Many Ugandans have become addicted to sauna baths due to their refreshing feel and the company that they find there.

Although saunas are enjoyable, there are several dangers that come with frequenting them.

Burning excess body fat and getting rid of pimples has over time become the quickest allure sauna owners use to trap individuals, especially men.

Moses Kayemba, a resident of Kakooge town council in Nakasongola district, says his friends wooed him into the sauna with tales of burning body fat, drying up pimples as well as making the skin smooth.

Later on, he realised the benefits go beyond getting a quick fix for fats and unwanted weight.

Residents at the scene of a sauna explosion in Ntinda in 2011. Many saunas are below minimum standards.

He discovered that it was also an avenue for socialising with people from diverse backgrounds and from then onwards, he became entrapped.

“Apart from a few reserved people, there is a lot of interactions and at the end of the day I make new friends,” Kayemba says.

Esther Ngogolo, also a resident of Kakooge, says he has spent six years visiting the sauna two-three times a week.

When she got married, she decided to build her own sauna at home.

“Whenever I am tired and exhausted from work, a sauna bath relieves me of stress and cleans my body,” she says, adding: “Nowadays, I take a sauna bath whenever I want.”

Sauna bathing is characterised by exposure to high environmental temperature for a brief period.

The sauna room has dry air and high temperature ranging between 70°C and 100°C.

However, most saunas are run by non-professionals and sometimes the temperature may exceed 150°C.

Sauna bathing has taken root and the business is booming in Kampala and other urban centres across the country, thanks to the growing middle class.

In Uganda, most saunas are heated using firewood. Patrons pay between sh5,000 and sh10,000 per session, depending on the place.

Each patron may give a different reason for frequenting the sauna, but medics say this may come at a heavy cost, including impotence and death.

Dr Annet Nankwanga, a physiotherapist at Makerere University Hospital, says a sauna improves the heartbeat because the heat triggers an expansion in the blood vessels that raises the heart rate.

This results in an increased blood flow along with the various nutrients, water and oxygen across the body.

The more necessary nutrients that the skin absorbs during the increased blood circulation and sweating may also detoxify and improve one’s skin.

However, Nankwanga warns that staying in high sauna temperatures beyond the recommended time — normally 10-20 minutes — may cause an irritating effect on the skin.

She further says addictive and prolonged sauna bathing can also result in rough and dry skin.

She explains that excessive high heat temperatures kill the skin’s sensory nerve cells, making the skin insensitive to even too much heat, thereby causing a burning effect.

She advises that when your body reacts to heat, you should stop taking your sauna and have some rest.

Erectile dysfunction

Nankwanga cautions men, saying sauna baths beyond the recommended two-three times a week may result in reduced sperm count, which puts one at the risk of impotence.

She says just like the skin’s sensory nerve cells that die of excessive heat, even the sperm cells do. 

“Each time you get exposed to abnormal heat, a given proportion of them gets damaged and die, which may lead to erectile dysfunction, especially under repetitive sauna baths,” she says.

The Chinese Society of Obstetrics and Gynaecology director, Dr Xu Deyi, in a recent online article titled Sauna Affect Male Fertility, said men who spend a lot of time in a sauna environment are prone to dead sperm, weak sperm and other illnesses which cause infertility.

Scientists say sitting for a long time in a sauna and steam bath exposes one’s genitals to excessive temperature, resulting in poor sperm development and ultimately, low sperm count.

The gonads (testes) which produce sperm are hidden in the foetus’ abdomen during pregnancy.

At birth, they come out and settle in the dangling scrotum. Scientists say the scrotum has no fat and veins.

 This is to ensure that the testes are kept at a temperature lower than the normal body temperature.

While the normal body temperature is 37°C, the scrotum needs between 35.5°C and 36°C to operate normally.

However, the temperature in most Ugandan saunas can rise to over 70°C, which they say is disastrous to the scrotum.

“If sauna becomes a part of your lifestyle, it means that slowly, you are switching off the performance of your testes,” Dr Charles Kiggundu (RIP), a consultant gynaecologist, explained years back in an article published in New Vision.

He said a man needs one sperm to fertilise an egg, but if he lacks 20 million sperms per one millilitre, he will find problems impregnating a woman because the sperm count would be low.

Besides reducing the amount of sperm produced, Kiggundu said excessive sauna heat could also weaken the sperms.

This hinders their movement as they would not be able to swim through the fallopian tubes to fertilise an egg.

 “Some men tend to think that ejaculating alone is enough to cause pregnancy.  Fertilisation does not occur at that exact point of the vagina where a penis ejaculates,” he said.

Kiggundu added: “The sperms must swim through the fallopian tubes to meet the eggs. Imagine a situation where the sperms are few and weak! This means they cannot fertilise the female egg. So, you may ejaculate whenever you have sex, but no conception will take place.” 

High blood pressure

Dr Harrison Uchungi, a cardiorespiratory physiotherapist at the Uganda Heart Institute, says sauna baths increase blood pressure — the rate at which one breathes, to facilitate the removal of the excessive heat from the body, which makes it risky for people with high blood pressure.

He says under heavy sunshine, the normal body temperature is usually 30°C -40°C, yet within the sauna it the temperature is increased up to 70°C -100°C, making it almost twice the normal temperature, which forces the heart to overwork beyond its normal rate in order to pump blood to the various body parts where excessive heat can be lost.

Stroke, death

Uchungi says too much heat is dangerous to the body, as it can cause a heat stroke, a situation which happens when there is a lot of heat in one’s body and the body cannot eliminate it, which kills body tissues and muscles, including the heart.

Besides heat stroke, he also points at possible sudden deaths, since sauna heat increases blood circulation.

He says in case one has some blood clots, the increased blood circulation may move them, and they block some sensitive and delicate vessels.

This is what causes abrupt death during sauna session. He says the increased blood pressure itself can burst some nerves and blood vessels, thereby creating risky blood clots. Uganda has in the recent past recorded sauna-related deaths.

For instance, in October this year, Dr Richard Bakamuturaki, the Ntungamo district health officer, collapsed and died in a sauna.

Loss of mineral salts

Uchungi says high temperatures cause excessive sweating, which results in loss of necessary salty minerals such as sodium and potassium — the most important minerals that give one’s heart and brain the power to function.  

He says excessive loss of sodium and potassium causes electrolyte imbalances, meaning the body either has less sodium or potassium, which either makes someone very talkative or very quiet or suddenly gets unconscious and collapses to death.

Dr Uchungi says with potassium and sodium imbalances, there also comes irregular heartbeats, a situation in which the heartbeats are either fast or slow.

Experts speak

For good health, Nankwanga advises people who go to saunas to supplement it with physical exercises such as jogging, walking or playing physical games such as football and netball. 

Dr Isaac Kakooza, the head of the physiotherapy unit at Nakasero Hospital in Kampala, says sauna baths fall under complementary therapy, not the mainstream medical fi elds and the treatments.

He says saunas do not have specific and evidence-based research on their contributions to health and are risky, especially in Uganda where their standards and the service providers are not regulated.

Kakooza advises that people should undergo general medical check-ups before starting sauna baths because some people/health situations must not be exposed to saunas except under guidance by a physician.

He says diabetic and obese people should avoid saunas since their fat narrows the blood vessels, making it hard for them to sustain the highly sauna-pressurised blood to pass through them effectively.

He says this puts such people at the risk of ‘bursting’.

He also discourages people with both high and low blood pressure, plus pregnant women from visiting saunas.

He says expectant mothers are always at the risk of high blood pressure.

He calls on those with heart related health problems and people with sensory nerve cells that can hardly sense and detect abnormal high temperatures to also desist from taking sauna baths.

Uchungi says the elderly and people suffering from cancer should not take sauna baths.

He says extreme heat increases the rate of multiplication of cancer cells and for elderly people, they tend to have a combination of various health complications such as high blood pressure, diabetes and obesity.

Except for steam baths where some medicinal herbs can be employed, Dr Kakooza also discourages asthmatic patients from stepping into a sauna room and advises all people with any major health problem to distance themselves from sauna sessions except under a medical expert’s guidance.

He appeals to the sauna service providers to produce health complication check lists in the form of questionnaires, which should always be provided to and filled in by any person attempting to take a sauna bath.

Dr Kakooza says this will help them to sort out problematic people and remain with those whose health status is fit for withstanding the sauna environment.

Sauna deaths in Uganda

Uganda has in the recent past recorded sauna-related deaths.

For instance, in October this year, Dr Richard Bakamuturaki, the Ntungamo district health officer, collapsed and died in a sauna.

Earlier in July 2021, a sauna in Kayunga, Wakiso town council, burst, killing Titus Munanura, 47, a businessman and critically injured three others.

In September 2019, at least five people were seriously injured and rushed to different health facilities after an explosion at Marcos Gym and Spa near Quality Shopping Mall located at Naalya.

In 2011, eight people were admitted to Mulago Hospital in critical condition after a sauna cylinder exploded in a new health club in Ntinda, a Kampala suburb.

Exhaustion

Geoffrey Etetu, a resident of Makindye division in Kampala, says he has been visiting the sauna for the past seven years.

“It was the allure to lose weight. There was this talk among friends that once you go in there, the heat makes you sweat and, in the process, you burn some calories,” he says.

Etetu’s experience has forced him to reduce the visiting from once every week to once a month.

“Whenever I go there, I feel exhausted. That exhaustion you get after sexual intercourse. With it came joint pain that would last for more than three days,” he says, noting that he also found out that frequent exposure to the heat could lead to internal organ damage.

 This story is part of the CABI, SciDev.Net and Robert Bosch Stiftung Script science journalism project