health reporting: winner - bamuturaki musinguzi, daily monitor

8/9/2019 Health reporting: Winner - Bamuturaki Musinguzi, Daily Monitor

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BY BAMUTURAKI MUSINGUZI

[email protected]

Anguish, pain, immobility andstigma, is what Peter Oyuki andPatrick Balikoba have. The two

ave been abandoned by their wivesecause of their large deformed legsnd feet, that are a result of elephan-asis.Oyuki, who has lived with elephan-

asis for 31 years, says he lost hisife, the mother of their three chil-ren, to his neighbour in Lukindu Bllage, Bukatube Sub-County in Ma-

uge District in eastern Uganda.“My wife left me three years ago.

y handsome neighbour took herway after convincing her that shehould not live with a sick, disablednd ugly man like me,” Oyuki, 51, says

sad low tone.Unlike Oyuki, Balikoba, a 47-year-d resident of Buseera B Village in

usakira Sub-County, Mayuge Dis-ict, is still wondering what forced

his spouse with whom he had fivechildren to move out of their maritalhome. “My wife left a month ago and

she did not give a reason for leaving.I don’t know if it was due to my ill-ness,” Balikoba wonders.

Oyuki recalls that the diseasestarted in 1983. “It began with itch-ing then I started feeling cold anddifficulty in walking. My legs becamepainful and heavy to carry. I havetried to get this illness treated andfailed. I do not know what causes thisdisease,” he shares.

In search for a remedy, Oyukiwent to Buluba Leprosy Hospital inMayuge District where the doctorsrecommended amputation. “WhenI went to Buluba Hospital, I thoughtI had leprosy but when the doctorssuggested amputating me, I left be-cause I feared losing my legs. ThenI tried traditional medicine whichfailed. Meanwhile, the symptomshave increased and I have lived likethis since,” he says.

Balikoba started suffering from el-ephantiasis a year ago. “It began withitching and swelling of my legs. Thepain comes with heat and sweatingall over my body, mainly during therainy season. The itching happensonly in the dry season,” Balikobasays.

“I don’t know what caused this dis-ease. I have not yet got any form ofmedication because I wasn’t awarethat I could get treatment in hospi-tal,” Balikoba adds.

Oyuki’s leg develops wounds onwhich he applies Procaine BenzylPenicillin (PPF) or amoxyl capsule

powder. He continues to take theIvermectin tablets, which are givenfree of charge by the Ministry ofHealth once every year. Extreme heatand coldness cause Oyuki a lot of dis-comfort. “I usually experience a lotof pain when it is very hot or cold. Iget so uncomfortable that I can’t evenmove around,” he says.

According to the Mayuge DistrictVector Control Officer, Juma Na-bonge, Oyuki’s condition is in the ir-reversible stage of elephantiasis andhe will have to live in this sad state.

“We shall make sure Balikobastarts getting drugs from the VillageHealth Team,” Nabonge promised,adding, “The drug will kill the wormbut unfortunately the size of his legswill remain the same.”

“I do not know if I will ever heal.My hopes are in the doctors. Other-wise, I have no option but to look af-ter my children until the time I leavethis world. My extended family willtake care of my children when I die,”Oyuki says.

Victim’s plea

“My wish is government shouldtreat me so that I can heal and othersufferers,” Balikoba says, addingrather optimistically: “If I heal, I willmarry again.”

The plight of Oyuki and Balikobais an example of the social stigmaand discrimination that victims ofNeglected Tropical Diseases (NTDs)face in Uganda. It is not only the malevictims who suffer, but the womentoo, are chased from their matrimo-nial homes by their husbands.

What causes elephantiasis?

Elephantiasis, an NTD, scientifi-cally known as lymphatic filariasis(LF), is caused by tiny thread-like par-asitic filarial nematode worms calledwuchereria bancrofti transmitted bymosquitoes to humans. Infection isacquired early in life but graduallybegins to cause internal damage.

Adult worms are found in thelymphatic vessels (used for carry-ing waste body fluids), where theycause damage, leading to elephan-tiasis (swelling of the legs and feet),hydroceles (swelling of the scrotum),the vulva in women and other partsof the body. However, the majority ofinfected individuals show no physi-cal signs.

According to the elephantiasis/podoconiosis Programme Manager inthe ministry of health, Gabriel Mat-wale, the symptoms filarial fevers,which are often mistaken for malaria.One will have general body weakness

and body pains.

Also, the victim’s skin stretchesso much that it hardens, thus turn-ing into a habitat for organisms like

bacteria, fungi and viruses resultingin full blown elephantiasis.The disease derives its name “el-

ephantiasis” from the fact that thelegs and feet swell a lot.

Prevalence rate

According to the Drugs for Ne-glected Diseases Initiative (DNDI),elephantiasis affects an estimated120 million people living in tropicalareas. The ministry reports that ele-phantiasis mostly affects the poorestUgandans. It is a major public healthand socio economic problem with 4.7million people in 54 districts out ofthe 112 suffering from the disease.Another 14.5 million are at a risk ofbeing infected.

In some communities in easternand northern Uganda, up to 25 percent of adults show chronic signs ofLF; mainly hydroceles.

Treatment coverage

The NTD Control Programmeprovides annual drug treatments tonearly 13 million people in affectedareas under its Mass Drug Adminis-tration (MDA) activity.

MDAs occur annually in districtsendemic with NTDs that can be con-trolled with medicine. The first MDAwith Ivermectin and Albendazoleagainst elephantiasis was carriedout in 2002 in two districts (Katakwiand Lira), reaching coverage rates ofabout 75 per cent.

The MDA has been scaled up tocover all the 54 affected districts.Health workers also conduct hy-

drocele surgeries. There are plansto scale up the number of surgeriesconducted by implementing surgicalcamps.

Those with elephantiasis get healtheducation to control secondary infec-tions and alleviate pain. Health offi-cials refute claims that elephantiasisis caused by witchcraft and hydro-celes are hereditary. Matwale saystreating elephantiasis in Uganda isnot clear-cut like treating malaria.

“This is chronic infection whereobvious signs (elephantiasis andhydrocele) appear later in life. Ourstrategy is to interrupt transmissionwhere by people are given medicines(Mectizan and Albendazole) despitetheir infection status. By doing that,those who have it will have reducedthe worm load, which can’t be pickedby the mosquito.”

“The major challenge is to con-vince those without the signs to takethe medicine. Also, there is little fo-cus or help for those already infectedbecause the medicine has little effect.Lastly, we lack transport and opera-tion funds to intensify supervisionof village health team members whoare our frontline service providers,”Matwale adds.

According to the ministry morethan 11 million Ugandans are suffer-ing from NTDs. Uganda has 12 NTDs.World Health Organisation says NTDssuch as leprosy, elephantiasis andleishmaniasis (kala-azar) are fearedand the source of strong social stigmaand prejudice. As a result, these dis-eases are often hidden – out of sight,

poorly documented and silent.

MONDAY, MARCH 24, 2014

DailyMonitorwww.monitor.co.ug

TEETH

CARING FOR AN

EXTRACTED TOOTH

Have you ever had a painfulcavity and all you can do isgo for extraction to relieve

yourself of the pain? Thenext few days before healingmight have been so bad that you questioned what wentwrong because the woundwas as painful as the cavity.

Dr Victoria Nanziri, a dentaladministrator at NakaseroHospital says: “The painonly comes either becausethe person who extractedthe tooth did not giveproper instructions or yousimply never followed theinstructions.”

After the tooth has beenextracted, you must notbrush immediately becausethe toothbrush mayaccidentally hit the gumcausing it to bleed.

Dr Nanziri also warnsagainst immediate rinsingbecause it washes away theplatelet clotting responsiblefor quicker healing of thewound.

“The pain comes due toinfections because you didnot follow instructions andproper medication. The areamust be healed within fourdays,” adds Dr Nanziri. Themedication given includespainkillers to reduce painand antibiotics to kill thebacteria.

If the pain persists, youmust see a dentist whowill make it bleed anddress it again and give youmedication that will help you heal.

Dos•Eat soft foods

•Take lukewarm fluids

•Take the medicine asinstructed by the dentist.

•Rinse the mouth withlukewarm water and salt thefollowing day.

Don’ts

•Take a lot of fluids on dayone

•Eat hard foods

•Roll your tongue on thearea

•Brush or rinse immediatelyafter the extraction.

•After a day, you may brushbut be careful not to hitthe affected area to avoidbleeding.

By Beatrice Nakibuuka

Battling elephantiasis

eter Oyuki has lived with elephantiasis for 31 years. PHOTO BY PAUL MENYA

THE NUMBER OF DISTRICTS

IN UGANDA AFFECTED BY

ELEPHANTIASIS

54THE NUMBER OF NEGLECTED

TROPICAL DISEASES IN UGANDA

12

healthyliving Neglected Tropical Diseases

he Minsitry of Health

ays more than 11 million

gandans are suffering fromeglected Tropical Diseases

NTD). Starting today,

ealthy Living will run a

eries of stories on NTDs. We

egin with elephantiasis, a

sease that leads to massive

welling of body parts.


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[email protected]

Emmanuel Kizito has been forced toabandon swimming, his favouritesport, after he contracted bilharzia

Lake Victoria where he indulged in hisastime.

“I developed a lot of stomach painsometime in 2012. I immediately informedy teachers at school who gave me medi-ne. I took the drugs up to August 2013.fter the completion of the dose, my stom-h stopped paining me. I advise childrenstop swimming in the lake, I got bilhar-

a while swimming there,” says. Kizito, a-year-old Primary Seven pupil .“15-year-old Sylvia Natukunda, also aimary Seven pupil, who has also sufferedom bilharzia says: “I had severe stomachain in April 2013. My teachers started giv-g me drugs in September 2013 and noweel better.”Both Kizito and Natukunda are pupils of

atosi Church of Uganda Primary SchoolNtenjeru Sub-County, Mukono District.

atosi Landing Site is famous for fishing.David Keuber, a teacher at Katosi ChurchUganda Primary School confirmed thatlharzia is prevalent in the area.“Most of our learners play in Lake Victo-

a and get infected by bilharzia. We adviseem not to play in the lake and that they

hould boil the water they fetch from the

ke before drinking it,” Keuber says.

ow it is spread

Schistosomiasis commony, known aslharzia, ( entumbi in Luganda is spread

y a parasitic worm called schistosome.s infection can damage the urinary andtestinal tracts.According to the Ministry of Health,lharzia larvae are released in water byesh water snails. As people enter water,e larvae penetrate their skin and moverough the body to the urinary and intes-

nal tracts, where they develop to matu-ty. The cycle is complete when infectedeople urinate or defecate the bilharziaggs back into fresh water.

The Carter Centre health programmeotes that the parasite can live for yearsthe veins near the bladder or intestines,ying thousands of eggs that tear and scarssues of the intestines, liver, bladder, andngs.The majority of infected people in

ganda do not have initial symptoms. Ifntreated, infected individuals can expe-ence stunted growth, cognitive impair-ent and severe damage of internal or-

ans which can lead to death. In children,lharzia can cause anaemia and reduced

bility to learn, health experts warn.According to the World Health Organi-tion (WHO), people are infected duringutine agricultural, domestic, occupa-

onal and recreational activities which ex-ose them to infested water. Poor hygienend certain play habits of children such

swimming or fishing in infested waterake them vulnerable to infection.

The ministry says individuals whopend more time in fresh water bodies

ave a higher risk of infection. Bilharzia

can be reduced to a level where it is nolonger a public health problem by treat-ing risk-prone people in all endemic areasevery year.

Prevalence

According to WHO, bilharzia affects al-most 240 million people worldwide, andmore than 700 million people live in en-demic areas. The infection is prevalent intropical and sub-tropical areas, in poorcommunities without potable water andadequate sanitation. In Sub Saharan Af-rica, it has been estimated that more than200,000 deaths per year are due to bilhar-zia.

According to the Ministry of Health, bil-harzia is in 74 districts in Uganda, mostlythose with large fresh-water bodies. Ap-proximately four million people are at riskof getting infected. And an additional 17million people risk getting infected.

“…In such heavily-infected areas, manypeople acquire infections at a young ageand either suffer early severe diseasewhich either leads to death, or to severecomplications later. If detected and treatedearly, these complications can however, beprevented,” the health ministry says.

The Ministry of Health NTD programmeprovides annual school and community-based drug treatments to risk prone popu-lations during Mass Drug Administration

MONDAY, MARCH 31, 2014

DailyMonitorwww.monitor.co.ug

HEARTBURN

GETTING RID OF THE

IRRITATING FEELING

Heartburn is a painful burningsensation just below orbehind the breastbone. Mostof the time, it comes from theesophagus. The pain oftenrises in your chest from yourstomach and may spread to your neck or throat.

In addition to a burningsensation in the chest, othersymptoms of heartburninclude a sour, acidic or saltytasting fluid at the back ofthe throat or a feeling of foodbeing stuck in the throat.There can also be chest painespecially after bending

over, lying down or eating.Sometimes it also comeswith nausea and difficulty inswallowing.

According to Dr EnothNahamya of Ultimate MedicalCentre, if the symptoms areaccompanied by shortness ofbreath, radiation to the armsor neck, dizziness or sweatand fatigue, the person needsto see a doctor. Dr Nahamyasays when one swallows,the esophageal sphincter,a circular band of musclearound the bottom part of your esophagus, relaxes toallow food and liquid to flowdown into your stomach andit then closes again. However,if it relaxes abnormally orweakens, stomach acid

can flow back up into your esophagus, causingheartburn. Some foods andbeverages such as garlic,onions, chocolates, coffee,oranges and other acidicjuices fatty foods, fried foods,grapefruits, tomatoes andspicy foods, are responsiblefor the abnormal relaxationbecause they stimulateoverproduction of stomachacid which causes heartburn.Alcohol and smoking can alsocause heartburn. However, headds that every person reactsdifferently to specific foodgroups and therefore, in orderto track what foods worsen your symptoms, keep a foodjournal where you keep trackof what you eat and the time.

Dr Nahamya recommendsdrinking plenty of water,avoiding over eating andtaking your time while eating,wearing loose fitting clothes,not going to bed with a fullstomach, avoiding smokingand drinking alcohol andstaying away from foods thattrigger heartburn. However,even if the pain lessens,go for a thorough medicalevaluation. If not controlled,heartburn can result intoserious complications suchas esophagitis, esophagealbleeding and ulcersand increase the risk ofesophageal cancer. It can alsolead to chronic cough, sorethroat or chronic hoarseness.

By Rose Rukundo

Water is life, but notwhen bilharzia walks in

healthyliving Neglected Tropical Diseases

re you a fan of swimming in

esh waters? Watch your back,

or bilharzia could just snatch you.

(MDA) exercises. Fishing communities aretypically targeted for treatment.

David Oguttu, the parasitologist in theVector Control Division, Ministry of Health,says praziquantel is very effective againstbilharzia. The side effects (abdominalpain, vomiting, dizziness, diarrhoea andskin rushes), he says, are as a result of thebody’s reaction to the dying worms.

“If you have more worms, you will havegreater side effects. The side effects willalso depend on one’s immunity,” he says,adding: “These side effects are short lived.We don’t expect them to last more thanthree hours after taking the medicine.Some people don’t follow the instructions.We tell teachers not to give praziquantel tochildren who have not had meals. We ad-vise adults not to take alcohol immediatelyafter taking the drug.”

Why it keeps spreading

James Kaweesa, the Mukono District Vec-tor Control Officer observed that schoolshave reported the highest rates of compli-ance in regards to taking drugs.

“Compliance is the highest in schoolsthan in the communities because someadults don’t take the drugs in fear of falseside effects like impotence. And becausebilharzia is a slow killer disease, infectedadults will continue with their normal lifeunlike malaria that weakens and puts onedown,” Kaweesa says. He adds: Adults alsothink that a single dose against bilharzia isenough to heal the illness. They don’t knowthat they get reinfected whenever they re-turn to the water in the lake. We have tocontinue telling them that whenever youreturn to the stagnate water, you pick otherwater bodies.”

“A number of people have resisted takingthe drugs because some politicians claimthat if they do, they will not have childrenin future,” says Godfrey Nsereko, a memberof the Katosi Village Health Team (VHT).

“The good thing is that those who havetaken the drugs have healed. We have alsodiscovered that those who complained ofside effects in the beginning of the pro-

gramme did not follow the proper proce-dures,” Nsereko adds.

The VHT supervisor in Bunakiffa Parishin Ntenjeru Sub County, Bakari Walakirasays: “Some even believe that they will notbe able to work when they take the drugs.We advise them to take water wheneverthey get side effects.”

According to Nsereko, since the recruit-ment of VHTs, bilharzia cases have beenreducing because the VHTs are able to ad-minister the drugs. Sanitation in homes hasalso improved.

To wipe out bilharzia, the ministry israising funds to improve sanitation, includ-ing the construction of latrines near waterbodies.

DEATHS IN SUB SAHARAN AFRICA

DUE TO BILHARZIA

200,000

THE NUMBER OF DISTRICTS IN

UGANDA AFFECTED BY BILHARZIA

74

THE NUMBER OF PEOPLE AFFECTED

BY BILHARZIA WORLDWIDE

240

Fishermen at Katosilanding site prepareto go fishing. Wadingthrough fresh lakewater puts peopleat risk of Bilharziainfection.PHOTO BY PAUL MENYA

“A number ofpeople have

resisted taking

the drugsbecause some

politicians

claim that ifthey do, they

will not have

children infuture,”’

GODFREY NSEREKO

KATOSI VILLAGE

HEALTH TEAM

MEMEBER


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MONDAY, APRIL 7, 2014

Daily Monitorwww.monitor.co.ug healthyliving Neglected Tropical Diseases

FUN TIME

ARE YOU WATCHING

TOO MUCH TV?

Are you watching too muchtelevision? Well, in the longrun, it could have negativeconsequences for your eyes.

According to CharlesMainga, an optician atEye-to-Eye Optical Centre,watching television generallydoes not damage the eyes,but rather strains it over aperiod of time.

He explains that there is nodefined distance from whicheither adults or childrenshould be while watching TV,but generally, being four tofive metres away from theset is recommended.

“Children have the ability tofocus very well at close rangebecause they have a shorterdistance between their eyesthan adults, hence theyprefer sitting closer,” Maingasays.

He, however, adds thatif a child has the habit ofwatching TV while sittingcloser to the set, the parentsshould consider undertakingtests to eliminate possiblerefractive error, especiallyshortsightedness.

“What happens is whenpeople are watchingtelevision, the musclesaround the eyes get workedup and the longer the personwatches the screen, themore tired the eyes get,”explains Mainga.

Other activities that causeeye strain may include sittingbehind computers over longperiods of time.

“It is not advisable to watchtelevision in a dark room

where it acts as the onlysource of light becauseeyes quickly get fatigued.The sitting posture shouldbe upright and not on thebed or lying on one’s backbecause it can lead to severebackache and neck pain,”says Mainga.

Dr Ronald Kiweewa of KadicHospital Bukoto, explainsthat when light enters theeye, it has to be refractedor reflected, which involvessending impulses to thebrain thus affecting theeye nerves. And when aperson consistently watchestelevision over a long periodof time, say four to five years, the cornea and iris(parts of the eye) tire out

and therefore cause damageto the eyes.

By Roland Nasasira


[email protected]

At first sight, Raymond Kabengeand Juliet Kisakye look like anynormal pupil in their school.

ut hidden behind their innocentces is the pain of suffering from in-stinal worms.Kabenge, 11, a Primary Four pupil of

useera Primary School in Busakiraub County, Mayuge District, recallseveloping painful stomach ache to-ards the end of last year. “When-

ver I slept, I felt painful movementn my stomach. I did not know what

was. I later noticed white wormsn my stool before I started taking

When walking barefoot and

sharing food spreads wormsn our third series oneglected tropical diseases,we look at worms, which

ontinue to infect many

eople, yet they can be easily

revented with good hygiene

ractices.

medication at school,” he says.“Last term, I took tablets (Albendo-

zole) and the stomach pain has beenreducing ever since,” Kabenge says,adding: “I am willing to take moremedication to heal.”

On her part, 12-year-old Kisakye,who is also in Primary Four, says shefeels pain stretching from her stom-ach to the chest. “I have taken drugstwice so far, given out by our teachersand I feel better now.

“I do not know what caused thisproblem which started when I was inPrimary Two. I get pain especially be-fore I have had a meal and it only re-duces after eating,” Kisakye laments.

David Wakaka, a science and math-ematics teacher at Buseera Primaryobserves that cases of worms shootup during the wet season when chil-dren share mangoes.

“We get a lot of reports during therainy season because it is the periodwhen mangoes ripen. So the childrenwill share mangoes or other snackssuch as pancakes among themselves,and those with long dirty nails willspread the worms,” Wakaka ob-

serves.Intestinal worms include round-

worm (ascaris lumbricoides), whip-worm (trichuris trichiura) andhookworm (necator americanus andancylostoma duodenale). They arecommonly transmitted through poorhygiene and sanitation.

The worms enter the body throughbare feet or ingestion of contami-nated foods.

Their eggs are released throughthe faeces of infected individuals intothe environment, hence the collectivename of Soil Transmitted Helminthes

(STH). They are also one of the ne-glected tropical diseases.

According to the World Health Or-ganisation, STH live in the intestineof infected individuals where theyproduce thousands of eggs each day,which are then passed out in faeces.

Humans become infected wheningesting infected roundworm andwhipworm eggs or hookworm larvaein contaminated food (for example,vegetables that are not thoroughlycooked, washed or peeled), hands orutensils or through penetration of theskin by infective hookworm larvae incontaminated soil.

There is no direct person-to-persontransmission or infection from freshfaeces because eggs passed in faecesneed about three weeks in the soil be-fore they become infectious.

According to WHO, the more thenumber of worms an infected personhas, the greater the severity of dis-ease.

The worms impair the nutritionalstatus of those infected in manyways, including causing intestinalbleeding, loss of appetite, diarrhoeaor dysentery and sometimes causingcomplications that require surgicalintervention.

Hookworms for instance can causechronic intestinal blood loss that mayresult in anaemia.

According to the Ministry of Health,worm infection in pregnant womencan lead to underweight babies andcomplications for the mother.

WHO notes that worm infectionsare among the most common infec-

tions worldwide, and affect mainly

deprived communities.

Pregnant women at risk

According to WHO, pre and school-going children and women of child-bearing age (including pregnantwomen in the second and third tri-mesters, and those who are breast-feeding face higher risk of sufferingfrom worms.

Infections are common in tropicaland subtropical areas and, since theyare linked to lack of sanitation, theyoccur wherever there is poverty.

The parasitologist in the VectorControl Division at the Ministry ofHealth, David Oguttu attributes thehigh burden of intestinal worms inUganda to the ignorance about trans-mission and prevention.

“There is poor sanitation espe-cially if somebody infected withhookworms openly defecates in thegardens, other people will also be in-fected. We also have poor food han-dling and hand-washing culture andhygiene,” Oguttu says.

The Mayuge District Vector Con-trol Officer, Juma Nabonge notes thatcontaining the disease that is spreadacross the district requires a com-bination of interventions includingconstruction of latrines. “As far assanitation is concerned we empha-sise wearing of shoes to reduce thetransmission rate and continued us-age of drugs,” Nabonge says.

Interventions

WHO’s control interventions arebased on the periodic administrationof anthelminthics to groups of peopleat risk, supported by the need for im-provement in sanitation and healtheducation.

The health ministry treats all chil-dren aged one to 15 years twice a year,under the Mass Drug Administration(MDA) programme with medicine(Albendazole and Mebendazole) do-nated by WHO.

The government and its partnersobserve that school-based MDA totreat bilharzia and STH has provento be a cost-effective intervention.Reasons for this include the reducedprice of the drug and the use of non-health volunteers to distribute themedicines.

Government admits in the NationalMaster Plan for Neglected TropicalDiseases Programme 2013-2017 thatsanitation management remains dis-mal, with latrine coverage still belowthe expected level.

As a result, after successful treat-ment of worms, majority of the peo-ple quickly get re-infected, thus com-promising the impact of Mass DrugAdministration. It is therefore vital toundertake sanitation improvement,behaviour change among communi-ties and snail (the vector for bilhar-zia) control, all of which are currentlynot being given adequate attentiondue to limited funding.

Latrine construction especially inpublic places such as landing sites,schools, health facilities, worshipplaces and markets should be made

priority.

Raymond Kabenge(above) admitshe does not knowwhat causesintestinal worms.(left) hookwormsare one of thecommon typesof worms thatUgandans sufferfrom.PHOTO BY PAUL MENYA/

NET PHOTO

FACTS WE SHOULDKNOW ABOUT WORMS

•According to the Ministry of Health,hookworm is the most common of allworm infections, and it is homogenouslydistributed in the country exceeding 60per cent prevalence in 85 per cent of theschools surveyed.

•On the other hand, roundwormand whipworm are concentrated insouthwestern Uganda, where up to 9 out of10 people are said to be infected.

•The health ministry estimates thatabout 17 million Ugandans are infectedwith worms and 33 million are at risk ofbecoming infected.

•The latest estimates from WHO indicatethat worldwide, more than 880 millionchildren are in need of treatment for theseparasites.


5/14



GOOD DIET

WHY YOU SHOULD EAT

A BALANCED DIET

Nutritionists encourageus to eat a well-balanceddiet. But how many of usknow what exactly entails a

balanced diet? According tonutritionist Jamiru Mpiimaof Family NutritionistUganda, people usuallymisunderstand what abalanced diet is and what itshould contain.

“It is sometimes referredto as a coloured plate. Thismeans your plate of foodshould have more than threecolours of food,” he says.

He explains that for ameal to be balanced, itshould have at least fivefood groups, each takendifferently, depending on therequirement for the body.

These comprise starchfrom grains such as cereals,cassava, sweet potatoes and

plantains. It can also containproteins as a source of bodybuilding. The proteins cancome from plant and animalsources. Animal proteins canbe got from fish, eggs andmilk, while plant proteinsinclude soy beans andground nuts.

Therefore, a balanced dietshould include both animaland plant proteins.

Fruits such as pineapples,paw paws, oranges and green vegetables should also beincluded in one’s meal. Fattyoils are also recommended,although they should alwaysbe taken in moderation.

Mpiima notes that abalanced diet is importantbecause one type of food

cannot have all nutrientsneeded for the properfunctioning of the body.“Whereas fish and eggs haveparticular nutrients, theymay not be able to cater forfibres found in vegetablesand minerals,” he explains.

Without a balanced diet, aperson risks being eitherover or under malnourished.“You can see a person having matooke and beans every dayand when they check withthe doctor, they are told thatthey are malnourished. Thisis not the best way to keephealthy,” he notes. He addsthat eating a balanced mealeveryday also helps to reducethe chance of developingconstipation and contributesto better brain growth inchildren.

By Sandra Janet Birungi


[email protected]

After 17 years of living with riverblindness, Tereza Akulu’s wishis to see development of strong

ugs that can heal the disease faster.have taken medicine for so long. I

m only lucky that I sought medicaltention in time which helped metain my eyesight,” she says.“Government should bring enough

rugs for everyone in our area be-ause this disease is causing blind-ess in many people,” she adds.Akulu, 65, a mother of five, lives in

amacha South Village, Awere Subounty, Pader District in northernganda.She was diagnosed with riverindness in 1997 at Lacor Hospital,ulu District. It was from here thathe was referred to Awere Healthentre III, where she continues to geteatment.When she first developed the dis-

ase, she recalls getting a feeling ofurning body pain, which was fol-

wed by itching and subsequentlye disfigurative skin malady that

eveloped on her legs and scalp.Whenever Akulu runs out of medi-ne, she has to walk three kilometersAwere Health Centre III to pick a

ew dose. But even though she wascky to be able to access treatment,did not come without challenges.

When I started treatment in 1997, Ieveloped rashes, although they latersappeared as I continued with theedicine,” she says.“But I am not happy because the

kin disease has not normalised.has now spread to my scalp and

aused grey hair around the affectedea,” Akulu explains.She is grateful though, that treat-ent is provided for free by govern-ent. “It would have been very ex-

ensive for me to buy the drugs.”Like Akulu, 40-year-old Angulleta

anyero first developed body rashnd itching in 2006. She later devel-ped painful lumps around her waistnd was unable to see clearly. Sheent to Lacor Hospital.“Doctors at the hospital discov-ed that I had worms in my eyes.

hey told me I had contracted riverindness. But I was not convincedat I could have got this disease, so

went to Gulu Hospital, which alsoonfirmed the same.

It is then that I started treatment,”anyero says. “The doctors told mee extent of the damage in my eyesill neither increase nor improve

ecause the nerves were damaged.hey said I am going to live like this

rever. My only problem is the eyes.

Fighting river blindness

along fastflowing streamsiver blindness continues toffect several communitiesUganda. In our series on

eglected tropical diseases,

e explore interventions that

e helping to address the

roblem.

I continue to see worms in my vision.I have a blurred vision. I cannot seedistant objects,” she says.

Inadequate drugs

However, Lanyero decries the inad-equate supply of the medicines.

Asked if she would be willing toshift to another place that is not af-fected by river blindness, Lanyerosays she has nowhere to go.

“Besides, where would I get themoney to buy land? This is the placewhere I will be buried.” Many peoplewho have been affected or infected byriver blindness also have to contendwith stigma in the community.

“This arises from some people whobelieve that the disease is contagious.They fear interacting with us duringsocial gatherings and sharing foodand drinks,” Akulu observes.

River blindness, also known as on-chocerciasis, is an eye and skin infec-tion caused by a worm (filaria) knownscientifically as Onchocerca volvulus.According to the World Health Or-ganisation, river blindness is trans-mitted to humans through the bite ofa black fly (Simulium species).

These flies breed in fast-flowingstreams and rivers in the inter-tropi-cal zones, increasing the risk of blind-ness to individuals living nearby,hence the commonly known name,river blindness.

Within the human body, the adultfemale worm (macrofilaria) producesthousands of baby or larval worms

(microfilariae), which migrate in theskin and the eye.

The death of microfilariae is verytoxic to the skin and the eyes, pro-ducing terrible itching and variouslesions. After repeated years of ex-posure, these lesions may lead toirreversible blindness, according to

WHO. Tom Lakwo, the manager incharge of the Onchocerciasis pro-gramme in the Ministry of Health,notes that the patchy skin conditionpresents in those who have lived longwith the disease.

“This condition is not reversibleeven when you take medication, andthis is common in older people.”

According to WHO, about 90 percent of the disease occurs in Africa.The latest figures from the Ministryof Health indicate that more than twomillion people are infected with theparasite that causes river blindness.Most cases have been reported in thewestern axis of the country border-ing the Democratic Republic of Congoand in areas around Mt Elgon in east-ern Uganda.

Leading cause of blindness

According to the health ministry,river blindness is a leading cause ofblindness and visual impairment inUganda.

In 2007, the National Onchocer-ciasis Control Programme (NOCP)launched an elimination plan. Theprogramme is currently being run in31 districts with the prevalence of thedisease through Mass Drug Adminis-tration (MDA), supplemented by vec-tor elimination in some feasible ar-eas. Bi-annual and annual treatmentprogrammes are being undertaken in14 and 17 districts respectively.

To address the shortage of drugs,Lakwo says: “The National Onchocer-ciasis Control Programme alwaysmakes application for drugs based

on population figures provided by

the district. And it is this informationthat is then used to deliver supplies.”Lakwo says the Neglected TropicalDiseases Programme has conductedfresh registration in all districts toobtain accurate numbers of peoplewho may be infected. This would beused to minimise cases of drug short-ages.

The health ministry says with agood prevention and disease man-agement plan, river blindness canbe reduced to a level where it is nolonger a public health threat, as longas individuals living in the affectedareas receive treatment every yearfor a period of 15 to 20 years.

“In some areas, where the pro-gramme treats all people twice a year,river blindness can be eliminated inless than seven years. With additionalblackfly control, it can take fewer

years,” the ministry adds.

Tereza Akulu speaks during the interview. (Below) She has developed a patchy skininfection on her legs as a result of living with river blindness for several years.PHOTOS BY PAUL MENYA

UGANDANS INFECTED WITH

THE PARASITE THAT CAUSES

RIVER BLINDNESS.

2 mUGANDANS AT

RISK OF INFECTION.

3 mNUMBER OF UGANDANS WHO

ARE BLIND BECAUSE OF THE

DISEASE.

20, 000AFFECTED DISTRICTS.

35


6/14



GOOD DIET

WHY YOU SHOULD

NOT SKIP BREAKFAST

Nutritionists encourageus to eat a well-balanceddiet. But how many of usknow what exactly entails a

balanced diet? According tonutritionist Jamiru Mpiimaof Family NutritionistUganda, people usuallymisunderstand what abalanced diet is and what itshould contain.

“It is sometimes referredto as a coloured plate. Thismeans your plate of foodshould have more than threecolours of food,” he says.

He explains that for ameal to be balanced, itshould have at least fivefood groups, each takendifferently, depending on therequirement for the body.

These comprise starchfrom grains such as cereals,cassava, sweet potatoes and

plantains. It can also containproteins as a source of bodybuilding. The proteins cancome from plant and animalsources. Animal proteins canbe got from fish, eggs andmilk, while plant proteinsinclude soy beans andground nuts.

Therefore, a balanced dietshould include both animaland plant proteins.

Fruits such as pineapples,paw paws, oranges and green vegetables should also beincluded in one’s meal. Fattyoils are also recommended,although they should alwaysbe taken in moderation.

Mpiima notes that abalanced diet is importantbecause one type of food

cannot have all nutrientsneeded for the properfunctioning of the body.“Whereas fish and eggs haveparticular nutrients, theymay not be able to cater forfibres found in vegetablesand minerals,” he explains.

Without a balanced diet, aperson risks being eitherover or under malnourished.“You can see a person having matooke and beans every dayand when they check withthe doctor, they are told thatthey are malnourished. Thisis not the best way to keephealthy,” he notes. He addsthat eating a balanced mealeveryday also helps to reducethe chance of developingconstipation and contributesto better brain growth inchildren.

By Sandra Janet Birungi


[email protected]

Health experts estimate that 80per cent of the population inthe developing world depends

n traditional medicine as their pri-ary source of treatment. Indeed for

early 25 years, this is what Monikaandego used to treat her right eyeat had been infected with tra-

homa.With hindsight now, she regretsat by the time she abandoned the

erbs which she usually squeezedto her eyes three years ago forodern medicine, it was too late to

ure the illness. “The pain in my rightye started when I was 10 years old.have grown up with this pain andhen it becomes too painful, I do notuch or wash my face,” says the 38-

ear-old mother of five.

hen herbs caused more pain

“I used traditional medicine for ang time but it did not cure my con-tion so I decided to switch to mod-n medicine, which I have now usedr the last three years. I apply Tetra-

ycline eye ointment whenever I feele pain and it gives me great relief,”

andego explains.She advises all those sufferingom eye problems to visit hospitals

nd not rely on traditional healers oredicine. Nandego lives in Ntafun-rwa Village in Buwaya Sub county,

ayuge District in eastern Uganda.

How untreated trachoma cancause permanent blindness

the Ministry of Health, over 900,000children under the age of 10 have tra-choma, and 10 million people are atrisk of being infected. Another 47,000people are said to be blind from thedisease. The trachoma control pro-gramme in Uganda follows the WHO

recommended use of the SAFE Strat-egy (Surgery, Antibiotics, FacialCleanliness, and Environmental Im-provements) to eliminate the diseaseby 2020.

Trachoma elimination throughmass treatment with Zithromaxstarted in seven districts in 2007.Since then, there has been a steadyscale up of treatment coverage tomore districts with Mass Drug Ad-ministration. Currently, all the 36districts with high prevalence of tra-choma receive Zithromax drugs, andabout 20,000 surgeries have beencarried out to prevent blindness.

Since 2007, a cumulative total 12.8million people have received treat-ments with Zithromax.

According to the Ministry ofHealth, elimination of blindness fromtrachoma is possible by treating ev-eryone in areas where the disease isprevalent over a period of three tofive years. This can be achieved byoperating all people with in-turnedeyelashes and improving hygiene andsanitation. Dr Turyaguma is optimis-tic that trachoma can be eliminatedby 2020 in Uganda, if there is im-provement in hygiene and the drugsare made available to all those whorequire it.

“Trachoma is a disease of poor hy-giene and so if you improve hygiene,it can be eliminated,” he adds.

Other ways to eliminate the diseaseinclude reducing fly breeding sites,encouraging the washing of chil-dren’s faces, improved access to cleanand safe water and proper disposal of

human and animal.

Monika Nandego(Left) has livedwith trachomasince she was 10years old. She saysthe disease hasseverely affectedher left eye andcauses her pain.PHOTOS BY PAUL MENYA

“I do not like to move a lot in the hotseason because I feel pain in the eye. Iprefer places with less sunshine,” shesays. Because Nandego’s case was inthe late stage of the disease, doctorsat Mayuge Hospital recommended aneye operation, which she hopes to do

as soon as her children come homefor the holidays.

Free drugs changing lives

Nandego is grateful for the freemedicine she gets from the publichealth facilities through the VillageHealth Teams. While she admitsshe does not know what causes tra-choma, she hopes her condition willbe healed if she gets the right treat-ment.

On his part, 70-year-old Kefa Mis-ango recalls when he first got tra-choma in 1990. “I do not know whatcaused this illness, but I immediatelywent to hospital for treatment.”

“It has been on and off. I still getblurred vision. Whenever my eyes arepainful, I buy Tetracycline eye oint-ment and apply,” says Misango wholives in Ntafungirwa Village in Bu-waya Sub county, Mayuge District.

The district vector control officer,Juma Nabonge, says while Misangohas not been examined by an opti-cian at the district hospital, he mayrequire an eye operation because hiscondition is in the advanced stages.

According to the World Health Or-ganisation, trachoma is caused by anorganism called chlamydia tracho-matis. Through the discharge froman infected child’s eyes, trachoma ispassed on by hands, through cloth-ing or by flies that land on the faceof the infected child. It is frequentlypassed from child to child and fromchild to mother, especially in areaswith water shortage, numerous flies,and crowded living conditions.

Infection usually begins during

infancy or early childhood, and canbecome chronic if left untreated. Theinfection eventually causes the eyelidto turn inwards, which in turn causesthe eyelashes to rub on the eyeball,resulting in intense pain and scar-ring of the front of the eye - a condi-

tion called trichiasis. This ultimatelyleads to irreversible blindness, typi-cally between the ages of 30 to 40,without proper treatment.

According to Dr Patrick Turyagumawho heads the trachoma control pro-gramme at the Ministry of Health,people who develop the disease usu-ally experience red and painful irritat-ing eyes, discharge and tears and theytend to fear light (photophobia).

Early treatment crucial

The recommended drugs by theMinistry of Health are zithromax (atrachoma-fighting antibiotic) andTetracycline eye ointment.

“If the disease is not treated earlyenough, a person can go blind. Un-fortunately, the blindness is perma-nent,” Dr Turyaguma says.

Trachoma is the world’s leadingcause of preventable infectious blind-ness. The disease is more common inpoor rural communities in develop-ing countries. WHO estimates that sixmillion people worldwide are blinddue to trachoma and more than 150million are in need of treatment.

According to latest figures from

rachoma is a preventable

sease which continues to

ind people in Uganda. In our

eries on neglected tropical

seases, today we look at

ow it can be managed.

“If the disease is not treated earlyenough, a person can go blind.

Unfortunately, the blindness

is permanent. Trachoma is adisease of poor hygiene and so

if you improve hygiene, it can be

eliminated,”DR PATRICK T URYAGUMATRACHOMA CONTROL PROGRAMME


7/14


DailyMonitorwww.monitor.co.ug healthyliving Neglected Tropical Diseases

DIAPERS

WHEN YOUR BABY

DEVELOPS RASHESDiaper rash is a skin irritationthat occurs when a child’sbody reacts to the organismsin a diaper. This results fromexcess moisture that a childhas been exposed to, andmostly affects the genitalareas. It makes the baby’sskin to become sore, red ortender.

Dr Ahmed Ddungu, a generalpractitioner at Mulagohospital, says the rashoccurs when a baby is keptin a diaper that has urineor faecal matter over longperiods of time.

When this happens, theacidic content in the faecesand the ammonia in the urineburn the baby’s skin, hencecausing the rash. The rashcan be prevented by keepingbabies clean and dry at alltimes. This means that ifa child wets their diapers,they should be changed assoon as possible before anyirritation or itching happens.

After a used-up diaper hasbeen removed, it is advisableto wait a little bit longer thebaby is dressed in a new one,as this gives an opportunityfor the child to get enoughfresh air and thereforeminimise the build-up ofmoisture.

Dr Ddungu says somebabies may however notdevelop body rash fromthe use of diapers. “The reis no particular reason forthis but children’s bodies

react differently to variousthings,” he says.

He advises that the usepetroleum jelly in the areaaround a child’s genitals canhelp reduce the itching.

Here are quick ways toprevent diaper rash:

•Change your baby’s soiledor wet diapers as soon aspossible and clean the areathoroughly.

•Put diapers on loosely inorder to allow enough airflow.

•Use absorbent diapers tohelp keep the skin dry andreduce the chance of gettingan infection.

•Occasionally soak thebaby’s bottom betweendiaper changes with warmwater

•Allow your baby’s skin todry completely before youchange to another diaper

By Pauline Bangirana


[email protected]

It did not occur to John Ocung thathe was suffering from sleepingsickness because tests from the

clinics he visited always concludedthat he had malaria. Even though hewas on medication, it did not relievehis pain.

Then, he developed severe head-ache, a visual blackout and paralysisin his left leg. His wife, who was wor-ried that he would not survive, sug-gested they turn to prayers. Ocungresisted. Eventually, he ended up atLwala Hospital in Otuboi Sub-county,Kaberamaido District.

“I did not know I had sleeping sick-ness because I was always diagnosedwith malaria. Their treatment never

healed me,” Ocung narrates from hishospital bed at Lwala, where he hasspent a week receiving treatmentafter doctors confirmed he was suf-fering from sleeping sickness.

“I suffered severe headache, I couldnot see clearly and always felt my legwas paralysed. I could not sleep atnight and could do so mostly dur-ing the day, between 8am and 2pm,”Ocung recalls.

He adds: “I wish I had come to thehospital earlier. I now feel better withthe medication I am receiving. My legis improving and I can now get somesleep. However, I still get headache, acold, and pass urine frequently.”

Ocung, 55, a father of eight, is op-timistic that he will be cured of thedisease soon.

Late-stage diseaseCharles Elamu, the Kaberamaido

District vector control officer says inOcung’s case, the disease was alreadyat an advanced stage. It had thereforeaffected his central nervous system.

During this stage, patients developvisual problems, they feel sleepymost of the time and their speechbecomes incoherent.

Like Ocung, Moses Eryengu ini-tially relied on malaria drugs whichhe got from his drug shop in SorotiTown to treat his illness. Little did heknow, at the time, that it was sleep-ing sickness that was keeping him illmost of the time.

“I was weak and could not evenstand up. I was admitted to hospital.Tests confirmed I had sleeping sick-ness and not malaria. I felt relieved

because at least I now knew what itwas. I even thought I had been be-witched because of the on-and-off

Sleeping sickness

still thrives inpoor communitiesAlthough many countries have

eliminated sleeping sickness,

it continues to affect several

communities in Uganda,

especially those who are poor,

with limited access to health

care services.

fever and body weakness,” he says.He adds that if he had remained in

Soroti treating malaria and typhoid,he would have succumbed to sleepingsickness.

In Eryengu’s case though, whenthe first tests were carried out, itshowed that his disease was in theearly stages. Subsequently, he startedtreatment and after successful com-pletion of the dose, further testsshowed he had been cured.

He was discharged from hospitalin January. “My only problem now isthat I spit a lot, even at night. WhenI move long distances I become dizzyand it becomes difficuly for me towalk in the sun,” he says.

“This illness has set me back in mybusiness and the education of mychildren and siblings because I haveno income to pay for their fees,” hesays, adding: “I am confident I will re-organise myself when I fully recover.”Lwala Hospital is the only treatmentcentre for sleeping sickness in Langosub-region.

Those with symptoms have to gothrough two painful lumbar punc-tures where fluids are sucked fromtheir cerebral spinal code and takenfor analysis in the laboratory. Thesecond puncture is usually carried

out if one has not cured from the firstdose of medication.

When infection happens

In Kaberamaido District, the num-ber of sleeping sickness cases is usu-

ally high between December andJanuary, and drops from February toApril.

Eryengu has an appeal for gov-ernment: “They should carry out anaerial spray all over our sub regionto kill the tsetse flies. Otherwise thetraps set against the flies are short-lived and people vandalise them oruse them as clothes.”

According to the World Health Or-ganisation (WHO), sleeping sicknessalso known as Human African Try-panosomiasis (HAT) is a vector-borneparasitic disease, which is caused byinfection with protozoan parasitesbelonging to the genus trypanosoma.It is transmitted to humans by tsetsefly (glossina genus) bites, which ac-quire their infection from human be-ings or from animals that harbour the

parasites that cause the disease.Symptoms of the disease include

fever, swollen lymph glands, aching

muscles and joints, headaches andirritability. When left untreated, thedisease attacks the central nervoussystem and can cause death.

According to WHO, sleeping sick-ness occurs only in 36 sub-SaharanAfrica countries where there is a high

prevalence of tsetse flies.The population most exposed to

tsetse fly and affected by sleepingsickness live in remote areas withlimited access to adequate healthservices, which complicates the sur-veillance and therefore the diagnosisand treatment of cases.

In addition, displacement of popu-lations, war and poverty are commonfactors that facilitate transmission, aspoor people with no access to healthservices cannot be diagnosed earlyenough and put on treatment.

Control efforts

However, WHO says continuousprevention control efforts over theyears have reduced the number ofnew cases. In 2009, there were 9,878new cases of the disease reported in

Uganda. This was also the first timein 50 years that less than 10,000 caseswere reported.

And in 2012, this figure droppedfurther to 7,216 cases.

“Sleeping sickness is prevalent inabout 40 districts, with 10 millionmore people at risk. Because of con-certed control efforts, we have beenreporting just a third of cases in thepast five years ago,” says Dr CharlesWamboga, the programme managerin-charge of sleeping sickness controlat the Ministry of Health.

The ministry notes that Uganda isaffected by mainly two types of thediseases-trypanosoma brucei gam-biense and trypanosoma brucei rho-desiense.

Trypanosoma brucei gambiensepredominantly occurs in the West

Nile region, which is bordered by theDemocratic Republic of Congo andSouth Sudan- countries also known to

have a high prevalence of the disease.Human beings are the main reservoirfor this form of sleeping sickness.

On the other hand, Trypanosomabrucei rhodesiense was originallylimited to the South Eastern region ofthe country. Recently, however, thistype of sleeping sickness has beenreported in some parts of NorthernUganda such as Alebtong District.

Cattle are the main reservoir forthis acute form of sleeping sickness.

Medication

According to the Ministry of Health,case detection, is mainly through pas-sive and active screening (on a lim-ited scale). All diagnosed cases aretreated with drugs such as suraminand pentamidine for early stages ofthe disease, and melarsoprol and ni-furtimox/eflornithine combinationtherapy for late stage cases.

The Health ministry managementcentres have been established in sev-eral districts across the country totreat cases of the disease.

With support from the Pan AfricanTsetse and Trypanosomiasis Eradica-tion Campaign (PATTEC), advocacyand social mobilisation have also

been revitalised, with most of thesupport for the programme fundedby WHO.

John Ocung (above) speaks during the interview. (Below) A campaign poster againstsleeping sickness hangs in a ward at Lwala Hospital PHOTOS BY PAUL MENYA

“It is a painful injection that is

administered on the back and

because of the fear of the prick,

some patients have escaped from

the ward without waiting for the

second puncture that confirms

if they have c ompletely healed

from the disease.” NELSON OGIDO,LABORATORY ASSISTANT, LWALA HOSPITAL.


8/14

MONDAY, MAY 5, 2

Daily Monitowww.monitor.co healthyliving Neglected Tropical Diseases

GOOD DIET

LIMIT YOUR DAILY

SALT INTAKESalt (sodium chloride) isessential for our bodies.However, if consumed inhigh quantities, it can caushigh blood pressure and alsdamage the kidneys.

When there is too much salin the body, the kidneys pasit through urine. However,because of the high saltlevel, the kidneys cannotkeep up with the salt level,and most of it ends up in thbloodstream.

Salt also attracts water. Anas it draws more water intothe blood, this increasesthe volume of blood, whichthereby raises bloodpressure.

That is why eating salty foo

tends to make us thirsty,as we end up drinking andretaining excess. With thisthe blood pressure alsocontinues to build as wateris consumed several hoursafter salt is ingested.

The result can be atemporary increase in bloodpressure, which persistsuntil the kidneys eliminateboth salt and water.

Foods that are high in saltwill increase blood pressureover time. Fortunately,limiting salt intake in thediet can reverse theseeffects. Discuss with yournutritionist, the alternative you can use to reduce yoursalt intake. These couldinclude adding lemons andspices to your daily diet.

Also, some people are moresensitive to salt than otherincluding the elderly, womeand people with diabetes.

These groups of peopleneed to control how muchsalt they consume. Most ofthe sodium we consume isin the form of salt, and the vast majority of it is found processed foods.

It is also recommendedthat you consume morepotassium containing foodbecause it is the balanceof the two minerals thatmatter. A potassium-richdiet includes a wide varietyof fruits, vegetables, andlegumes.

Alternatively, discuss with your nutritionist how to coo

delicious food without orwith limited salt.

By Jamiru Mpiima

The writer is a nutritionist


[email protected]

For two months, Nakor Nawaterelied on traditional medicineto treat kala-azar, a disease she

had been suffering from over a longperiod. By the time she was broughtto Amudat Hospital by a communityhealth worker, the blood in her bodywas too low that she had to get trans-fusion and was put on a healthy dietbefore embarking on medical treat-ment.

“I do not know what causes thisdisease that sucks nearly all yourblood,” says Nawate.

Nawate, who does not know her ageis married with three children and

lives in Kosiroi Village in KatikekileSub-county in Moroto District.

Benson Ruto is another survivorof kala-azar disease. He too cannottell how old he is, nor can his father,Benson Lolingang. But he looksabout eight or nine. For four months,Ruto’s parents treated their son us-ing local herbs and coartem becausethey thought he had malaria. “Whenhis condition did not improve, wecalled the community health workerwho tested him at home. The resultsconfirmed he had kala-azar. He wasadmitted here at Amudat Hospital,”Lolingang says of his son who is re-covering from his hospital bed.

“I developed fever, a swollen stom-ach and general body weakness beforeI was admitted here. After the treat-ment, I now feel better. I can even run

around the ward,” says Ruto.Not all Lolingang’s seven children

attend school. Ruta was one of those

Pastoral communities pay high

price for kala-azar disease

districts. Mapping is important to es-tablish the extent of the disease, how-ever, we need to know where the vec-tor is more prevalent. We also need tohave good diagnosis and treatment,”Prof. Olobo notes.

Illiteracy

A poor health seeking behaviourand low literacy levels are some of thechallenges that make it easy for kala-azar disease to thrive in Amudat.

“When people in these areas fallsick, they do not seek medical carefrom hospital immediately. Their firstcall is usually the traditional heal-ers and when this fails, they cometo hospital,” says Lawrence Okello,the medical officer in charge of themanagement of kala-azar patients atAmudat Hospital.

According to WHO, kala-azar ismost prevalent in the Indian sub-continent and in East Africa. Anestimated 200,000 to 400,000 newcases of kala-azar occur worldwideeach year. Over 90 per cent of the newcases occur in six countries of Ban-gladesh, Brazil, Ethiopia, India, South

Sudan, and Sudan.

Treatment

Following a kala-azar disease as-sessment, Medecins Sans Frontiers(MSF), which has been offering tech-nical assistance to Amudat Hospital,initiated a control programme in2000, focusing on case detection andtreatment.

Treatment of kala-azar usually in-volves the use of antimonial drugssuch as sodium stibogluconate (SSB),which has also been included on theessential drugs list of Uganda.

Research has also been conductedin the past three years to see if drugcombinations are effective.

The health ministry admits thereis no established control programmefor kala-azar, with current diagnosis

and treatment largely supported bythe Drugs for Neglected Disease ini-tiative (DNDi).

Benson Ruto (farleft) is excited thathe will go to schoolafter recoveringfrom kala-azardisease. NakorNawate (left) hasalso benefitedfrom treatment atAmudat Hospital.PHOTOS BY PAUL MENYA

who were herding livestock insteadof attending school.

“If I take all of my children toschool, who will look after our ani-mals? Ruto has been herding cattlebut I have now decided to take himback to school because he falls sickfrequently,” says Lolingang.

Ruto is excited about going toschool. “I want to become a doctorand treat people in future,” he sayswith a wide smile.

Mobile communities

The Amudat District communitymobilizer, Andrew Ochieng observesthat because of their pastoral nature,the community in this region is mo-bile and difficult to mobilise.

“When I test them in their differentlocations and find some are sufferingfrom kala-azar, they do not come tohospital immediately. I have to pleadwith them all the time. However,those who know the values of a hospi-tal do not hesitate to seek treatmentas soon as they can,” Ochieng says.

He adds that most young boys inthe region have to look after the fam-

ily livestock even when they are sick.“Unless parents get replacements,

the boys are not allowed to go to-hospital, and only do so when theyhave become too weak,” explainsOchieng.

According to the World HealthOrganisation (WHO),kala-azar isthe most serious form of the diseasecaused by leishmaniasis visceral.Others are cutaneous and mucocu-taneous.

leishmaniasis is caused by a proto-zoa parasite from over 20 leishmaniaspecies and is transmitted to humansby the bite of infected female phle-botomine sandflies.

The disease is commonly associ-ated with malnutrition, poor housing,climate change and a weak immune

system. According to the Ministryof Health, the disease is common inremote villages of Uganda, Sudan,Ethiopia and Kenya.

Kala-azar is characterised by ir-regular bouts of fever, weight loss,enlargement of the spleen and liver,and general body weakness.

Up to 90 per cent of people whoare not treated against the diseasedie due to organ failure, anaemia andother secondary infections. It can alsocause skin ulcers. People of all agesare at risk of infection if they live ortravel in areas where the prevalenceof kala-azar is high, although maleteenager are said to be at a higherrisk of infection because they engagemore in animal herding.

The Leishmaniasis East Africa Plat-form (LEAP) clinical trial principle

investigator in Uganda, Prof. JosephOlobo observes: “At household level,the impact of kala-azar is disastrous.It is lethal if not treated. The diseaseis mainly found in children, so fami-lies will lose their loved ones if it isnot treated on time.”

The Health ministry says the dis-ease has predominantly been re-ported in Amudat District, whichforms part of Karamoja sub-region.

Termite mounds are a dominantfeature of the area and form themain breeding and resting site for thesand fly vectors which transmit thedisease. However, two cases were re-cently reported in Moroto and Kotidodistricts, which are part of the Kara-moja sub-region in north-easternUganda.

“We do not know the extent of the

disease in Uganda. In the past, it wasmainly in Amudat District, but nowwe are getting cases in neighbouring

In our series on neglected

tropical diseases, today we

look at kala-azar, a disease

that largely affects pastoral

communities and efforts

being made to eradicate it.

“When people in these areas fall

sick, they do not seek medical

care from hospital immediately.

Their first call is usually the

traditional healers and when

this fails, they come to hospital,”LAWRENCE OKELLO, MEDICAL OFFICER

IN CHARGE OF KALA-AZAR MANAGEMENT,

AMUDAT HOSPITAL


9/14

8MONDAY, MAY 12, 2014

Daily Monitwww.monitor.c healthyliving Neglected Tropical Diseases

FIRST AID

TIPS FOR BURNS

IN CHILDREN

Children like to keep

active at all times, andthis is recommended fortheir growth and socialdevelopment. However, sochildren may end up playinext to fire places, puttingthem at risk of burns andinjuries from hot liquids sas water and porridge.

A burn is an injury that mabe sustained from exposuto heat or flames, or fromchemicals, electricity,friction or radiation.

And yet, some parents manot know what kind of firsaid to administer whenchildren suffer such burnsAs a result, it is commonfor parents to apply sugarcooking oil or cold water tburn wounds.

Dr Alfonse Omona of MulaNational Referral Hospitasays it is important not toattempt to treat burns on your own, as this will onlymake the condition worse

The first step should beto remove the child fromthe accident scene, andput them in a safe, cleanenvironment for observatBefore administering firsaid, it is also crucial toevaluate the extent of theburn.

“If the child experiencesexcessive pain, the parentshould apply warm wateron the burn. Warm wateris recommended becauseit reduces pain, while coldwater, which many people

tend to use actually causemore pain and swelling,” sDr Omona.

Prompt medical attentionto serious burns can helpprevent scarring, disabilitand deformity. Burns onthe face, hands, feet, andgenitals can be particularserious, as children have ahigher risk of complicatiofrom severe burns. “Howethe child should be taken the hospital as soon as firaid has been administeredIt is also dangerous to appherbal concoctions to burwounds because some macause bacterial infectionssays Dr Omona.

He says as the child is beitaken to the health facility

the burn should be coverewith a clean cloth to proteagainst infection. Parentsare also advised againstusing lotions, ointments ocreams on fresh burns.

By Joseph Kato


[email protected]

When Jesila Ngoloru devel-oped pain in her salivaryglands in 2013, she thought

the discomfort would go away by it-self. She was wrong.

Ngoloru, who lives in Ewavinivillage in Vurra Sub-county, AruaDistrict, recalls that when the painpersisted, her family suspected shehad contracted the deadly plaguedisease.

“By January, 2014, my left sali-vary aliva glands were swollen.I developed fever, headache andgeneral body pain. When I went toOpia Health Centre III in Vurra Sub-County, a blood test confirmed that Ihad plague. I am now on treatment,”says Ngoloru.

“Although I feel much better now, I

still experience some pain.”At the time of this interview, Ngol-

oru had been on treatment for oneweek, and was preparing to returnto Opia Health Centre III for medicalreview.

Ngoloru, a Primary Seven pupil atOyoo Primary School, says she couldhave contracted the disease from themany rats in their house.

“There are many rats at our homeand the only way we try to get rid ofthem is through poisoning. We havecleared the bushes around our homebecause this is where most of the ratsbreed from,” Ngoloru adds.

The district health team now plansto spray the villages surroundingNgoloru’s home with chemicals tokill the rats.

“We shall spray Ewavini, Opio Cen-tre, Kongodo and Offa, which havebeen most affected by the plague,”says Nickson Anguyo, the districtvector control programme officer.

After the villages are sprayed, thechemicals are expected to keep fleasaway for at least four months.

For Ruzalia Maturu, the story isdifferent. She is still mourning thedeath of her granddaughter, SabinaOndoru, who succumbed to plague inSeptember last year.

“I never realised Ondoru hadbeen infected with plague after shecomplained of fever, headache andgeneral body pain. We took her ill-ness lightly thinking it was a simplefever, only for her to succumb aftertwo days,” says Maturu, who is cur-rently nursing her 10-month-old twin

daughters for respiratory tract infec-

How rodentsare spreadingbubonic plaguePlague outbreaks are largely

unheard of in most parts of

the world. But in Uganda,

many communities are still

affected by this problem,

largely because prevention

programmes remain weak.

tion and pneumonia at Opia HealthCentre III.

When a member of the VillageHealth Team (VHT) heard of Ondoru’sdeath, they alerted the Sub-countyhealth assistant, who stopped theburial to conduct a test on the de-ceased. It confirmed that the eight-year-old had indeed died of plague.

“After the burial, the health assis-tant advised us not to return to thehouse, and it was later sprayed withchemicals. After a few days, dead ratswere falling from the roof top. Wehave also cleared the bushes aroundthe homestead,” adds Maturu.

According to the World Health Or-ganization (WHO), plague is a bacte-rial disease, caused by Yersinia pestis,which primarily affects wild rodents.It is spread among these rodents byfleas. Humans bitten by an infectedflea usually develop bubonic plague,which is usually characterised by aswelling of the lymph node in the af-fected area.

If the bacteria reach the lungs,the patient develops pneumonia(pneumonic plague), which is thentransmitted from person to personthrough infected droplets that canspread from cough.

Symptoms

Initial symptoms of bubonic plague

appear between seven and 10 days af-ter infection.

If diagnosed early, bubonic plaguecan be successfully treated with an-tibiotics. Pneumonic plague, on theother hand, is a deadly infectiousdisease, and infected people can diewithin 24 hours after infection. Casesof plague are still prevalent in tropi-cal and warm temperate countries.

Between 1989 and 2003, WHO saysan estimated 38,310 cases, includ-ing 2,845 deaths, were recorded in25 countries with high prevalence ofhuman plague worldwide.

WHO observes that plague casesremain largely under-reportedaround the world for several reasons,including the reluctance of countriesto declare cases, lack of timely andaccurate diagnosis and the absence oflaboratory confirmation equipment.

Arua and Zombo districts, border-ing DR Congo have registered thehighest cases of plague in the last 40

years, with at least five outbreaks re-

ported in the last 20 years.And in the past 10 years alone,

more than 2,000 cases of plague havebeen diagnosed in Arua and Zombodistricts. The health ministry has re-ported an average of 200 plague cases

per year from this region, with 30 percent resulting in death. Uganda ac-counts for 50 per cent of all plaguecases worldwide.

The flea species responsible fortransmission of the disease are Xeno-

psylla cheopis and Xenopsylla brasil-iensis. If a person is infected with anyof these flea species, they experiencesymptoms such as fever, headache,body weakness and swollen lymphnodes.

Control plans

Plague outbreaks in Uganda typi-cally occur as a result of cultivation ofgrain crops, deforestation and poorsanitation. The Ministry of Health,Uganda Virus Research Institute andthe US Centres for Disease Controland Prevention are collaboratingon plague research and control pro-grammes in Arua and Zombo dis-tricts, as a result, have set up a testlaboratory in the area.

Beside laboratory testing pro-grammes, the ministry also carriesout flea control programmes byspraying affected areas during out-breaks and administering treatmentsuch as prophylaxis against thosewho are infected.

Community Medicine Distribu-tors (CMDs) or VHTs have also beentrained to identify cases and referthem to health facilities.

Anguyo says seeking medical carein time is crucial.

Rapid diagnostic kits and facilitiesfor diagnosis have been establishedin the affected areas. Clinicians have

also been trained to manage cases in

a timely way, according to the Minis-try of Health.

On the issue of vector control, theministry says habitat and householdmodifications are being carried outto decrease the number of rodentsthat breed in houses.

“People need to raise their beds atleast one foot above the ground, sothat fleas to not fly from the groundon to the beds” Anguyo says

Sensitisation

According to Arua District HealthInspector, Manaseh Anziku, sensiti-sation of the community has alwaysbeen a key priority.

“We advise people in the commu-nities to report high cases of suddendeaths of rats in their homes to VHTs.The VHTs will then alert the nearesthealth centre that will collect theserats and bring them to the UgandaVirus Research Institute for investi-gations,” Anziku says.

However, the health ministry ad-mits cross border collaboration withDR Congo, which also has a high prev-alence of plague remains weak, mak-ing it hard to eliminate the disease

completely on the part of Uganda.

Jesila Ngoloru shows the swollen lymph nodes caused by the plague. Below, MaturuRuzalia who lost her granddaughter to the the plague recently. PHOTOS BY PAUL MENYA

“We advise people in these

communities to report high cases

of sudden deaths of rats in theirhomes to VHTs. The VHTs will

then alert the nearest health

centre that will collect these ratsand bring them to the Uganda

Virus Research Institute for

investigations.”

MANASEH ANZIKU, ARUA DISTRICT HEALTH

INSPECTOR


10/14

MONDAY, MAY 19, 2014


FIRST AID

RELIEVING

CONSTIPATION FAST

Constipation is such acommon uncomfortable

condition that occurswhen one gets a problemwith their digestion. DrAlex Kakoraki, a generalpractitioner at MurchisonBay Hospital in Luzirasays that the conditionis also caused when themuscle contractions inthe intestines are too slowto push the stool out ofthe body and sometimes,it is lack of enough waterto soften the stool so asto move it through theintestines to the anus. Othercauses of constipationinclude; cancer of theintestines, local swellingof the walls of the largeintestines, failure to drinka lot of water, over eatingof fast foods like chips,

chapatis, and chicken,among others.

Kakoraki further mentionssome of the ways one can doto relieve the constipation.

•Take a soap enema withwarm water

•Take a lot of warm water.As a start, try just drinkinga glass of water 3-4 times aday in addition to what younormally drink. after a heavymeal

•Take laxative tablets

•Aim to eat at least fiveportions of a variety of fruitand vegetables each day.One portion is: one large fruitsuch as an apple, pear.

• Keeping your body activehelps to keep your gut

moving. It is well known thatdisabled people, and bed-bound people (even if justtemporarily while admittedto hospital) are more likely toget constipated.

In children, the doctoradvises that one should rub vaseline or oil on the middlefinger, push it into his or heranus to remove the stool.One can use gloves in thiscase or rush the child to anearby hospital.

The doctor also cautions,“you may notice an increasein wind (flatulence) andtummy (abdominal) bloating.This is normal and tendsto settle down after a fewweeks as the gut becomesused to the increase in fibre

(or bulk-forming laxative).”

By Christine Katende


[email protected]

May 2012 evokes sad memo-ries for Martin Tako. It wasthe month when something

ricked the lower limb of his left leg,esulting in buruli ulcer.

At the time, he did not know whatas ailing him even when the affected

pot got swollen and developed blis-rs which eventually turned into aound.The father of eight says, “I then

ought medical attention. I firstsed local herbs and therapeuticuts were done with no change.” Heas referred to Adjumani Hospital.would feel pain right to my bones

n the affected leg. My left leg wouldwell even after a short walk. Thewelling would only reduce when Iaised the leg.”

oment of truth

On June 17, 2012, he was admittedo Adjumani Hospital where he wasold he had buruli ulcer.

This diagnosis was then followedith surgery and then skin graftingas done. He was discharged on July

0, 2012. That gave him a new leasef life because the pain disappearednd he was able to wear closed shoesgain.

Although he does not know whatauses buruli ulcer, his advice to vic-ms is to seek medical attention.

Tako says he did not react to drugsut he complains of the swelling ofs left leg. “I can’t say I have com-etely healed because my left leg oc-

asionally swells. I hope for complete

Buruli Ulcer: A misunderstood

mycobacterial disease

recovery,” he says. As a result, Tako’sfarming activities have retarded yet

this is his only source of income.He owns 11 acres of land, five in

Pakele Sub-county and six in Adju-mani Municipality where he used togrow ground nuts, rice, cassava andmaize.

“I can’t do anything on my farmfor fear of harming my leg. A stone orany other object could hit the leg andcause another wound,” Tako says.

Prevalence

According to the World HealthOrganisation (WHO), buruli ulcer iscaused by infection with mycobac-terium ulcerans, an organism whichbelongs to the family of bacteria thatcauses tuberculosis and leprosy. It is achronic debilitating skin and soft tis-sue infection that can lead to perma-nent disfigurement and disability.

Infection leads to destruction ofskin and soft tissue with large ulcersusually on the legs or arms. Patientswho are not treated early suffer long-term functional disability. Early di-agnosis and treatment are the onlyways to minimise morbidity and pre-vent disability.

Buruli ulcer has been reportedin 33 countries in Africa, America,Asia and the Western Pacific. Mostcases occur in tropical and subtropi-cal regions except in Australia, Chinaand Japan. Between 5,000 and 6,000cases are reported annually from 15of the 33 countries.

Most cases occur in rural com-munities in sub-Saharan Africa andnearly half of the people affected arechildren under 15. West Africa, Benin,

Côte d’Ivoire and Ghana report most

cases, with Côte d’Ivoire reportingalmost half of the global cases.

According to statistics from Minis-try of Health, the disease is the thirdmost common mycobacterial infec-tion after tuberculosis and leprosy. Itis also the most misunderstood of thethree human mycobacterial diseases.

The disease affects men and womenequally.

About 75 per cent of those affectedare children under 15 years of age and90 per cent of the lesions are on thelimbs; mostly lower limbs. There islittle seasonal variation in the inci-dence of the disease.

Impact

The ministry adds that buruli ul-cer imposes a serious economic bur-den on the affected household andon health systems that are involvedin the diagnosis of the disease andtreatment.

Although the disease was initiallyidentified in Buruli (Nakasongola Dis-trict), a recent survey found no casesthere. They also add that the diseaseis prevalent in areas near rivers,swamps and wetlands. Some cases ofthe disease, however, were recordedin Adjumani and Moyo districts.

WHO observes that buruli ulceroften starts as a painless swelling(nodule). It can initially also presentas a large painless area of induration(plaque) or a diffuse painless swellingof the legs, arms or face (oedema).Local immunosuppressive propertiesof the mycolactone toxin enable thedisease to progress with no pain andfever.

Without treatment or sometimesduring antibiotics treatment, thenodule, plaque or oedema will ul-cerate within four weeks with theclassical, undermined borders. Occa-sionally, the bone is affected causinggross deformities.

The Adjumani Hospital Medical

Superintendent, Dr Dominic Dram-etu, says he has on average beentreating 2 – 3 people per month.

According to Drametu, cases ofburuli ulcer are common during therainy season between the months ofApril and October. The disease is soprevalent around the shores of RiverNile in Adjumani District and alsoSouth Sudan.

“One of the features of a noduleis that it is usually painless, unlessthere is a secondary bacterial infec-tion. Otherwise, people don’t come

for treatment. They usually dress thewound themselves along with herbsfor a long time. It is only when thewound fails to heal that they come tohospital,” Drametu says.

A combination of rifampicin andstreptomycin/amikacin for eightweeks as a first line treatment for allforms of active disease is being used.Nodules and uncomplicated casescan be treated without hospitalisa-tion. For complicated cases, the onlytreatment available is surgery to re-move the lesion, followed by a skingraft if necessary. Health workers inAdjumani and Moyo hospitals havebeen trained in diagnosis and man-agement, including skin grafting. Inaddition, village health teams weretrained in case detection and referralto health facilities.

WHO notes that the exact modeof transmission of mycobacteriumulcerans is still unknown. However,it appears that different modes oftransmission occur in different geo-graphic areas and epidemiologicalsettings.

There may be some role for livingagents as reservoirs and as vectors ofmycobacterium ulcerans, in particu-lar aquatic insects, adult mosquitoesor other biting arthropods.

The health ministry on its part ad-mits that the major gap in the man-agement of the disease is the absenceof a well-established national controlprogramme.

Currently, there is limited dataavailable on buruli ulcer. Routine sur-veillance needs to improve for early

detection.

artin Tako (inset) shows his scarred left leg which is healing after a buruli ulcer operation. His biggest complaint is that the leg still swells. Dr Dominic Drametu (R) says the diseasevery common during the rainy season. PHOTOS BY PAUL MENYA

uruli ulcer is caused by a germ that mainly affects the skin

ut which can also affect the bone. Left untreated, the disease

ads to functional disability, loss of economic productivity, and

ocial stigma.


11/14

MONDAY, MAY 26, 2014


FIRST AID

HOME REMEDIES FOR

MIGRAINES

A migraine is a severeheadache which is

characterizsed by throbbingor pulsating on the forehead, on either side ofthe head. Dr Umar RashidGulooba of MakerereUniversity Business schoolhealth centre says whenserotonin, a chemical in thebrain, reduces, the blood vessels first contract andthen they dilate whichtriggers the initial stagesof a migraine before severepain set in. He also says amigraine is triggered byemotional, physical, dietary,environmental and medicalcircumstances.

Under emotional situations,Gulooba says, anxiety,panic, stress from workand depression triggersa migraine; and physicalcircumstances liketiredness, fatigue and failureto have enough sleep alsobrings about migraines.Poor dietary conditionslike dehydration, alcoholand taking much tea orcoffee which has caffeinesthat affect the serotoninchemical in the brain andenvironmental conditionslike bright light fromtelevision and computerand loud sound also triggersmigraines. Medically,taking sleeping pills andcontraceptives frequentlyact as triggers.

“When one side of one’s vision is not clear and alsowhen there is an experienceof flash lights and blind

spots in the eyes, are allsymptoms of migraines.Similarly, when someonealso smells weird thingswhen they actually aren’tthere is also a symptomof migraines,” Guloobasays. He adds that “when you put a person in a darkquiet room and give themsedative pills to rest forsome time, by the time theywake up, the migraine painwill have reduced.” Usingpain killers and medicineto stop vomiting also curesmigraines.

As anyone who getsheadaches knows, certainsmells can trigger the pain.But peppermint in particularseems to have pain-reducing

effects. “It’s very individual,”he says, and may not workfor everyone. Or, it could just

mask less pleasant smells.

By Roland Nasasira


[email protected]

One salient feature of neglectedtropical diseases is that theyare silent killers which pounce

n their victims when least expected.William Bukoma’s story is true tes-ament of this – having lived withhe deadly podoconiosis disease orephantiasis of the lower limbs for

4 years. Bukoma was attacked by the dis-

ase in 1960 – the same year he un-erwent the Bamasaba initiation rit-al of circumcision. He was 23 yearsd then, meaning podoconiosis has

een part of his adulthood for 55ears. “This disease has been on andff since 1960, but last year (2013) theain and itching intensified. The pain

When fertile soils spread

the deadly podoconiosisloughing for many yearsr going barefoot onoils appears to trigger

nflammatory changes within

he lymph system in the legs

ausing elephantiasis of the

ower limbs.

always comes with burning and itch-ing of my legs and feet. Once the painintensifies and I am eating, I have toput the food aside and concentrate onscratching my legs and feet,” Bukomalaments.

The father of 10, thought he hadbeen bewitched, but quickly addsthat he has not tried traditionalmedicine and is pinning all his hopesof ever healing on modern medicine.“I have now given up on getting curedbecause I have suffered for so long.I wish a cure could be got and thedrugs brought nearer to us,” he bit-terly says.

What its all about

According to the World Health Or-ganisation (WHO), podoconiosis is atype of tropical lymphoedema clini-cally distinguished from elephan-tiasis (lymphatic filariasis) by beingascending and commonly bilateralbut asymmetric. Research suggeststhat podoconiosis is the result of agenetically determined abnormal in-flammatory reaction to mineral par-ticles in irritant red clay soils derivedfrom volcanic deposits.

Podoconiosis is found in high-

land areas of tropical Africa, CentralAmerica and north-west India.

The disease occurs in highland redclay soil areas, mainly among poor,bare footed agricultural communi-ties, who do not wear protectiveshoes and, or wash the dust off theirfeet using soap and water.

Characteristics

According to WHO, podoconio-sis is characterised by a prodromalphase before elephantia

health reporting: winner - bamuturaki musinguzi, daily monitor

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