anything that can hold water like flower vessels, old tyres or water containers, mosquitoes will have found a perfect breeding ground.” According to a study, “Relationship between malaria infection intensity and rainfall pattern in Entebbe peninsula, Uganda”, parasite density tends to rise soon after the start of the rain. “As vector population increases, transmission of infection subsequently rises hence the increase in parasite density,” the report says. We appeal to the public to conduct residual indoor spraying and be inside the house early to minimise mosquito bites especially those living around swampy areas or water bodies, thick shrubs or many trees, empty plots, water channels. One can also opt for safe repellents or take anti-malaria medicine.
Cholera Epidemiology in Uganda
According to the World Health Organization, cholera remains a global threat. Since 1979, cholera has been endemic in Uganda. The biggest epidemic was recorded in 1998 (over 38,600 reported cases). While sporadic cholera cases are reported throughout the year, outbreaks are associated with the rainy season and overcrowded places such as refugee camps [International Federation of Red Cross and Red Crescent Societies, Uganda: Epidemic Cholera 2009].
What is cholera?
Cholera is an acute diarrheal disease caused by an infection in the intestines that can kill even a healthy adult in a matter of hours. Symptoms include severe watery diarrhoea which can surface in as little as two hours or up to five days after infection, and can then trigger extreme dehydration and kidney failure. With such a short incubation period, cholera can easily explode into an outbreak, as is the case currently in Eastern Uganda where there have been over 100 confirmed cases since the beginning of the year. Approximately 80% of people infected with the cholera bacterium never develop symptoms. However, the bacterium stays in their faecal matter for seven to 14 days, leaving others at risk of infection. Of those who develop symptoms, 80% of them are mild to moderate while between 10% and 20% develop severe watery diarrhoea. If left untreated, as much as 50 percent of cholera cases can be fatal.
Cholera is caused by vibrio cholera germs and it is transmitted by eating food contaminated with the pathogens that thrive in human faecal matter. Cholera is a serious acute infectious disease characterized by watery diarrhoea and vomiting and kills a person within hours.
Cholera is most common in areas that lack clean water sources and sanitation services. Areas like refugee camps and urban slums, where people live in close proximity with little to no access to clean water and sanitation facilities are at a very high risk of experiencing a cholera epidemic. In complex emergencies like war and natural disasters, in which thousands of people are displaced and forced to resettle amid poor living conditions, cholera is particularly a threat as health infrastructure is frequently damaged or non-existent. Most cases – 80% can be treated through oral rehydration salts (ORS), which help reverse dehydration and restore potassium levels following the onset of acute diarrhoea. The most severe cases, in which the patient is extremely dehydrated, can be treated through intravenous (IV) fluids and antibiotics.
Precautions during rainy season
1. Keep Rain gear with you always
2. Take Vitamin C
3. Shower if rained on
4. Take hot drinks
5. Ensure you leave in a clean environment
6. Drink plenty of water
7. Watch what you eat
8. Wash your hands as many times as possible and before eating