Cholera is an acute diarrheal disease caused by eating food or drinking water that is contaminated by faeces. T
By Dativa Maria Aliddeki
Currently, Hoima district, located in Western Uganda is battling with an outbreak of Cholera, amidst a humanitarian crisis that has led to an influx of more than 26,151 refugees fleeing civil unrest in the Democratic Republic of Congo. Cholera has affected 1,727 people and left 36 dead.
Cholera is an acute diarrheal disease caused by eating food or drinking water that is contaminated by faeces. The unique location of Hoima District on the shores of Lake Albert and in the great East African Rift Valley has posed considerable challenges for the district in addressing recurrent cholera outbreaks especially at the various landing sites.
Recently, while responding to this outbreak that started out in Kabwoya and Kyangwali sub-counties, affecting mainly the refugees, it was brought to our attention that a school in the municipality had reported students with Cholera like symptoms.
Upon further investigation, a team of Fellows of the Uganda Public Health Fellowship Program, under Ministry of Health discovered 15 people with these symptoms, both within the school and the nearby sub-county. Investigations showed that all the affected individuals had eaten fish brought from a landing site in Sebagoro village, where an active Cholera outbreak is raging.
This outbreak is a clear example of the need to prevent, rapidly detect and respond to outbreaks so that they are controlled at the source before spreading further. This is the focus of the concept of Global Health Security, which Uganda must strengthen to effectively control disease outbreaks. For this to be successful, the three key areas of prevention, detection and response must be strengthened.
The prevention pillar focuses on preparedness and calls for focus on antimicrobial resistance, zoonoses, biosafety biosecurity and immunization. An example of how this pillar could be premised upon in preparedness for outbreaks is to introduce an oral cholera vaccine, especially for the vulnerable populations so as to create a considerable number of immune people. This vaccine has been used in a number of African countries, including Malawi and South Sudan. However, it’s important to note that this vaccine does not provide lifelong immunity and thus must be coupled with other preventive measures including the provision of safe drinking water, safe disposal of faeces, among others.
The second pillar calls for a focus on surveillance and reporting, early detection and laboratory confirmation and preparedness of the health workforce to rapidly respond to outbreaks as they arise.
The approach that has been adopted by Uganda in responding to outbreaks is the use of mobile laboratories which have helped reduce the turnaround time and thus inform the rapid response teams of the next steps for the response. Mobile laboratories were key in the response to the Marburg outbreak in Kween District in 2017, and have proved effective in the response to the current Cholera outbreak in Hoima District.
Laboratories are also key in informing the response of the required treatment especially in the era of growing antimicrobial resistance. However, Uganda must continue to prepare the health workforce for response and also ensure availability of proper infrastructure especially isolation facilities in an effort to be ready to respond to outbreaks as they arise.
The third and last pillar of response calls for a focus on effective coordination mechanisms for the response efforts, prepositioning of medical stock, required essential supplies and multi-sectoral coordination, including law enforcement agencies.
Currently, Uganda boasts of a vibrant Public Health Emergency Operations Centre (PHEOC) that has been focal for reporting outbreaks, coordinating response efforts to outbreaks including the ongoing Cholera outbreak and ensuring a multi-sectoral participation and engagement in responding to outbreaks.
With all these key pillars in place, Uganda should be able to control outbreaks at the source rapidly with no room for spread to other areas such as; district, region or even the country at large.
The writer is a Field Epidemiology Fellow with the Uganda Public Health Fellowship Program, Ministry of Health