Uganda: Poor hygiene fuelling Hepatitis in north

KAMPALA, 7 August 2008 (IRIN) - "The major challenges are inadequate access to safe water, unhygienic disposal of faeces, poor personal and domestic hygiene," Steven Malinga, the Health Minister, told IRIN on 7 August.

The disease is spread along the faecal-oral route and outbreaks tend to be linked to contaminated water or food supplies. Mortality rates are generally low, ranging from 0.5 to 4 percent, but can rise to 20 percent among pregnant women in their third trimester. According to the UN World Health Organization, an infected person develops fever, headache, general weakness, muscle pains and eventually yellow eyes and yellow urine.

Since October 2007, when it was initially identified in Kitgum District, the disease has spread to Gulu, Pader and Yumbe districts, and claimed a total of 104 people, mainly pregnant women, across northern Uganda.

Health officials, however, said the overall number of reported cases had started declining, although there was still concern over a resurgence as new areas were reporting infections.

Sources at the district epidemic taskforce in Kitgum - the epicentre of the outbreak - said their assessment indicated a reduction in cases reported at health centres, but they were puzzled by new cases reported from areas that had not recorded any previous cases.

"The current trend is that the number of cases is coming down, but we still see some new sub-counties recording cases. We have tried to contain the situation, but with the coming rainy season, which seems to promote infection, we don't know what will happen," an officer, who requested anonymity, said.

He said 72 percent of the recorded fatalities among the more than 6,500 cases reported were women. "Because women have lower immunity during pregnancy, cases of Hepatitis E are severe and have caused more death among them," he explained, adding that some cultural beliefs that bar pregnant women from using latrines had made matters worse.

"Most of the women will just [relieve] themselves in the open, which is a good breeding ground for the Hepatitis E virus," the officer told IRIN.

In Kitgum, where formerly displaced people were returning to their villages, returnees faced a lack of water and sanitation facilities.

"We lack resources for water and sanitation," the Kitgum official said. "We also lack resources for social mobilisation, incentives for sensitisation and for the health teams that visit the villages to educate people about the proper way of living."

An emergency 10 billion Uganda shilling (US$6 million) plan to fight the epidemic in northern Uganda has been launched and the health ministry hopes it will help eliminate the virus. The plan focuses on teaching residents about proper hygiene, improving sanitation through construction of boreholes and pit latrines in the remaining displaced people's camps, and monitoring infected people to ensure they are treated.