Fix sanitation and sewage systems in the city

Aug 13, 2015

The typhoid outbreak in Kampala which started at the beginning of 2015 has so far affected over 10,000 people. The outbreak was first confirmed among individuals working around Qualicel building, Nakasero Market, Total Petrol station on Namirembe Road and Disabled Peoples’ Market (New Taxi Park).

By Dr. Ben Masiira

The typhoid outbreak in Kampala which started at the beginning of 2015 has so far affected over 10,000 people. The outbreak was first confirmed among individuals working around Qualicel building, Nakasero Market, Total Petrol station on Namirembe Road and Disabled Peoples’ Market (New Taxi Park). Emerging evidence now shows that the outbreak has spread to other districts. 


Typhoid fever is one of the oldest documented public health threats to human existence. Around 430-424 BC, typhoid fever is believed to have killed one third of the population of Athens including their leader. During the 19th century, the United States of America and Europe saw typhoid fever become a major cause of disease among their population. By the 20th century, these countries had invested much in sanitation and safe water to eliminate typhoid outbreaks.

However, typhoid outbreaks still remain a public health challenge in developing countries. Whenever an outbreak occurs, there is a break down in the sanitation and safe drinking water supply systems. This results into consumption water and foods contaminated by faeces and thus acquisition of typhoid fever. In an urban setting where thousands of people share a common source of drinking water, this may have disastrous effects in terms transmission of the disease to a large population. Disease transmission is also facilitated by unhygienic practices such as not washing ones hands after the toilet.

Investigations that were conducted by the Ministry of Health indicated that drinking water packed in polythene carrier bags (Kaveera) and juices packed in Kaveera or plastic bottles was a risk factor for getting typhoid fever. Considering how typhoid is transmitted, this implies that the water used in preparation of these products is inadequately boiled or treated and is contaminated with sewage. The investigation also revealed bad practices among fruit and vegetable vendors who keep their merchandise fresh by dipping them in streams such as Nakivubo Channel. 

Improvements in provision of safe water and sanitation still remain the key to prevent occurrence of typhoid outbreaks. These improvements also give us an opportunity to prevent other water-borne diseases such as cholera. Public sewers in the city should be expanded, made easily accessible and connections should be affordable. Enforcements to ensure safe disposal of faeces should be done among those who can’t access connections to public sewers e.g. having alternatives such as septic tanks and pit latrines. Communities residing in areas where the water table is low should be supported to construct improved toilets.

 

All individual staying or working in the city should have access to safe drinking water at affordable rates. This can be achieved through affordable water connections to all premises, provision of public standpipes and protection of wells outside the city centre. All wells located in Kampala city centre should be closed. There is a possibility that the water sold very cheaply in Kaveera and some locally squeezed juices are prepared using well water. In addition, some of the town dwellers have been observed drinking water directly from wells. These efforts should be augmented by regular monitoring of the quality of water through conducting water testing.

People directly drinking water from a well in Kampala
 
These investments may look alien, expensive and impossible to achieve but in the long term, this is the cheapest approach if we are to eliminate these threats. The cost of doing business as usual that is managing epidemics as they come is clearly far much higher than preventing them. In a typhoid outbreak in Calamba City (2008), which affected a total of about 2000 people, about 302 US dollars was spent on managing each patient (direct and indirect costs). If they had treated 10,000 people, like in the 2015 Kampala typhoid outbreak, this cost would have been 3 million US dollars (9 billion Uganda shillings!).

As the country heads into the modernization phase, we need strategic investment in prevention of disease outbreaks in order to have a healthy work force. Financing effective response to disease outbreaks requires huge sums of money which is much more needed in the socio-economic transformation of our country.

The writer is a MakSPH-CDC-MoH PHFP-FET Fellow
 

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