How residents in Zombo kicked out deadly plague

As the dry season approaches in Zombo District, residents living in plague-prone areas are mindful of the potential threat posed by rat bites, which can lead to infection by the deadly disease that has historically devastated families across the region. 

This is the time most wild rats leave their dens to look for food and cool shelter at home.

The wild rodents sometimes live on the roof of the grass-thatched huts. 

With poverty limiting access to proper bedding, many individuals sleep on papyrus mats on the floor, increasing their vulnerability to rat bites and potential infection. 

For at least five years now, no new cases of plague outbreaks have been recorded in the Zombo. 

The last case of the plague outbreak in West Nile, according to the Uganda Virus Research Institute (UVRI), was recorded in 2019.

According to the World Health Organisation, plague is an infectious disease caused by the bacteria Yersinia pestis, a zoonotic bacteria, usually found in small mammals and their fleas. 

It is spread through bite of an infected flea carried by the rats; handling dead infected rats, coming into contact with saliva, blood, urine or feces of infected rats.

The symptoms like flu, present in three to seven days. Other symptoms include the sudden onset of fever, chills, head and body-aches and weakness, vomiting and nausea.

As Monitor set foot in the villages to find out how the communities have been able to fight the disease, Ms Julia Acikani, a resident of Paduba, where outbreaks of plague were recorded annually, said: “People no longer believe that witch doctors would treat the disease. We have realised that when the rooms and compounds are made clean, the rats would not come.”
 
She said improved hygiene practices and investing in rat poison, have been embraced as effective measures to deter rats.

Here, it is called Tho uyoo or Zukpa and health teams have used the local dialect to sensitise the masses, including schools.
 
Narrating her experience, Ms Acikani said: “In 2010, my uncle almost perished due to plague, but we managed to rush him to a health centre early, and was treated. He had boils at the armpit which caused him chills, and a terrible headache.”
 
She added: “The nurses treating him could not sleep, especially at night, while for us, we were stopped from getting in contact with him. He could cry due to pain. Since then, I took advice from doctors seriously about having a clean home.”
 
Ms Acikani said families are encouraged to smear houses with cow dung and change the grass for roofs regularly. 

According to the Science Museum, the first outbreak of plague was recorded in the 1300s mainly in Europe and killed millions of people. It has persisted due to myths about the disease where people believed it was a divine punishment.

At the time of outbreaks, apart from quarantine and clean-up measures, the medical teams imposed restrictions on movement, limiting the number of people allowed at markets and increased travel and trade regulations with neighbouring DR Congo.
 
Mr George Opio, a resident of Zeu Trading Centre, noted the Uganda Virus Research Institute’s extensive sensitisation efforts, emphasising that people have diligently adhered to reporting any suspected cases early, even at health centres.
 
Mr Opio said: “Many people can now afford to buy beds and sleep on unlike in the past when they used to sleep on the floor. We ask the government to continue with surveillance because we do not wish for this disease in our area.”

Experience from doctor
Dr Sam Orach, a health worker, recounted: “In 1995, I went to Agiermach Mission Health Centre for a clinical out-reach. I found two patients had been admitted with bubonic plague and one had died that day. The following afternoon, together with other staff from Nyapea Hospital, I visited the home of the deceased and found many people gathered to pay respect to the dead one.”

Dr Orach advised people to avoid gathering to deter the spread of the infection. 

He said: “The crowd was annoyed by my remarks and indicated that I had shown no respect for the culture of paying respect for the dead for the past three or four days despite the fact that I was from the same ethnic background. I was also considered to have implicitly insulted the people as being dirty in their homes.”
 

He, however, said three days later the people from that village reached out to him, requesting his assistance again, as two additional individuals had succumbed to the infection. 

The plague
To combat the spread of plague, health experts from Uganda and the Democratic Republic of Congo (DRC) convened for three days in August last year to find solutions. They attributed the heightened risk of outbreaks to cross-border movement for trade, farming, and social interactions.

This makes the West Nile districts of Zombo, Nebbi, Arua, and Maracha bordering the DRC susceptible to contraction of the disease.
 
Also, according to 2023 statistics from the health department in the neighbouring DR Congo, there were 72 cases of plague and 14 deaths reported in 2023. The most affected zonal areas, include Rethy with 67 cases and 14 deaths, Logo with three cases and zero deaths, Aru with two cases and zero deaths, and Kambala with one case and zero deaths in DRC.
 
Efforts
Efforts to strengthen cross-border surveillance and response to plague are underway. 
 
According to the in-charge of Biringi Health District in Ituri, Dr Cleophase Ntumba, there were cumulatively 321 cases of plague cases reported in the DRC from 2021 to 2023. 

He highlighted the need for increased funding and support to address the disease’s high prevalence. 

“Of 321, we have had six deaths as a result of plague. We only have one laboratory that is being constructed in Bunia with support from the WHO that will now help us to do testing on samples. If we had a nearby laboratory, it would enable us to quickly do tests and manage the problems,” he said.
 
Dr Pascal Ulama, a health analyst, emphasised the importance of training personnel in disease surveillance and control.

“We ask the Ugandan experts to help train our personnel in disease surveillance, reporting, and control because it will be a great milestone for us because people move a lot in the two countries. We have been training our personnel on safe burial procedures to de-escalate the spread,” he said.

The Assistant Director of Uganda Virus Research Institute (UVRI), Dr Tom Lutalo,  stressed the necessity of collaboration with DRC health officials to detect and manage cases early.

“We need to ensure that there is collaboration with the health officials from DRC who could be able to detect, report and refer cases early because we cannot stop people from visiting their relatives or going for farming in DRC and vice versa,” he said.
 
He applauded government for setting up the laboratory in Arua City to manage sample tests both within West Nile and DR Congo once there is formalisation of the process. 
  
The Arua Regional Programme Manager-in-charge of Plague at Uganda Virus Research Institute, Ms Linda Atiku, highlighted ongoing efforts to curb transmission and protect communities from the disease’s resurgence.
 
“We last had cases of plague in West Nile or Uganda in 2019, where some community members in Zombo went and attended a burial in Congo. And so, a mother was infected and her family and only one child survived.  We have managed to use various mechanisms to stop plague to date.”
 
Statistics
The statistics of 2008 from the Arua health office indicate that 90 cases of human infections were recorded with 17 deaths. 
 
Distribution of total plague cases in Zombo District in 1998, 2000, and 2001 in the sub-counties of Atyak were seven, Jangokoro seven, Kango 128, Nyapea 38, Paidha Town Council 29, and Zeu 10.
 
In 2006, at least nine people were reported to have been killed following a fresh outbreak of plague disease in Okoro County.
 
In October 2007, two people were killed following the outbreak of plague in Kango Sub-county.