By Stephen Ssenkaaba
As Uganda joins the rest of the World to mark World Health Day, vector control remains a serious challenge to the country’s health system.
Ronald Simwa did not go to work for a whole week. He called in to say, he had malaria. His boss was concerned when he had not improved even after a whole week. The doctors said he needed more time to rest. But his boss did not understand.
“He certainly thought malaria wasn’t that serious to keep me away from work for that long,” he says.
Transmitted through the bite of a female anopheles mosquito, malaria is one of the major vector-borne diseases in Uganda today.
And yet it is one of a number of many vector-borne diseases that this country is grappling with. From elephantiasis to river blindness, a number of such diseases continue to challenge our health system and in some cases slowly but surely eating away at our society.
A 2006 Ministry of Health study of neglected diseases and their control in Uganda identified vector-borne diseases as part of a group of the most neglected diseases in the country.
The study indicated that despite these diseases being preventable and treatable, “Uganda remains affected by a high burden of these diseases.
Understanding Vector-Borne Diseases
According to Tom.L Lakwo
(Right) a senior entomologist at the Vector Control Division of the Ministry of Health, vectors are organisms that transmit an infectious agent from an infected human or animal to another human or animal.
“Vectors are mostly arthropods. Insects, mosquitoes, black flies, fleas, tsetse flies and other such.
They can transmit these agents, either passively or actively. Actively by picking the parasite and then depositing it in the human or animal body.
The vector then multiplies in the host’s body, “he explains.
There are also mechanical vectors which pick the infectious agents on the outside of their body.
“For instance, when flies land on human excreta, feacal material sticks to their bodies. When they carry this and land on food, they contaminate it and transmit disease to all those that eat that contaminated food,” says Lakwo.
Diseases that are transmitted by vectors are called vector-borne diseases.
While there are a number of vector borne diseases the commonest ones in Uganda include: malaria, elephantiasis, sleeping sickness, river blindness, bilharzia, plague and the kal-azar- sandfly fever.
Kabaka Ronald Mutebi II on a Malaria control drive, handing over mosquito nets to parents carrying their babies at Kayunga District Hospital. This was during his tour of Kayunga district. File Photo/ Steven Musoke
Malaria is believed to be the leading killer in Uganda today.
According to the Ministry of Health, the disease accounts for 25% to 40% of outpatient visits to health facilities and is responsible for nearly half of inpatient pediatric deaths.
The disease is spread by female anopheles mosquito bites from an infected person to a healthy one.
Malaria is a threat to many people in Uganda especially those that live in wet, water-logged areas.
As such, various interventions have been put in place to curb the disease.
“There has been nationwide distribution of mosquito nets in different parts of the country and indoor spraying to control malaria vectors,” Lakwo said.
We are also currently undertaking large scale trials in Nakasongola- testing various insecticides.
We would like to target the anopheles mosquito in its early stages.
We are targeting open breeding places such as pods, brick pits, dams and swamps: This follows a similar test that was conducted in Wakiso.
Sleeping Sickness is also very common in Uganda. It is transmitted to humans through the bite of bloodsucking Tsetse flies.
Infection leads to illness and irregular fevers and, in advanced cases even death.
Cattle and wild animals act as reservoir hosts for the parasites.
Sleeping sickness is, according to studies endemic in 36 countries of sub-Saharan Africa.
This vector, according to information from the Vector Control Division of the Ministry of Health is very rampant especially in North Western Uganda, West Nile and Eastern Uganda.
Patients with sleeping sickness at Dokolo health unit. File photo/Patrick Okino
The most effective control is early spraying especially through netted conical traps sprayed with chemicals and put in open- bushes to attract and trap tsetse flies.
This is manifested through swollen legs resulting from bites of a female anopheles mosquito from an infected person.
The Parasite blocks the fluid draining system in the body resulting into fluid accumulation in the affected part.
Elephantiasis is very common in Uganda. “It is endemic in 54 districts in Uganda mainly in Eastern and Northern Uganda and Bundibugyo,” says Lakwo.
Another vector-borne disease that is common in Uganda and is caused by black flies that breed in fast flowing rivers.
When they come out of the water, they go to feed on human blood which they transfer from one sick person to infect health ones.
The parasites develop inside the body.
Once this happens, the host develops an itchy skin with rough patches and gradual blindness.
River blindness is very serious. According to information from the Vector Control Division, it affects about 37 districts in the entire country.
It is commonest in Western Uganda. And some parts of Northern Uganda.
These places are vulnerable because of the presence of fast-flowing rivers there.
The disease was common in the Elgon area but, thanks to government’s intervention, it was reduced.
The government has been engaged in aerial spraying using aircrafts and ground spraying with the help of hand-held sprays.
This according to ministry of health has successfully worked in Kyenjojo, Kabarole, Kibaale, Mitoma, Ibanda, Kamwenge, Rubirizi, Buwheju.
It comes about when someone with parasites defecates near a water source.
When it rains, the feaces flow into the water and infest it with parasites which are then picked up by water snails.
The snails release parasites into the water. When human beings got to collect water and step into the infested water, they catch these parasites through their feet.
Bilhazia manifests through stomach pain and diarrhea.
President Yoweri Museveni giving a boy tablets to treat/prevent nodding diseases and Bilharzia as the Minister of Health Christine Ondoa (L) looks on. This was at Angagura Village, Angagura Sub- County Pader District. File photo/PPU
“In order to control this we target the snails by spraying the places where these snails breed. In Uganda however, chemical spraying for this is not done as it has not yet been approved because of environmental concerns,”Lakwo said.
Bilharzia is a serious vector-borne disease widespread in 63 districts in the entire country. It is commonest in the districts surrounding Lakes Victoria, Kyoga and along the Nile.
About 5.7 million Ugandans are affected by the disease, according to the Vector control Division.
It is also a common vector borne disease. Even though it is linked to only three districts namely Zombo, Arua and Nebbi, this disease continues to pose a serious threat to the people in communities.
It is transmitted by fleas normally associated with rats and through person-to-person contact.
It manifests as fever, headache, and swollen lymph nodes.
The Kal-azar- sandfly fever is one other vector borne disease that is wreaking havoc in the Karamoja districts of Moroto, Amudat, Kotido and other surrounding places.
The disease presents as a fever, accompanied by skin complications.
According to Dr. Edridah M. Tukahebwa, acting assistant commissioner in the vector control division of the ministry of health, this fever is transmitted by sandflies.
“It dwells in the dry lands; in the anthills. People get it when they go out in the land to graze.” She explains.
Dr. Tukahebwa says that this disease is serious and while efforts are being undertaken to address it, there is insufficient facilities to work with.
“For instance, patients are only being admitted in Amudat hospital, but the hospital lacks sufficient capacity to adequately handle the situation.”
Challenges in controlling vector borne diseases
One of the most serious problems currently affecting vector control in Uganda is poor funding of activities and services.
“There is a serious shortage of funds at the centre and in the districts where the ground work is being implemented,” Dr. Tukahebwa explains.
Tukahebwa explains that the vector control division receives about Ug sh30m every quarter, which is far below the required amount of about sh80 m every quarter.
Poor funding means there is not enough staff to carry out crucial activities.
It also leads to shortage of transport facilities to enable health officers reach out to the communities as well as absence of crucial medicines and vector control facilities.
The situation is even more serious in the districts.
“90% of the districts have not budget allocation for vector-borne disease control programmes.
They depend mostly on donor funding,” Dr. Tukahebwa said.
Efforts to wipe out vector-borne diseases in areas that boarder with other countries have also been undermined by cross boarder reinfections.
This has made it impossible
to completely get rid of some vector-borne diseases.
“For instance while we thought we had completely wiped out black flies in Kasese, there was reinfection from the Congo side of the boarder. The same applies to trachoma which we had tackled in Lamwo only to be reawakened through interactions with South Sudan,” Saya Tukahebwa.
Insurgencies in some parts of the country have also undermined efforts to address vector-borne diseases.
For instance, wars and armed conflict in many parts of Northern Uganda delayed crucial intervention.
This often made the situation in those areas only worse,” Tukahebwa explains.
Vector-borne diseases continue to ravage our country, despite all efforts to address the diseases.
More funding, and more government support coupled with commitment from all stakeholders is still needed.