Government undertakes Indoor residual spraying in 10 epidemic districts in northern Uganda

In a bid to intensify efforts towards the management of the malaria epidemic in northern Uganda, the Ministry of Health is undertaking indoor residual spraying (IRS) in 10 epidemic districts in September this year. The exercise is intended to contribute to the objective of achieving and sustaining protection of at least 85% of the most at risk population.

IRS is the application of a long-lasting residual insecticide to potential malaria vector resting surfaces such as walls, eaves and ceilings of all houses or structures, including domestic animal shelters.

The IRS will be conducted in districts of: Kitgum, Amuru, Agago, Apac, Gulu, Kole, Lamwo, Nwoya, Oyam and Pader. Approximately $9m (Shs 29.7b) has been earmarked for the activity, with funding support from government of Uganda USAID/Presidents Malaria Initiative and DFID.

WHY IRS @ THIS TIME

According to a recent Malaria Indicator Survey, IRS has rapidly reduced malaria outpatient attendances, in-patient case admissions and malaria test positivity rates in all districts where it has been implemented. Additionally, IRS controls other household pests such as bedbugs, houseflies, lice and fleas, making it cost effective and acceptable to the communities as they spend less on treatment of related diseases.

“The exercise is being undertaken with the background that malaria remains the biggest cause of morbidity and mortality in Uganda. It is therefore critical for its reduction and interruption of malaria transmission,” said Prof Anthony Mbonye in a press release.

Mbonye is the director general of health services in the ministry of Health.

The IRS is being used together with other malaria interventions such as use of long lasting insecticide treated nets, case management, intermittent preventive treatment in pregnancy (ITPp), surveillance and behavioral change communication.

The Ministry urges the public to destroy all breeding places for malaria vectors by slashing compounds; work closely with village health teams to monitor and report cases to health facilities; sleep under a treated bed net and for those already diagnosed with malaria to complete the dose of anti-malarials given to them.

According to the Uganda Malaria Reduction Strategy 2014-2020, it is hoped that by 2020 the country will have reduced annual malaria deaths to near zero and a reduced malaria morbidity to 30 cases per 1000 people.

Thousands flee to Uganda from South Sudan following latest violence

A refugee shows off some of the deceased relatives (Photo credit-Oxfam)

The number of people seeking shelter and safety in Uganda from South Sudan has risen significantly in the past few days and we believe the influx will keep growing in the days ahead as tensions remain high across the border.

A total of 1,326 crossed into Uganda between Friday and Saturday, with 1,633 more arriving on Sunday. The majority are South Sudanese, but there are also believed to be some Ugandans. Prior to Friday, the average daily rate was 233. These new arrivals bring the total number to have fled to Uganda since the latest violence in South Sudan began on July 7 to 5,015. More than 90 per cent of the new arrivals were women and children under the age of 18 years.

UNHCR expects more people to flee to Uganda, especially now that the 200-kilometre Juba-Nimule road, linking the South Sudan capital to Uganda, has been cleared of checkpoints. As a result, more people are now coming by truck, and this explains the rising numbers of arrivals. Many are also bringing belongings.

Thousands of people have entered Uganda’s northern region via the border crossing points at Moyo, Kuluba, Lamwo, Yumbe and Elegu, while some are heading directly to Kiryandongo refugee settlement in the mid-west of the country. The border was previously closed on the South Sudan side, but restrictions have been eased.

The new arrivals are mostly fleeing from Eastern Equatoria state, with a smaller number arriving from Juba. They report that the security situation remains volatile and fighting could return at any time. The refugees talk of an increase in looting.

Inside Uganda, more than 6,000 South Sudanese are staying in the Pagiarinya settlement in Adjumani District, while others are waiting at collection points to be transferred to the settlement. A recent evaluation found that Pagiarinya has capacity for another 6,500 people, meaning it is likely to be full within a few days.

An inter-agency site assessment mission, including officials from the Government of Uganda Office of the Prime Minister and UNHCR, are currently visiting sites to identify areas suitable for establishing new settlement areas.

People are arriving in Uganda tired and hungry. Many of them have walked for days carrying belongings. Others are suffering from malnutrition after walking without food for days. Militia activities in some areas of South Sudan have made it difficult to harvest crops in recent months.

Some of the refugee children queue for food-Photo credit-UNHCR

The UN has said that at least 300 people were killed and over 10,000 fled their homes after the violence in Juba. We condemn violent attacks against humanitarian workers, which have left at least one person dead. Several countries have evacuated their nationals. UNHCR, as part of the overall humanitarian response, is undertaking assessments and providing assistance in displacement sites.

Although a fragile ceasefire has held since late Monday, the United Nations has warned of the possibility of fresh fighting in Juba. The situation is being exacerbated by the devaluation of the South Sudanese pound, leading to skyrocketing prices and making the food that is available too expensive for many. The fighting also disrupted supply routes from Uganda into South Sudan, including aid and food.

In western Ethiopia’s Gambella region, the number of new arrivals has not risen significantly since June 11, but the fresh fighting has dampened hopes of returning home soon. The Kenya-South Sudan border has also been relatively quiet. To date UNHCR has transferred 169 new arrivals from the Nadapal border to Kakuma camp. 

The fresh displacement will put a further strain on UNHCR’s resources for the South Sudan operation and our ability to provide timely and life-saving assistance. Especially with access to Juba difficult. Last Friday in Nairobi, UNHCR presented a revised appeal for its South Sudanese refugees operations, seeking US$701 million. The earlier appeal for US$638 million was only 17 per cent funded.

Presenting the appeal, Ann Encontre, Regional Refugee Coordinator for the South Sudan situation, said the overall planning figure had risen from 867,239 refugees to 973,000. She warned that it could pass the 1 million mark in the coming months.

For more information on this topic, please contact:

In Kampala, Charles Yaxley, yaxley@unhcr.org , +256 (0) 776 720 045 

In Nairobi, Teresa Ongaro, ongaro@unhcr.org, +254 735 337 608

In Geneva, Leo Dobbs, dobbs@unhcr.org +41 79 883 6347

In Nairobi, Duke Mwancha, mwancha@unhcr.org +254 722 207 863

PRESS STATEMENT ON THE UGANDA POPULATION BASED HIV IMPACT ASSESSMENT.

The Government of Uganda through the Ministry of Health conducts population level surveys to inform the planning for HIV activities after every five years. The last one was conducted in 2011 and this was known as the Uganda AIDS Indicator Survey(UAIS 2011). This has been very useful in improvement of the HIV interventions in this country over the past five years.

The previous round of AIDS Indicator Survey shows that HIV prevalence in the general population in Uganda increased from 6.4% in 2004/5 to 7.3% by 2011,  tallying with the 2013 HIV estimates which show that HIV prevalence stabilized around 7.4% in 2012/2013. This however seemed to undermine the fact that the country that was well known for earlier interventions that drastically reduced the prevalence in the earlier years of the epidemic is seeing a reversal. However the stagnation of HIV prevalence was partly due to the high coverage of ART program where the number of PLHIV enrolled on ART increased from about 330,000 in 2011 to about 750,896 in 2014 and the reduction in AIDS related deaths from 67,000 to 63,000 in 2010 and 2013 respectively, and down to 31,000 in 2014.

To further boost government efforts towards containing the scourge, this year, we are conducting another survey - the Uganda Population Based HIV Impact Assessment – that will measure the reach and impact of the country’s HIV prevention, care and treatment services. This nationwide household survey aims to estimate HIV incidence, prevalence, and viral load suppression among adults and children. UPHIA will also benchmark Uganda’s progress toward targets of 90% coverage in each area. This information is critical to helping Uganda chart a course to reach the UNAIDS’ 90-90-90 targets and ultimately bring the HIV epidemic under control.

The assessment exercise, which will be flagged off next month (August 2016) during a national launch in Kampala, will see up to 25 teams of trained personnel dispatched to all regions across the country. This survey will inform the next prevalence indicator and guide efforts towards reversing the HIV prevalence in the country.

Survey teams will visit approximately 13,000 randomly selected households throughout the country, who will voluntarily participate in the survey. Those who choose to participate will receive HIV counselling and testing in their home, with results returned the same day. Syphilis and hepatitis B tests will also be provided and results given on the same day.

Treatment of syphilis will be given at the household level while the HIV and Hepatitis B cases will be referred to health facilities. Children and adolescents are part of this survey. However, children will only be allowed to participate after obtaining permission from their parents or guardians.

UPHIA data will help Uganda sustain its achievements in responding to HIV, and help improve the response in the future while individuals who participate in the survey can contribute to improving health services for all Ugandans.

By combining interviews with in-home HIV counseling and testing, UPHIA can provide more accurate estimates of HIV incidence and prevalence in Uganda.

The assessment will be implemented with support from ICAP at Columbia University through the U.S. Centre for Disease Control and Prevention (CDC). The other partners include Uganda Virus Research Institute (UVRI), Uganda Bureau of Statistics, Westat and ICF Macro.

I wish to state that the success of this survey largely depends on the voluntary participation of the selected households countrywide and also on everyone encouraging and supporting the survey teams in the different enumeration areas.

It is against this background that we have engaged you as the media fraternity to partner with us in creation of awareness and play a role in engaging the different stakeholders in supporting this very noble cause.

UNHCR calls for open borders for possible South Sudan refugee outflows

UNHCR is calling on all armed parties to ensure safe passage for people fleeing the fighting that erupted late last week in Juba between troops loyal to President Salva Kiir and First Vice-President Riek Machar and we urge neighbouring countries to keep borders open to people seeking asylum. Inside South Sudan, some 7,000 internally displaced people have sought shelter in the UN’s bases in Juba. Providing them with food, shelter, water, hygiene and sanitation facilities will remain a critical challenge so long as the security situation remains bad. The situation of some 9,000 urban refugees is worrisome. Some refugees who spoke to UNHCR are uncertain about their security and have difficulties in getting food and water. Other refugee-hosting sites across South Sudan are reported to be calm. Meanwhile, some borders have been affected such as the Uganda-South Sudan crossing, where security is tightened on the South Sudan side. This has led to a significant decrease in the number of new arrivals coming into Uganda over the weekend. Just 95 people crossed on Saturday, dropping to 36 on Sunday, compared with a daily average of more than 200 for July. Higher levels of new arrivals are expected once the border reopens. Those that have managed to cross have reported indiscriminate attacks against civilians, with buses from Juba to the Uganda border being stopped and robbed. In western Ethiopia’s Gambella region, UNHCR has stepped up border monitoring with Ethiopia’s refugee commission. Emergency preparedness is in progress in Kenya, Sudan and other neighbouring countries in case of a major influx. There has not been any big influx at the Kenya-South Sudan border, though over the weekend UNHCR received 36 individuals from Eastern Equatoria state. We have stepped up border monitoring and await more news. For more information on this topic, please contact: In Kampala, Charlie Yaxley, yaxley@unhcr.org , +256 (0) 776 720 045 In Nairobi, Teresa Ongaro, ongaro@unhcr.org, +254 735 337 608 In Juba, Rocco Nuri, nuri@unhcr.org +256 779 663 793 In Gambella, Sulaiman Momodou, momodu@unhcr.org +251 935 978 519 In Geneva, Leo Dobbs, dobbs@unhcr.org +41 79 883 6347

Ssese beauty blighted by dysfunctional health system

Don’t let the tranquil, picturesque seclusion of the island district of Kalangala fool you; this home to Ssese islands, an archipelago of 84 islands, is a perfect natural beauty, but also a poster child for numerous health and system plagues associated with many far-flung districts. Seeing Lake Victoria’s waves reluctantly touch the shores and feeling the morning chill bite one’s skin is tantalizing. However, on this particular morning, hundreds of people saunter through the serpentine roads on Bugala Island to receive free medical care courtesy of a medical camp organised by Uganda Health Marketing Group (UHMG) last week. The stories from the locals about the challenges of accessing health services are striking. Robina Nakato, formerly from the island of Bubeke whose toddler died earlier this year from severe malaria, blames the death on the poor quality health care on the island. “I had earlier reported to a drug store in Bubeke and was given drugs by a ‘nurse’ since there was no doctor, but [the drugs] did not work. I cannot afford coming to Kalangala Health Centre IV all the time, because a trip costs me about Shs 40,000, which I don’t have,” the mother of two says. “My son worsened at home and a few hours after arriving at the health centre, he died.” ACCESS DELAYS There is no district hospital and Kalangala HC IV is the main referral health facility for the 64 habitable islands. The islanders have repeatedly highlighted the austerity of an inadequate transportation to access health facilities, leaving many of them to resort to the expensive and scarce private clinics or even traditional healers. “That night will forever haunt us, because I wonder, had it not been for the transport delay and earlier wrong diagnosis, would my son be alive?” Nakato forlornly says. According to Willy Lugoloobi, the Kalangala district chairman, Bubeke and Mazinga islands are the hardest to reach. It will cost a person 80 litres of fuel and four litres of oil to travel from Bubeke to Kalangala HCIV. For those from Mazinga Island, the furthest from Kalangala town council, it takes 100 litres of fuel and five litres of oil. Each litre of fuel costs Shs 5000 in these parts. “In Kalangala, a walkable distance is talked of in terms of a swimmable distance. It is not only a hard-to-reach district but also a hard-to-stay in. About Shs 600,000 for primary health care is channelled in per quarter but even accessing that money from the bank is hard. In Mazinga, you have to use eight litres of fuel to reach the bank,” Lugoloobi says. All the islands are served by only 15 health centres, two thirds of which are located on Bugala, Kalangala district’s biggest and administrative island. Further referrals to Entebbe hospital or Masaka regional referral hospital are facilitated by the MV Kalangala ferry that costs Shs 15,000 per head from Lutoboka to Nakiwogo in Entebbe, and MV Pearl that docks at Bukakata, respectively. Deeply concerned for the wellbeing of their other children, Nakato and her family moved to Bugala last year. Unlike Nakato who could afford moving nearer to the health facility, thousands remain stranded on smaller islands meaning that delays in accessing health care services is costing lives and hampering the right to health. According to the 1995 Uganda Constitution, Objective XIV (b), the state shall ensure that all Ugandans enjoy the rights, opportunities and access to health services. However, the realisation of this access is still a far cry for the locals in Kalangala. According to the district’s statistics, only 17 per cent of expectant women deliver in health facilities. Sarah Subo, a health educator with the district for 15 years, says majority of the women depend on traditional birth attendants. MORE DEPRESSION Although health worker deployment is at 80 per cent within the district, Lugoloobi says that harsh working conditions are forcing medical workers out. “Teachers are now forced to share their accommodation with medical workers, because medics have nowhere to sleep,” he agonised. Moreover, HIV prevalence remains high at 25 percent which implies that 25 of every 100 people are infected. Subo attributes the high prevalence to the falling condom use in the face of ever increasing commercial sex associated with fishing communities. “Unprotected sex costs Shs 20,000 and above, whereas protected sex is negotiable from about Shs 5000. Having more than eight sexual partners and swapping them is also common,” Subo explains, adding that the vice is spreading to adolescents too. The high prevalence is also brought on by drug stock outs in some months. To deal with these challenges, Prof George Kirya, a founder member of UHMG says it (UHMG) organises annual health camps in the district, bringing drugs, HIV testing, cancer screening, immunisation and health awareness closer to the locals. However, Lugoloobi says, all the health problems cannot be met in a health camp. “We need a district hospital and more health centres, because each of the seven sub counties is supposed to have a Health centre III. We appreciate the camp efforts but if one gets sick after, they are met with the familiar challenges,” he said. NEW PLEDGES Sarah Opendi, the state minister of health in charge of primary health care pledged to give the district two motorised boats to ease health workers’ movement among the islands. Their delivery is expected in August this year. “Government is also going to give the district priority status and establish maternity wards to reduce on maternal deaths,” she told residents during the health camp. Opendi, however, urged them to observe personal hygiene and safe practices to avoid diseases such as cholera. At least 1000 women, men and children attended the camp.

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New cancer unit lights up patients

Each day, about 200 people report to the Uganda Cancer Institute (UCI) in Mulago for treatment, checkups and counseling about the devastating malignancy. Some of them travel miles from the Democratic Republic of Congo (DRC), Burundi and Tanzania because UCI is the only national and regional free cancer referral centre.

Outside the outpatient department, tens of patients try to find sits, floor space and tree shades to rest and wait because wards are full. When the sun sets, patients who cannot afford transport fare back home saunter into the wards to sleep. Christine Namulindwa, the institute’s publicist, says the prohibitive cost of cancer treatment in private facilities has led many to seek free treatment at the institute. The high cost of equipment and drugs explain the exorbitant cost of treatment.

“The cheapest cancer treatment is about Shs 14 million and majority of the patients cannot afford it, which explains the overcrowding here. However, we are also met with the challenge of limited skilled personnel as there are only 12 oncologists,” Namulindwa says.

Children afflicted with cancer find rest-Photo Credit/Nicholas Bamulanzeki

In the past few years, UCI has reported a spike in cancer incidence, particularly infection related cancers such as Kaposi Sarcoma, sending a wakeup call to government. Although there is no nationwide data, estimates obtained from UCI’s registry indicate that some 300,000 Ugandans develop invasive (advanced stage) cancers and over 10,000 of these die annually.

NEW PREMISES

In 2011, government invested Shs 10.4 billion to construct a new, modern cancer unit. Currently, some of the wards on this six-floor unit are up and running. For now, mainly children, patients admitted to the private wing and those going to be operated are using the facility. Majority of patients are still using the old block as the new block is short of medical equipment.  

The new cancer block-Photo credit/Nicholas Bamulanzeki

Inside the children’s ward on level four, hued caricatures painted across the walls are a fresh face to the children’s treatment. Accordingly, these play a role in keeping the little ones in high spirits. Six year old Jordan Kibirige from Mukono was admitted here one week ago.

He is battling Burkitt’s lymphoma, a potentially fatal cancer that has left him with a painful swelling on the left side of his face. The lymphoma, associated with malaria, is known to grow rapidly such that the tumours double their size in five days.

“So far, we have been able to get quick treatment and bed space at this new facility. I hope my boy will soon recover,” Kibirige’s mother forlornly says.

At least one doctor and nurses are on duty here throughout the day, a sign of relief to the over 20 patients here.

So far the journey is comfortable; clean toilets, lifts, regular electric power, piped water and free lunch. The theatre, on level two, is operational and Namulindwa says it has greatly reduced congestion at Mulago hospital’s general theatre. The building also has a mortuary, intensive care unit, private wing and an imaging and nuclear medicine department.

Inside the children's ward

However, Namulindwa expresses fear that with the swelling number of patients, this facility will soon be overwhelmed.

“The new centre is expected to accommodate 100 patients but we’ll be seeing more than these,” she said.

The new facility will officially open mid this year.

MORE DEVELOPMENTS

A comprehensive state-of-the-art research, training and outpatient cancer centre is currently in the final stages of construction. The Hutchinson Cancer Research Institute- Uganda sits on 25,000 square feet and will include an outpatient clinic, chemotherapy infusion rooms, research laboratories, molecular diagnostic labs, a training center and data centre among others.

This facility seeks to ensure the availability of medical care, overcome the social and economic barriers to completing treatment and improve capacity of the medical infrastructure to diagnose and care for patients. With the new premises, it is hoped that the five-year survival rate of cancers such as leukemia which is less than 40 per cent will be improved.

The centre, whose construction began in April 2013, is slated to officially open in May this year. It is supported in part by the United States Agency for International Development, American Schools and Hospitals Abroad Programme.

Namulindwa also told The Observer that plans are underway to construct a Radiotherapy and Nuclear Medicine Centre.

In spite of these developments, challenges of limited beds and equipment, medical personnel brain drain and forbiddingly expensive drugs are rife.

“Diagnosis equipment for examining biopsies is only available at Mulago Referral hospital and because of the limited number of pathologists, results take up to two weeks to return,” Margaret Okello, a volunteer counselor at UCI, notes adding that there is only one radiotherapy machine in the entire referral hospital.

Moreover, because of the limited number of oncology personnel, nurses have had to be trained on the job in order to administer drugs.

Okello and Namulindwa urge government to subsidize pharmaceutical companies that supply drugs in order to make them more affordable and available.

“We also appeal to government to adequately remunerate skilled personnel and invest in the purchase of modern equipment such as a magnetic resonance imaging machine,” Namulindwa says. 

This article first appeared in The Observer.