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Uganda has fertile ground for disease outbreaks – Health Ministry
Health minister Jane Ruth Aceng. Photo | File
What you need to know:
- Records from the Health Ministry indicate that 2023 was not any different from previous years in terms of the frequency of disease outbreaks.
Health system gaps, favourable climatic conditions and geographical location have made Uganda a fertile ground for disease outbreaks and the flourishing of preventable illnesses, health experts say.
Records from the Health Ministry indicate that 2023 was not any different from previous years in terms of the frequency of disease outbreaks, except for the limited number of people affected and the low extent of the spread.
The country started 2023 with the exciting declaration of an end to the Sudan Ebola virus outbreak on January 11 by the Health ministry. By then 164 cases (142 confirmed and 22 probable) had been recorded with 55 confirmed deaths and 87 recovered patients.
However, the end of Ebola gave room for other bugs to manifest. Records from the Uganda National Institute of Public Health (UNIPH) and the Health ministry indicate that at least six disease outbreaks and events of concern to public health were investigated by government scientists last year.
The scientists investigated reports of a measles outbreak in Bundibugyo District, rift valley fever in Nakaseke District, cholera in Namayingo and Kayunga districts, unexplained deaths and anthrax in Kyotera District, cassava cyanide poisoning in Terego District, food poisoning at a school in Mukono District, and suspected rotavirus outbreak at a babies home in Mpigi.
These outbreaks and public health events, which were reported between January and November 2023, were contained, making them localised to particular districts even for some diseases that spread from animals to humans like the Ebola virus in greater Mubende and anthrax which is still in Kyotera.
“The climate is good for human habitation, agriculture, leisure and hospitality and many economic activities,” Dr Jane Ruth Aceng, the Health minister, says. “But this same climate is also very good for bacteria and other microorganisms that affect both humans and animals.”
“This is why we have all sorts of diseases; endemic, emerging, reemerging such as malaria, TB, Marburg, Ebola among others,” she argues.
According to a 2018 report by Anthony Mbonye published by a scientific journal, the Lancet, “Uganda had frequent disease outbreaks between August 2017 and August 2018.”
The report adds: “Within 1 year, eight disease outbreaks occurred in Uganda, of which three were viral haemorrhagic fevers (VHFs), Crimean Congo haemorrhagic fever, marburg virus disease and rift valley fever that are among the prioritised zoonotic diseases for Uganda.”
The other outbreaks in the period 2017 to 2018 were anthrax, measles, cholera, meningitis and rubella which can be prevented through good hygiene and vaccination.
Many Ugandans are studying health sciences and related courses to come up with innovative ways to reduce the outbreaks and prevalence of such diseases so that the population can be healthier and more productive. However, records from the government and research reports indicate that things have not yet changed much.
Dr Alex Ario, the head of UNIPH, an institution under the Health ministry which trains scientists on disease response and participates in responses, says it is becoming more complex to prevent disease outbreaks.
“Human beings are moving, cutting forests and doing all sorts of things. So we have a lot of interfaces with animals and forests and that is how diseases are coming up. Because of that, we need to prepare to respond to that,” he says.
He says the country is now more prepared to respond to outbreaks.
“Previously, we did not have the capabilities -technical know-how to do this. So we are having fellows [that are trained at UNIPH]. The moment we receive any alert at the Emergency Operation Center and officers there confirm that it is probably an outbreak, and the Director General [of Health Services] gives a directive to deploy the fellows, we do so immediately,” Dr Ario adds.
He notes that this is not what has been going on in the past.
“In past, it was like a firefighting approach, we didn’t even know what to do and who to turn to,” he says.
However, Dr Ario says they are stretched because of the high frequency of disease outbreaks and limited funding.
“But we still have challenges, fellows are few and outbreaks are many. The share of the national budget that we get is not big so we rely on donors,” Dr Ario says.
The Mubende Ebola burial team prepares to transport one of the disease’s victims in 2022. The country started 2023 with the exciting declaration of an end to the Sudan Ebola virus outbreak on January 11 by the Health ministry. Photo | File
The government scientists said in November they had not yet determined the actual source of the Ebola outbreak, a critical element for preventing future outbreaks. The outbreak was confirmed in Mubende in September 2022.
The scientists partly blamed the high number of Ebola deaths on poor coordination at the community level and seeking divine healing in shrines and other places instead of going to hospitals. This they said delayed detection of the disease.
Private facilities where many patients sought care were also blamed by the Health ministry for having a low index of suspicion, which experts said delayed detection of the outbreak and, thus delayed access to the right treatment and effective containment measures.
Scientists say Uganda experiences many disease outbreaks because of cross-border transmission from neighbouring countries.
Even during the recent outbreak of anthrax in Kyotera where at least 17 have died, people also reportedly went to shrines for divine healing, delaying the detection of the disease.
“First of all, the disease was confusing,” Mr Joachim Wasswa, a resident of Kyotera and the former district surveillance focal person, told our reporter.
“It is a zoonotic disease between animals and humans. Suspects were going to shrines so we couldn’t access those patients on time. The other issue is that the laboratory that is testing anthrax is very far.”
Dr John Lutaaya, the Kyotera District veterinary officer, and Dr Edward Muwanga, the Kyotera District health officer, says besides the quarantine that has been imposed, they are also sensitising communities on prevention measures and treating those infected.
Dr Aceng and Dr Ario say they are putting a lot of emphasis on the prevention of illnesses to reduce the spending on treatment.
Some good things have also happened. Some scientists had also in 2022 warned that the threat of Covid-19 resurgence should not be ruled out. But this has not come to pass except for an announcement by the World Health Organisation (WHO) on December 19, saying there is a new variant of coronavirus, JN.1, which spreads faster.
Following this announcement by the WHO, the Health Ministry of Uganda has not issued any official statement to suggest that this would cause a resurgence.
However, the ministry has continued encouraging people to adhere to Covid-19 preventive measures such as handwashing which is also effective in preventing other common illnesses like diarrhoea and respiratory illnesses.
Since the first outbreak of coronavirus in Uganda, the disease has killed 3,632 out of the 171,888 who have been confirmed as infected, meaning the majority recovered from the infection. Also, 26 million doses of Covid-19 vaccines have been administered in the country to reduce the death risks.
“Current vaccines continue to protect against severe disease and death from JN.1 and other circulating variants of SARS-CoV-2, the virus that causes Covid-19. WHO is continuously monitoring the evidence and will update the JN.1 risk evaluation as needed,” the WHO stated.
Hopeful
To strengthen its roots in communities, the Health ministry in February launched the National Community Health Strategy (NCHS) (2021/22 – 2025/26) to increase access to health services for all persons right from the grassroots level. Information from the ministry indicates that the government needs Shs5 billion to implement the strategy.
In the same month, the government also announced that President Museveni had signed the Public Health Amendment Bill into law.
The Bill was passed in July last year with major adjustments being the deleting of clause 47 (2) which prescribed a fine of Shs1 million or imprisonment not exceeding three months for those who fail or neglect to comply with provisions on vaccination and revaccination.
However, the new law still provides for at least 16 offences, including penalising owners of homes or businesses with unkempt compounds or individuals who spend nights where food is prepared.
Some issues cited as potentially problematic in the law include mandatory access by the inspector to premises at any hour and mandatory vaccination provision for children’s admission to schools.
In the midst of this, the country has since 2022 been experiencing a sustained surge in malaria cases. To tame this, in April, the State minister for Health in charge of General Duties, Ms Anifa Kawooya, launched the countrywide distribution of 28.5 million mosquito nets.
The distribution has been going on with a fire incident in a warehouse in Entebbe, Wakiso District where the National Medical Stores was keeping some of its mosquito nets, cited as one of the causes of delays in the completion of mosquito net distribution.
But those who have malaria also report struggles in accessing services with stock out of drugs and staff absenteeism reported in public health facilities by locals and politicians.
To address some of these issues, the Health ministry in May launched the Uganda Health Information and Digital Health Strategic Plan under the theme “a health sector in Uganda driven by evidence and leveraging digital health to improve efficiency in service delivery.”
A veterinary doctor examines cattley. At least 17 people died during the recent outbreak of anthrax in Kyotera District. The disease is believed to have spread from eating cattle that were already infected with it.
Dr Diana Atwine, the Health ministry permanent secretary, said implementation of this strategy was the only way to know non-performers and those who come late to work, among other outputs.
Around the same time, between March and May, there were heated debates on the issue of homosexuality as Members of Parliament, with a strong backing of religious leaders debated and passed the Anti-Homosexuality Bill.
The President signed the bill into law on May 26, amid heightened criticism from the international community and threats of sanctions and cutting down donor support to the country.
The country’s health system is greatly reliant on external (donor) support due to the limited allocation of local funds.
Some areas such as drugs for persons living with HIV, are more than 80 percent reliant on support from donors like the US government which is strongly opposed to the anti-homosexuality law.
This threat, amid the low commitment of the government to take charge of purchasing drugs for the 1.4 million Ugandans living with HIV, left many uncertain about the future.
But the US embassy in Kampala said their government would continue buying Anti-retroviral drugs (ARVs) and giving HIV/Aids-related support as they find the best way to work amid the new law.
Anti-homosexuality law
Some donors argued that the law would bar homosexuals from accessing services. Still, the Health ministry said everyone would access care and that no provision allows health workers to deny some people services.
The law was initially passed by Parliament on March 22, 2023 having been introduced as a Private Members Bill by Bugiri Municipality Member of Parliament, Mr Asuman Basalirwa.
Despite the Bill receiving unanimous legislative support, it was returned to Parliament by President Museveni on April 27, 2023, with proposals before he would sign it into law.
The House reconsidered the Bill on May 2, 2023, and passed it with amendments to five clauses in regard to proposals by President Museveni. It was from then that the President signed.
But there was also something else which happened after this. In June and August, the reports about the rise in the number of men taking children secretly for Deoxyribonucleic acid (DNA) paternity testing, started rising.
Some reportedly abandoned the children in the facilities where the tests were conducted after discovering that the results were negative.
Some politicians claimed that the rise in appetite for paternity testing was sponsored by homosexuals who wanted to tear apart families, the argument which many, especially men, said was lacking in substance.
The rise in demand saw the Health ministry in July come up with a special regulation, allowing only two laboratories to carry out paternity tests and strict rules.
The ministry said it was doing this to protect families from being torn apart and reduce suffering, especially for children who become victims.
This move (the new regulation) attracted widespread criticisms against the ministry but over the months, few reports about men who have gone for paternity testing have been reaching media houses.
One of the tough rules was a requirement that three –mother, child and father should consent to undergo the tests and should be at the same place on the day of taking the samples and receiving the results amid another mandatory requirement of having a counsellor speak to them before sample collection and before receiving the results.
Amid the paternity tests issues, medical graduates, 1901 in number, who needed to undergo internship placement to get permanent practicing licenses’ were also stuck in their homes as the Health Ministry said they didn’t have money to pay their allowances.
The graduates are supposed to get somewhere between Shs2 million to Shs2.5 million per month according to a directive from the President.
Some of the graduates, the Uganda Medical Association (UMA) said, had been waiting for more than six months for the deployment.
Faced with the hopeless situation, many were engaging in different strikes to catalyse the process and as they did this, some were arrested by police, especially in Kampala.
However, in July, the Health ministry said they got a commitment from the Finance ministry that there was money to pay the interns so they were deployed in August to 58 internship sites.
After this, around October and November, concerns about whether young people and adolescents should access contraceptives to tame high rates of teenage pregnancy sparked disagreement.
Many parents and moralists argued that this would increase promiscuity and HIV infections and that contraceptives should be restricted to those who are married.
According to activists and some doctors, it was time to revisit and remove barriers to access to contraceptives and sexuality education because many young people and adolescents are engaging in sexual activities and they are getting pregnant because of the gap in access to services and information.
Around the same time, the reports about the high number of adolescent girls and young women who were contracting HIV alarmed the public.
Of equal concern was the declining number of those young people and adolescents who were adhering to ARVs, a shortfall which puts them at high risk of falling sick and dying; developing drug resistance and requiring more expensive drugs; and spreading the infection during intercourse because they are not virally suppressed.
Many health experts and civil society organisations said there was a need to increase interventions to reduce infections among adolescents.
