The onset of a belated rainy season in Uganda looks set to be bittersweet as the joy of those that take part in rain-fed agriculture is tinged with the economic toll of water-related events.
Already, the Bill for the damage inflicted by last weekend’s flash floods in the eastern town of Mbale threatens to be ominous dark clouds.
Besides resettling 800 households, the government has to pick up the tab for repair jobs of 14 bridges, three health centre IIIs, an industrial park and a handful of educational institutions. It also pledged to extend Shs5m to families affected by the flash floods.
Now the Ministry of Health is warning that the rains, which the weatherman forecasts will pound parts of northern, eastern and mid-western Uganda this month, will most likely trigger an upsurge in malaria and cholera cases.
The government spends $125m (about Shs485 billion) annually in dealing with malaria cases. A further Shs6 billion is needed to deal with cholera cases every year. It is unclear what the economic cost of an influx of malaria and cholera cases will look like. There is, however, almost complete unanimity that it won’t be cheap.
Saturday Monitor also understands that the Health ministry is bracing itself for the worst. Floods displace people and increase breeding grounds for mosquitoes, raising vulnerability to insect bites and the spread of malaria. A normal rainy season increases stagnant water on surfaces, which also serve as breeding grounds for mosquitoes.
“With the rainy season, like we are now are getting in Bududa [and eastern Uganda], we expect those families who are displaced [because of landslides] to be subjected to a lot of mosquito bites because they are outside,” Dr Henry Mwebesa, the director general of health services at the Ministry of Health, said in an interview on Thursday.
“We are also worried about the upsurge of cholera, especially in those areas where there have been floods and a lot of sewage has been thrown up,” he added.
Dr Imelda Tumuhairwe, the district health officer for Bududa, told Saturday Monitor that malaria is on the rise in the district.
“As per the last quarter, the positivity rate is at 21 percent—higher than the national target of 10 percent. We are now experiencing landslides. Two days ago, we had landslides and so we have four villages that are relocating. So we expect a tough situation in terms of malaria,” she warned on Thursday.
The warning from health officials comes amid a sustained upsurge in malaria cases in the country since November last year. Health experts have attributed the upsurge to the resistance of malaria parasites and mosquitoes to drugs and pesticides, respectively.
Dr Jimmy Opigo, the head of the Malaria Control Programme at the Ministry of Health, said people are taking the medicine, but they don’t get cured.
“And after the medicine, you get [malaria illness] again. But in between, you are also transmitting because you are not cured. The parasite has made some changes in that our Rapid Diagnostic Test (RDT) kits detection is becoming a problem. It will indicate negative when it is not,” he revealed.
An average of 37,600 cases are being registered in the country per day, resulting in increased hospitalisation and deaths.
Malaria kills 16 Ugandans daily and causes an estimated annual economic loss of $658m (Shs2.4trillion) due to treatment costs and work time lost, according to statistics from the Health ministry and a report by Juliet Nabyonga Orem from the World Health Organisation (WHO).
Dr Mwebesa said the Health ministry has not given up on the fight against malaria in areas that are already experiencing the upsurge.
“We are giving them a little more bed nets, but also treating the cases and especially the children and pregnant mothers,” he revealed, adding: “We are also providing adequate blood because the children, once they get malaria, they become anaemic and that is how we lose them. We have been trying to improve blood supply to those areas.”
Dr Mwebesa said they are also ready to combat any incident of cholera.
“We are already sending our teams to the areas to prepare for any eventualities. We have already sent medicines there and we are ready to support the areas. Even for malaria, we have provided enough medicines for prevention,” he said.
Sleeping under insecticide-treated bed nets, destroying stagnant water near homes, indoor residual spray, and treatment of infected people are some of the effective ways to prevent malaria infection and deaths.
Boiling drinking water or using tap water minimises the risk of cholera, according to scientists. Other preventive measures are washing hands often with soap and safe water and covering food as well as eating food when it is still hot.
Dr Ian Clarke, the chairperson of C-Care IHK (formerly International Hospital Kampala), said drug resistance can be caused by misuse of medicines. He said medical workers wrongly give drugs such as antibiotics “because it is more satisfying, to both the doctor and the patient, to make a diagnosis for which there is a definite treatment” so as to get profit and make the patient feel their issue was handled.
Dr Jimmy Opigo, the head of the Malaria Control Programme at the Ministry of Health,said they are promoting the test-and-treat strategy to avoid the wrong prescription and misuse of medicines. Lack of adherence to medication also increases the risk of mutation of the parasite, which causes drug resistance.
A recent study by Bosco Agaba from Makerere University, which utilised Polymerase Chain Reaction (PCR), the gold standard in medical diagnosis, to confirm the accuracy of RDTs, found that “195 of 219 (89 per cent), which initially came out negative when RDT was used and positive when a microscope was used, were “falsely registered as negative on the kits”. “Overall, gene deletion contributed to 12.3 percent (24/195) of false-negative RDT results. Of the false-negative RDTs results, 80.0 percent (156/195) were from subjects with low-density infections,” the report reads in part.
