Why typhoid is still a problem in Kampala

Children take juice packed in buveeras. Sometimes the water used to make such beverages is not boiled and is contaminated . PHOTO BY Rachel Mabala

What you need to know:

There was a typhoid outbreak in Kampala last February. Emmanuel Ainebyoona assesses the aftermath of the epidemic and measures being taken to avert a future outbreak

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.

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