By Halima Athumani
KAMPALA
As the world gears up to mark World Water Day on March 22, Uganda's chronic inability to deliver clean water to its citizens has led to a recent surge in typhoid infections.
"As of yesterday, March 19, we had recorded 4,949 suspected cases in Kampala, of which 1,033 tested positive for typhoid," Jane Ruth Aceng, director-general of health services at Uganda's Heath Ministry, told reporters.
She confirmed that the ministry had been seeing an increase in cases for several reasons.
"We did not have a standard case definition of typhoid in the beginning, but it [a standard definition] has now been sent to clinicians to guide them in identifying suspected cases of typhoid for laboratory investigation," she said.
Typhoid is caused primarily by the consumption of food or liquid that has been contaminated with fecal matter. Symptoms, ranging from mild to severe, usually develop between one and three weeks after exposure.
Symptoms include high fever, malaise, headaches, constipation or diarrhea, rose-colored spotting on the chest, and swollen spleen or liver.
While typhoid fever can be treated with antibiotics, resistance to common antimicrobials remains widespread.
The Health Ministry has conducted several research projects aimed at identifying the exact source of water contamination.
Aceng explained: "Preliminary findings show that most water sold and packaged in plastic bags in downtown Kampala, some wells, protected and unprotected springs, are contaminated with fecal matter."
Contrary to reports attributing the cause of infection in many cases to tainted tap water, Aceng asserted: "Findings from [the analysis of] tap water provided by the National Water and Sewerage Cooperation as of March 7 [indicate that the water] was not contaminated."
The government has launched an inter-ministerial committee to work in cooperation with the World Health Organization (WHO), the U.S. Center for Disease control and UNICEF.
The committee has developed a three-month, comprehensive response and intervention plan, expected to cost some 4 billion Ugandan shillings.
Intervention measures include designating five medical centers in Kampala for the treatment of citizens showing symptoms of typhoid and retraining health workers to deal with the illness.
"For those who are critically ill and need to stay in the hospital for treatment, we have designated centers in the Mulago National Referral Hospital and the Chinese Uganda Friendship Hospital for referrals," Aceng said.
The Ugandan army, meanwhile, is providing health workers at various facilities.
In a Tuesday statement, the WHO said the typhoid outbreak had spread to 14 neighboring districts of Kampala and that Salmonella Typhi had been laboratory-confirmed in four of 16 specimens tested.
The WHO further noted that additional specimens had been tested during the outbreak, citing five confirmed cases of Type A Salmonella Paratyphi.
According to Aceng, a critical verification of data from affected districts had revealed a number of suspected typhoid cases in the area in question, but that there had been "no confirmation yet of any of the cases."
"Our experts have been sent to these districts to verify the reports," Aceng said.
According to the WHO, an outbreak of typhoid is declared if an area reports over five cases per 50,000 people, and if Salmonella Typhi organisms – which cause Typhoid – are found in at least five suspected cases, "which has not been the case in these districts," said Aceng.
"The Ministry of Health therefore assures the public that the outbreak has only been confirmed in Kampala as of now," she added.
Aceng urged the public to remain calm, asserting that all possible measures were being taken to counter the outbreak.
"All people are urged to observe personal and community hygiene to avoid the possible spread of the infection and to be careful about the source of their drinking water," she said.
The public was further advised to avoid eating cold foods, raw vegetables and fruit washed with tainted water.
As of June 30 of last year, access to improved water supplies in urban areas – based on estimated populations of both large and small towns – had reached 70 percent.
However, access to clean water was less common in rural areas, where it stood at 57 percent – compared to 77 percent in urban areas.
