Fighting a cholera outbreak in the middle of a COVID-19 pandemic

Moroto’s story of resilience

By Alex Taremwa
water borne diseases, WASH, borehole, clean water, disease, cholera, unsafe water, health, hygiene,
UNICEF Uganda/2020/Taremwa
23 July 2020

“We have been very unfortunate.” “The district suffered first a water shortage, then a locust invasion, in came COVID-19 and later a cholera outbreak,” Moroto District’s Water Officer, Lowot Musa explains how the last six months (January – June 2020) have been.

A cholera outbreak started in Natapara Kocuc in Loputuk Sub-County affecting 60 villages across six sub-counties in North and South divisions as well Moroto Municipality with a population of over 18,000 people. As of July 2020, the district had recorded a total of 700 cases and six deaths since the outbreak was announced on May 11. 

Currently, over 80 patients are recovering from the disease in different treatment centres while the epicentre, Loputuk Health Centre III has not registered any new cases in the last two weeks. The hospital in-charge, Phillip Lotee credits this to efforts by the Ministry of Health and partners such as UNICEF who swiftly delivered critical supplies to the hospital and local communities to curb the usage of contaminated water from open defecation.

“We now have drugs to treat about 200 cholera patients. UNICEF gave us protective gear for our frontline health workers, disinfectants such as aquatabs for water, jerry cans, gumboots and handwashing facilities,”

Lotee said. 

While the district seems to have a grip on cholera, a visit to the local communities communicates that little change has happened. Open defecation is still rampant in Natapara Kocuc, Rupa and other villages around Moroto Municipality.

“One cannot take two feet without encountering a “landmine,” a UNICEF staff exclaimed. 

UNICEF’s Water, Sanitation and Hygiene (WASH) Specialist in the region, John Bosco Kimuli admitted in an interview that “the change we anticipated has not been easy to achieve” as the locals are keen on sticking to their old habits.

Moroto District is only at 24.6 per cent in hygiene levels according to the District Water Officer despite having a 72 per cent clean water coverage. One of the reasons as advanced by Lomilo Michael, the Kaloi Village Local Council 1 Chairman is that the locals prefer to consume the seasonal river water to the one from boreholes and other treated water sources.

water borne diseases, WASH, borehole, clean water, disease, cholera, unsafe water, health, hygiene,
UNICEF Uganda/2020/Taremwa

“The villagers say that river water is sweet. They tend to drink it directly from the streams, sometimes without even boiling,”

he said. 

Lomilo is running a campaign to remove all open faeces from riverbanks as the rains continue to pound Moroto and the rivers, mostly seasonal are about to flow downhill, washing all the human waste with them. 

Water hygiene critical to success

When cholera broke out, the district took water samples from 35 water sources that served local communities. Of these, 14 were found to be grossly contaminated. These wells, streams and dams were cordoned off and clean alternatives have since been provided. 

While Cholera is a highly virulent disease, it can be courted with proper sanitation and hygiene – all of which hinge on clean water supply to work. Karamoja sub region, however, still ranks high in water shortage countrywide. According to African Development Bank data, water consumption per capita in Karamoja is between six to ten litres per day. 

UNICEF, using funds from KOICA is working with a local partner, Cooperation and Development (C&D), who have rehabilitated five boreholes so far and supplied jerry cans, handwashing facilities and aquatabs to all households in Moroto.

Michael Lokee, the C&D Assistant Programs Officer said that local communities were also trained on how to use the handwashing facilities after visiting latrines, they were also given bars of soap to use for washing hands, utensils and clothes and were also sensitised on how to dispose of human waste after using ash as a disinfectant. 

“We are training the locals to wash hands before touching food, fruits, meat, after using the latrine or disposing off human waste, before and after feeding babies. Our plan is to increase the water consumption per household to 15 litres per day and we are grateful to UNICEF for the support,” he added.  

Lokee said that they have trained health workers, VHTs and community leaders on response plans for infection and prevention. UNICEF has also supplied detergents, chorine granules, filtering pots to boost sanitizations efforts in local communities.

Additionally, UNICEF has also supported sensitization of locals through IntraHealth by funding radio programmes, spot announcements, mobile vans and physical stakeholder meetings to change people’s attitudes – continuously discouraging open defecation, promoting handwashing and regular disinfection.

Through IntraHealth, UNICEF has also supported social mobilisation and contact tracing of persons with cholera, ensuring that they get treatment, psycho-social support against stigma and health supplies. 

“We are now back to the basics of the four Fs; faeces, food, flies and fingers to fight the disease. We teach locals how to prepare and eat clean food, keep away flies, washing hands thoroughly with soap before eating or handling food stuffs and proper disposal of faeces in latrines,” UNICEF’s J.B. Kimuli said. 

With no new cases reported since April, Moroto District authorities are confident that sustainable capacity within their health force, communities and administration has been developed to tackle any future outbreaks should they arise. 

Children can now safely play outdoors without the threat of new cholera infections and dehydration since the clean water threat has been thatched and community hygiene heightened.