How cholera was wiped out in Arua City
Residents of Oli Division collect stagnant water after rainfall. Such contaminated sources contribute to the spread of waterborne diseases. Photo by Felix Warom Okello.
What you need to know:
For over 20 years, health authorities have battled the annual threat of cholera, which has claimed lives and caused suffering among Arua residents
In 2010, when Ms Sauda Ayikoru, 44, a resident of Obolokofuku Cell in Arua Central Division, experienced stomach cramps, body aches, and severe weakness during the night, she had no idea what illness she was battling.
That night, she visited the toilet about seven times and attempted to take Flagyl tablets as an emergency remedy to make it through to morning. But her condition worsened with persistent diarrhea. By morning, she was too weak to stand and was rushed to Oli Health Centre, where she was diagnosed with cholera.
"I have never had a worse night in my life. At one point, I thought I was dying. I was extremely weak, and my head was spinning. It was a horrible experience," she said.
While at the health centre, medical personnel and relatives had to use a basin to collect the watery stool she was passing frequently. "I couldn’t even get up to walk to the toilet because the diarrhea was so frequent. Nobody should underestimate cholera," she warned.
Asked how she might have contracted the disease, Ayikoru recalled buying cold roadside food the day before. "I believe the food was contaminated. At home, we drink boiled water and maintain proper hygiene. I thank Allah for saving my life," she said.
That morning, four other cholera cases were admitted to the same facility.
For over 20 years, health authorities have battled the annual threat of cholera, which has claimed lives and caused suffering among Arua residents.
Last Cholera Outbreak
The last recorded cholera outbreak occurred in 2015, with 11 confirmed cases. The affected areas in the then municipality were plagued by uncontrolled sewage, low water coverage, poor garbage disposal, and inadequate drainage.
Another survivor, Mr Bosco Andema, from Aroi Sub-County (now Ayivu West Division), was taken to Arua Regional Referral Hospital. "I had Oral Rehydration Salt (ORS) at home, which helped. I was aware of the outbreak and had stocked it as part of a first aid kit," he said.
He took antibiotics and ORS before being put on a saline drip at the hospital, which helped stabilize his condition.
The outbreak areas included Oli B and Oli C Cells, and Adalafu village in Dadamu Sub-county (now Ayivu West Division).
In 2013, latrine coverage in Oli Division was only 48 percent, with many resorting to 'flying toilets' – using polythene bags to dispose of human waste.
A 2010 survey by Act Together and the Uganda Slum Dwellers Federation found that most families used pit latrines, with little to no drainage systems. Wastewater often flowed freely through settlements. For example, Upper Bibia, with about 3,390 people and 624 households, had only 280 pit latrines.
Due to recurring outbreaks, health teams adopted a robust approach: crafting targeted messages, conducting door-to-door sensitization, and removing makeshift houses lacking proper sanitation.
Cholera, being a migratory disease, can spread quickly through communities.
Infections and Deaths Over the Years
- 2008: Over 38 cases, including 3 deaths
- October 2008: 6 deaths in River Oli Division
- 2009: 28 cases, no deaths
- 2012: 2 cases, no deaths
- 2013: 14 hospitalizations, 2 deaths
- March 2014: 2 deaths, 14 hospitalizations
- July 2015: 11 cases, no deaths (last recorded outbreak)
How It Was Controlled
Dr Paul Onzubo, then the Municipal Health Officer, explained, "We closed food stalls, forced construction of latrines, and encouraged drinking of clean, boiled water. Sewerage lines were repaired. That was a turning point."
Village Health Teams (VHTs) advised families to stock ORS and use antibiotics when necessary.
"Some residents defecated in polythene bags and buckets, then dumped them. With rain, this waste contaminated water sources," Dr. Onzubo said.
He added that they created key messages in local languages, disseminated through churches, mosques, home visits, and media platforms.
VHT member Ms. Joyce Akandru said: "When you start vomiting and experiencing diarrhea, the first step is rehydration. At clinics, patients receive saline drips. We told people this, and early reporting changed the game."
She emphasized that cholera is controllable through proper hygiene. "It’s not like Ebola or HIV/AIDS."
However, in remote areas, people often arrived at clinics too late, severely dehydrated.
Lessons Learned
Health authorities, politicians, and residents collaborated to improve clean water access and hygiene. Efforts included banning cold roadside food, testing water sources, and closing contaminated points.
Mr. Godfrey Apangu, Arua City Health Inspector, said: "Our success reflects coordinated governance, community ownership, and evidence-based public health strategies."
He noted that transitioning from bucket systems to proper sanitation, increasing water access, and raising public awareness helped secure the city’s future.
UNICEF and Médecins Sans Frontières (MSF) were key partners. They helped build a permanent cholera treatment and isolation center at Oli Health Centre IV – the first of its kind in Uganda at the time.
Municipal Mayor Charles Asiki and LC3 Chairperson Mr. Swadick Angupale mobilized leaders to discourage dumping fecal waste in polythene bags. They also opened roads, repaired sewer lines, and worked with the National Water and Sewerage Corporation to extend piped water and install water kiosks.
Health teams earned the nickname "Public Health Commanders-in-Chief."
A 2015 SNV report revealed that in rural communities, open defecation was still common due to poverty and lack of awareness.
SNV's Mr. Henry Kakoza stated: "We aim to change behaviors – handwashing, bathing, and latrine construction. We want open defecation-free communities."
He added: "If people can borrow money to wed or marry more wives, why not borrow to build latrines and save lives?"
Open defecation, ingrained from early childhood, continues due to poverty and rental homes lacking toilets.
Ms. Halima Osman, a resident of Jascinto Cell, said she shares one latrine with 12 tenants and cannot afford to build another due to other household needs.
Today, most Arua City residents enjoy a cleaner environment. While the educated population has embraced preventive measures, challenges persist in some suburban areas.
About Cholera
Cholera is a diarrheal disease caused by the bacterium Vibrio cholerae, usually transmitted through contaminated food or water. Cooked grains left at room temperature for long periods are a common cause.
Treatment
Cholera is treatable with rapid fluid and electrolyte replacement, either orally or intravenously. Antibiotics can reduce the duration of illness but not its severity.
