Why typhoid is still a problem in Kampala

A walk to downtown areas of Kampala city, which were worst hit by the typhoid outbreak a few months ago shows some lessons have not been learned – yet. Food vendors still sell bottled water and beverages which were found to be the source of the problem.
One Ssali, who believes he contracted typhoid after eating mangoes, says that the illness forced him to stop working for about three weeks since he had to drink a lot of water and fluids from home, which was not available at the office.
“I went back for checkup after the treatment and the doctor found me negative. However, I suspect the mangoes I took caused me problems. I like eating the green cover,” he says.
The typhoid outbreak that hit Kampala and its neighbouring districts of Mukono and Wakiso for about four months was confirmed by the Ministry of Health and Kampala Capital City Authority (KCCA) in February this year.
The director general of health services, Dr Ruth Aceng, then noted the confirmation was after investigations into reports initially of a strange diseases among individuals working at Qualicel, Nabukeera Plaza, and Total Petrol Station in Nakivubo. The strange illness at the time, which killed two people, was later confirmed as typhoid.
Dr Monica Musenero, the assistant commissioner in-charge of epidemiology and epidemic diseases, said investigations had revealed that people were affected through eating or drinking things that were contaminated at their work stations.
Efforts were made to deal with the disease and finally in June, Dr Aceng announced an end to the outbreak, reporting that a total of 14,304 suspected cases were received. Of these, 10,230 met the case definition for typhoid and were treated in the six designated treatment centres in Kampala’s divisions. However, she said, a total number of confirmed cases stood at 1,090 cases out of which 52 cases were confirmed by blood culture and 1,038 by Tubex.
Dr Willington Amutuhaire, the supervisor epidemiology and disease control in the health department at KCCA explained that the human and environment samples collected and investigated in February confirmed presence of pathogens which cause typhoid.
“We collected samples of water and other beverages from the areas, which were hard hit by the outbreak. For water and food, we were looking for contamination but for environmental samples we were looking for faecal matter,” said Dr Amutuhaire who was the lead supervisor of the health facilities demarcated as insolation treatment centres.
According to Dr Amutuhaire, January and February are dry seasons and the level of water in the springs, wells and channels goes down. This leads to increased concentration of typhoid-causing bacterium known as Salmonella Typhi.
“Due to the lack of water, people are forced to drink water containing typhoid pathogens thus the emergency of the problem,” he added.
However, he was quick to state that the absence of water does not take away the challenge of poor personal hygiene and sanitation in Kampala, and this is one of the reasons the typhoid problem has not been completely erased.
A study conducted and released by the Ministry of Health this year, titled, “The National Burden Food Borne diseases Pilot Study Report,” indicated a rise in the number of patients diagnosed with food borne diseases due to sanitation failures, consumption of contaminated water, chemical residues and other contaminants in food.
Another study conducted by scientists from the Center for Disease Control and Prevention (CDC) and KCCA officials during the typhoid outbreak indicated high levels of faecal contamination in springs or wells, and in some brands of bottled water.
Citing the root cause of poor hygiene and sanitation which is absence of water, Dr Amutuhaire says the water supply that is clear of those pathogens, from NWSC, is still limited to a few households and the toilet coverage is also a nightmare in Kampala as “flying toilets” are still an alternative for some people.
Dr Amutuhaire also blames the disease outbreak in Kampala to lack of strong disease surveillance systems and limited funds.
“In the first place, if we had a strong surveillance system this would not have happened,” said Dr Amutuhaire.
Dr Charles Okot, an adviser with World Health Organisation (WHO) on Disease Surveillance and Response also emphasised the need for early detection of the disease and encouraged proper sanitation to prevent typhoid.

According to the health expert, behavioural change is needed among majority Ugandans but also the other regulatory bodies including Uganda National Bureau of Standards and National Water and sewerage Corporation, should play their part.
At Kisenyi Health Centre IV, which was designated as typhoid screening and treatment centre during the outbreak, Mr Ronald Lubega, a nursing officer who heads the Out-Patient department (OPD) said the situation has since normalised ever since the ministry declared an end to the outbreak.
“After following up all the cases, in a week, we currently receive and diagnose about two people with typhoid fever,” said Mr Lubega.
He added that most of the typhoid patients who were treated those days come from Nansana and Makindye divisions.
“We provide information on how to avoid typhoid by advising all our patients to boil drinking water, promote personal cleanliness and avoid eating dirty fruits and also eating from dirty places,” said Mr Lubega.
Although work has been done to deal with the outbreak, typhoid remains a problem and more needs to be done.

Causes

Typhoid fever, water borne disease, is associated with fever caused by bacteria from a group called salmonella. In humans it’s caused by Salmonella typhi.
Symptoms include: Fever and abdominal pain, cough, joint pains, general malaise and dizziness.
Most cases during the outbreak were identified among people working around Nakasero Market, Disableds’ Maket, New Taxi Park, Allen Road, Nabukeera Plaza, Qualicel and Total petrol station on Namirembe Road. However, most of the affected people reside in Kibuli, Namungoona, Lugoba, Kanyogaga, Bulenga and Natete, all Kampala suburbs and some from Wakiso.

Big restaurants, hotels also culprits

On addressing the disease burden, Amutuhaire noted that food safety and hygiene in Uganda is still a big challenge given that even the so called big and famous food restaurants and hotels have been found lacking.
“You have seen us close famous eateries, supermarkets and food houses with rotten kitchen areas,” he says.
Amutuhaire adds that the business community has a role to play in fighting this food borne disease because most of the restaurants are owned by ordinary people.
“The contaminated beverages are still on the market but as the KCCA health department, we are doing everything possible to stop the unhygienic businesses but the media has to supplement us on social mobilisation both on the supply and demand side,” he added.

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