Bath mats and rugs can help prevent accidents in a bathroom. Photo by Racheal Mabala
Engineers and public health experts have warned of widespread use of inappropriate materials in Uganda’s booming construction industry, leading to rising deaths of Ugandans due to falls in bathrooms.
Separately, the government said that bathroom fall-related fatalities and injuries that otherwise are preventable have become a “public health concern”.
“It (falls in the bathroom) is becoming a public health concern, especially in the elderly,” said Dr Charles Oyoo, the commissioner for non-communicable disease prevention at the Health Ministry.
“As you age, you get some reduction in the muscle power; so, you may lose the sense of balance and you get prone to falls,” he added.
Dr Oyoo listed drunkards, epileptics, those battling high blood pressure, and drug abusers among individuals prone to falling in bathrooms due to wobbled movements and sudden loss of balance.
“In the bathroom, the main issue is in the design of the floors. Sometimes people make the cement too smooth or the tiles used are not the ones meant to be in the bathroom,” he said, adding, “But they put them because they want cheap labour and they use non professionals in that area. So, they do it unknowingly,” he said.
His comments echo similar red flags by the Uganda Institution of Professional Engineers (UIPE), the umbrella body of practicing engineers, technicians, and technologists in the country, and trauma, injuries, and disability specialists that developers are risking the lives of occupants of their buildings by using wrong finishing materials and non-professionals to reduce costs.
UIPE President, Mr Andrew Muhwezi, said property owners should use the right type of tiles in bathrooms to prevent themselves or tenants from falling in the bathrooms, leading to injuries or death.
“There are anti-slip tiles, they have rough surfaces. They are also clay floor tiles specifically made for bathrooms,”he said.
He added: “Because bathroom floors are slippery environments, when you are constructing the bathroom, you must have antislip tiles so that when the person is there, whether they are barefooted or wearing slippers, the rough surface prevents the fall.”
Similarly, an engineer at the National Housing and Construction Company Ltd (NHCC), a government corporation, attributed some of the cases of slips and falls in bathrooms to poor regulation of the housing sector.
“Uganda’s housing sector is not well regulated. Many builders do not have the right training. Sometimes the owner of the house chooses the type of tiles they want; they may prefer a particular colour like pink or what is cheaper, neglecting the right type,” said Mr Kenneth Kaijuka, the chief executive officer of NHCC.
Bathrooms are wet sections in a building and regular use of soap and water in the area makes surfaces more slippery, according to Eng Kaijuka, tiles used “must have a strong grip”.
“We need comprehensive regulation in the entire chain. People should buy the right tiles. Local authorities should consider inspecting the bathrooms just as they have done for latrines be cause it is a health hazard if people are not using the right tiles,” he said.
Engineer Kaijuka suggested that developers should ensure the bathroom sections in private, commercial and public buildings have guardrails for those falling to grip and stabilise or to firm up those with challenged mobility.
These experts spoke out for this story that this newspaper initiated to explore solutions to rising accidents in bathrooms involving mainly notable and senior citizens, the most recent victim being Uganda People’s Defence Airforce Deputy Commander, Brig Stephen Kiggundu. The army said he was electrocuted in the bathroom at his official residence in Entebbe, although detailed findings of the investigators into the senior officer’s demise have not been made public.
Mr Jimmy Osuret, a researcher at the Trauma, Injuries, and Disability (TRIAD) Unit of Makerere University School of Public Health, attributed slips and falls in bathrooms too, among others, wet floors, inadequate lighting, and slippery surfaces like tiles.
He identified a lack of grab bars, improper footwear, and impaired mobility due to aging as other risk factors.
Falls in bathrooms are not only a public health concern in Ugandan where Health Ministry’s Dr Oyoo urged citizens besides changing sedentary and other unhealthy lifestyles to when
in the bathroom, to start bathing by “washing the legs and the hands to get used to the water as opposed to starting [to shower] from the head.”
In a separate interview, Ms Susan Akori, a senior physiotherapist at Mulago Specialised Women Hospital, explained the benefits introducing water to the body gradually instead of plunging headlong under cold or hot shower.
“When one starts pouring water from the head, it can constrict essential blood vessels in the brain, causing increase in blood pressure which can hamper brain function, thus, leading to stroke and fall in the bathroom,”Ms Akori said.
A 2019 study report by American re searcher Morgan Schellenberg and colleagues cites drugs/alcohol, cardiovascular disease, neuromuscular disorders, and diabetes as triggers of mishaps in the
bathroom.
They recommended that “efforts to minimise fall risk should be directed toward these individuals.”
In Uganda, police classify fatalities from falls in bathrooms as “fall deaths”, according to the Force's Spokesperson Fred Enanga.
Asked whether deaths linked to falls in the bathroom could be used to conceal the murder, Mr Enanga said the law enforcement agency’s investigations in such instances are guided by “postmortem which reveals the cause of death”.
Neither the police nor any government institution hold a date base on cases of bathroom fall and related death and injuries.
Without disclosing the source of his data, sports doctor and fitness trainer Stephen Ayella-Ataro, however, said such accidents are rising in Uganda, with 15 - 25 percent of victims requiring hospital admission due to the severity, leading to deaths or lifetime impairments.
“Bathroom accidents or falls are very common in our homesteads, both for those who use the modern shower rooms and those who use the outside bathroom,” Dr Ayella-Ataro said.
Common causes
The commonest causes of the falls are unrelated to medical conditions, he noted, but a slippery bathroom.
Individuals interviewed for this article noted that old bathtubs and showers, or those with slimy coating due to improper cleaning, add to the risk of falls exacerbated by poor-quality floor tiles.
Sports doctor Ayella-Ataro separately senior citizens are susceptible to falls due to “lack of physical fitness and chronic diseases like diabetes and heart diseases which cause numbness to the legs and affect the blood floor”.
“The epileptics are [as well] at risk because they get convulsions and they can fall. People living with disability and or mental impairment are more at risk of a fall in the bathroom,” he added.
A 2022 global report by Nader Salari from Iran’s Kermanshah University of Medical Sciences,indicates that the prevalence of falls in the older people of the world stands at 26.5 percent.
In the report, Africa had a prevalence of 25.4 percent, marginally higher than Europe’s 23.4 percent, but below Oceania’s 34.4 percent.
The report did not provide country-specific statistics for comparison on how Uganda ranks, regionally and internationally, on evaluated matrices.
Reached out for comment following experts’ concern linking bathroom falls to improper floor finishing, Mr Akram Dhiwa, the managing director of Dreyz Interior,and Mr Arnold Tenza,an interior designer at Kampala-based Furniset Ideaz Design Studio, separately said more Ugandans have started embracing floor and bathroom designs that uphold safety.
National Housing and Construction Corporation’s Eng Kaijuka had raised a red flag that the design and finishing materials used at public buildings were unsuitable.
“It is concerning that even in public places, some floors that are likely to become wet are also constructed with wrong tiles that increase the risk of falling,” he said.
Response system
The experts also raised concerns that an inadequate emergency response system in Uganda means help delays in reaching victims of bathroom falls, making them die before their time.
In a rejoinder, Dr Charles Oyoo, Health Ministry’s commissioner for non-communicable disease prevention, victims sometimes pass on because they live alone, the bathrooms are isolated or the individuals become unconscious after falling.
“If someone did not sense that there was some accident [in a bathroom], it can be hard. But if they sense, they can call for help.If you can access your phone or if you can also shout, that can also help,” he said.
DIRECTIVES
1. Get non-slippery til
Mr Akram Dhiwa, the managing director of Dreyz Interior, notes that most builders in Uganda mainly look at beauty and price when it comes to buying tiles.
“Smooth surfaces like tile or marble can become slippery when wet, increasing the likelihood of slips and falls. Installation of wrong floor tiles and brands in bathrooms is a hazard,” he says.
“Installing the right floor tiles in the bathroom. The bathroom should have floor tiles that are non-slippery for example unglazed tiles or textured tiles, that is to say, ceramic tiles, porcelain tiles, stone tiles, and vinyl flooring,” he advises.
Mr Arnold Tenza, an interior designer, on the other hand explains that such non-slippery tiles provide “excellent traction even when exposed to soap and water since they are designed with various slip-resistance features.”
Asked about the cost, he says “They vary depending on the manufacturer; you can find some in the range of Shs85,000 to Shs100,000.”
2. Do away with bathroom rugs
Mr Tenza says bathroom rugs contribute to beauty in a bathroom space but they are fall hazards that need to be avoided to decrease the opportunity for tripping and other injuries.
“Get a non-slip mat for your bathtub. Non-slip tubs are designed with grooved features to assist with fall prevention. If you don’t have a non-slip tub, consider a non-slip mat or coating for your bathtub or
standalone shower to add traction to these surfaces,” he explains.
3. Have good bathroom lighting
Mr Tenza says they always advise their clients to have well-lit bathroom space. “Injury opportunities come with those night trips to the bathroom,” he says.
“Walking through the dark while half-asleep is a dangerous thing in case you don’t have extra lighting in the bathroom such as hidden strip lights. Having them improves visibility throughout the bathroom which prevents falls and injury,” he adds.
4. Make all bathroom accessories easily accessible
The interior designers also advised people to ensure the bathroom accessories are accessible.
“Why stand on your tip-toes to reach your soap dispenser from the top shelf of your linen closet? That sets you up for a dangerous fall. Place shampoo, soap dispensers, and other commonly used items in areas
that are within reach for everyone who uses them,” Mr Tenza advises.
5. Physical exercise
Sports doctor and fitness trainer Stephen Ayella Ataro say in the morning, one should do some exercise for at least five minutes before taking a bath to reduce the risk of falling in the bathroom because the blood flow to the brain is not at its best.
‘‘Avoid showering when you’re too hungry or when you’re too full because when you’re too hungry, the blood sugar may be low and you can black out,’’ he warned.
6. Have lower bathtubs and Jacuzzis
“Difficulty getting in and out of high tubs or showers increases the risk of falls, especially without proper handholds. Replace high tubs with walk-in showers or low-threshold showers for easier access and install sturdy grab bars and a built-in bench or shower seat in the shower area,” Akram added.
7. Invest in grab bars
Mr Akram says grab bars provide support and stability, especially for seniors or individuals with mobility issues.
“These can be placed in the shower area, bathtub area, and sometimes the toilet area. Grab bars help while moving in or out of the showers,” he advises.
“They also help to prevent falling in case of an accident by grabbing onto them. Install grab bars near the toilet, shower, and bathtub, following the right guidelines for height and placement. Ensure to screw them tightly onto the walls instead of using Suction cups,” he adds.
8. Treat or prevent diseases or habits linked to fall risks “When someone is under the influence of alcohol, they can lose the sense of balance and can easily fall. The other one is drugs. Some other conditions like epilepsy can also contribute, especially when you get the triggers,” Dr Charles Oyoo Akiya, the commissioner for non-communicable disease control at the Health Ministry said.
9. Avoid cluttering the bathroom
Mr Akram Dhiwa, the managing director of Dreyz Interior, on the other hand, says a bathroom needs a minimalistic look and feel.
“This has to be decluttered to keep away unused items to keep walkways free and open to prevent tripping over. We need to keep the bathroom organized and decluttered by having minimalistic design accessories of bins towel rails, rings, and rob hooks among others. Ensure to use bathmats and keep them clean and dry. Only keep commonly used items in reach,” he said.
10. Separating wet areas and dry areas Mr Akram Dhiwa, the managing director of Dreyz Interior, says wet areas in a bathroom include tabs, a shower area or a Jacuzzi - a large bath with a system of underwater jets of water to massage the body.
“These are areas that have a lot of water traffic. The dry areas are mainly the toilet, vanity, and storage areas. These in a bathroom have to be separated/zoned. Zone out/Separate dry areas from wet areas by using shower glass partitions or shower screens to prevent water spillage to unwanted areas,” he says.
“Having a spacious bathroom could also help zone out these areas. Using multiple floor traps and long floor gratings will give a quicker drainage for water on bathrooms and keep them dry faster,” he adds.
The health experts and interior designers also advised people to avoid cluttering the bathroom, and have lower bathtubs and Jacuzzis to minimize hardship in getting into or out of them, have proper wall height for toilet, and treat or prevent diseases or habits that are linked to increased risk of falls.
SOME VICTIMS OF BATHROOM ACCIDENTS
1. Hajj Badru Magoba, proprietor of Magoba Shopping Arcade
2. Brig Stephen Kiggundu, deputy commander of Uganda Peoples Defence Airforce
3. Brig Victor Twesigye, UPDF liaison officer at East African Community headquarters in Arusha, Tanzania
4. Esta Nakaima, lawyer with the International Criminal Court (ICC)
5. Dr Kevin Florence Tsatsiyo, resident of Akright Estate, Kirinya,
Bweyogerere
6. Lt Col Charles Omara, attached to UPDF Magamaga Service Brigade
8. ASP Daniel Mugisha, police officer
9. Victoria Nakimuli, law student at Uganda Christian University
10. Dr Baker Godwin Wairama, a senior lecturer at Makerere University’s School of Law,
11. Emmanuel Mayanja, alias AK47, artiste.
