How safe water provision can prevent diarrhoeal disease outbreaks

By Dr Kwesiga Benon

In 2015 alone, we have had several outbreaks of diarrhoeal diseases in Kampala, Kasese and Arua. These have been mainly typhoid and cholera. Detailed investigations found that these outbreaks were caused by water that had been contaminated by faeces.

These areas lacked safe water facilities and latrines. Therefore the most sustainable solution is to provide these communities with affordable, safe and permanent public water sources. With these in place, there will be no need for people to collect drinking water from dirty water sources like rivers and underground wells.

Investing in safe water provision and proper waste disposal saves a lot of money because it helps prevent all diarrhoeal diseases whose treatment would be much more expensive.

Diarrhoeal diseases are a leading cause of death and suffering in the world, and mostly result from contaminated water sources and food. Worldwide, 780 million individuals lack access to improved drinking-water and 2.5 billion lack improved sanitation. Diarrhoea due to infection is widespread throughout developing countries like Uganda.

Unsafe drinking water was linked to all these outbreaks.

We have recently had a large typhoid outbreak in Kampala city that affected more than 10,000 people and a cholera outbreak that affected up to 247 people in Kasese district. Through detailed investigations, we found that the Kampala typhoid outbreak was caused by drinking unsafe water from underground wells.

This water was sold in buveera (polythene bags) or used to make drinks like bushera, Munanansi, katunda etc. Banning the selling of these unsafe drinks helped a lot in controlling the outbreak.

Other interventions involved provision of aqua tabs and treating water, education on seeking treatment and general hygiene practices. KCCA also closed off underground wells from which people were obtaining their drinking water and temporally provided them with free safe water.

Kasese, is prone to outbreaks of diarrhoeal diseases. It suffered from a large typhoid outbreak in 2012 and is in fact only just recovering from its third cholera outbreak in fifteen years. This outbreak that started from Bwera Sub County spread through drinking water that was either not boiled or not treated with aqua safe or other water treatment tablets.

Many people use river water which was found to be very unsafe for drinking unless boiled or treated. We suspect that this water was contaminated by feaces from the cholera patients and this spread the disease further.

Another cholera outbreak later broke out in Katwe-Kabatoro town council, a fishing village on the shores of Lake Edward, still in Kasese district. Here we found that the outbreak was caused by a contaminated water collection cage. These cages were constructed to protect people from crocodiles and hippos in the lake. The water was most likely contaminated by feaces from sick fishermen who defecated in the lake and the first sick people who washed their clothes from this cage.

Through proper disposal of patients’ feaces, provision of water chlorination tablets like aqua safe, adequate chlorination of piped water and educating residents to boil or treat drinking water, we were able to stop the cholera outbreaks in Kasese.

The above measures helped prevent these outbreaks but are not enough to prevent future outbreaks. The most sustainable solution is to provide these communities with affordable, safe and permanent public water sources.

The general public also has a big role to play. We must continue to avoid these unsafe drinks if we are to avoid future outbreaks. Let us not just drink any water or eat any food, we have to always ask ourselves if it’s safe. Getting sick is definitely much more costly than taking time to ensure that whatever one eats or drinks is safe. Better sanitation and waste disposal are also important as they will prevent contamination of water.


Key message: Safe water provision and improved sanitaion are the most cost-effective and sustainable interventions in the prevention and control of diarrheaol disease outbreaks in Uganda

The writer is Epidemiology Fellow with the MakSPH-MOH-CDC Public Health Fellowship Programme