Undiagnosed illness - Uganda - Typhoid suspected

[alert]

http://www.monitor.co.ug/artman/publish/regional-special/Strange_disease_leaves_30_admitted_in_Bukwo_88351.shtml

Strange disease leaves 30 admitted in Bukwo
David Mafabi

Bukwo

One person has died and 32 others are admitted at Bukwo Health Centre IV following an outbreak of a strange contagious disease. Zacharia Sokuton succumbed to the strange disease on July 13 after the medical team at Bukwo Health Centre failed to tame the disease.

An eerie cloud of fear now hangs over the villages of Kapses, Sosho, Kapkorosoy and Kapkuripson in Bukwo Sub-county, Bukwo District along River Bukwo where the disease broke out from before spreading to the surrounding villages.

A mini-survey by Daily Monitor reveals that most of the homesteads have been abandoned, villages deserted and it has become increasingly rare to come across people walking in groups for fear of contracting the disease.
The World Health Organisation Public Health Specialist, Dr Mary Amongin, confirmed the disease outbreak in Bukwo.

?We have lost one person and 32 are already admitted at Bukwo Health Centre IV but we have not yet established the disease,? Dr Amongin said, adding: ?We are just suspecting that it could be typhoid due to the surrounding dirty water.?
Dr Amongin told Daily Monitor that the patients are complaining of abdominal pain, headache, fever, diarrhoea and constant vomiting sending fears that it could be a contagious typhoid fever that has broken out.

She revealed that a team of laboratory technicians have already camped in Bukwo to take blood and stool samples of the patients and water from River Bukwo for analysis to find out the disease and its cause. The District Health Officer, Dr Michael Mwanga, said it was a strange disease, the first of its kind in the district ever since they were elevated to a district status.

Dr Mwanga also revealed that the villages of Kapses, Sosho, Kapkorosoy and Kapkuripson that surround the main local river Bukwo have contracted the disease raising more fears that the waters of the river could be dirty.

?The people around River Bukwo have contracted the disease and the numbers keep going up but we suspect the water of the river that is being used for drinking could be dirty and thus causing the strange disease,? said Dr Mwanga.
He said the number of people seeking treatment at Bukwo Hospital is overwhelming despite inadequate medical attention at the health facility.
Last month, Moroto Municipality was hit by the leishmaniasis (kala-azar) disease which claimed some lives.

[alert]

Re: Undiagnosed illness - Uganda - Typhoid suspected

ProMed's East Africa regional site has posted this article along with the following comments:

http://eafr.promedmail.org/

--
Communicated by:
ProMED-EAFR
< promed@promedmail.com >

[Typhoid fever is a water related disease transmitted by the oral
fecal route. Contaminated water has been implicated in previous
outbreaks and as indicated in the newswire, there is need to conduct
water quality tests on water drawn from the local river (river
Bukwo). According to the WHO, typhoid is principally a problem of
unsafe drinking water, inadequate sewage disposal and flooding ( see
http://www.who.int/water_sanitation_...es/typhoid/en/).


All open water sources are presumed contaminated until treated hence
there is need to investigate water purification methods used in the
affected communities. The recommended preventive interventions for
typhoid fever include: health education about personal hygiene,
especially regarding hand-washing after toilet use and before food
preparation; provision of a safe water supply; proper sanitation
systems; and excluding disease carriers from food handling (see
http://www.who.int/water_sanitation_...es/typhoid/en/).

Bukwo District in eastern Uganda can be located on the map at

http://www.coetzee-uganda.com/index_files/District_Map_of_Uganda.htm

and the HealthMap/ProMED-mail interactive map at http://healthmap.org/r/00BK.

For additional background information on typhoid, available from the
general ProMED-mail list, the postings below can be found at
http://www.promedmail.org. - Mod.JFW]

[see also:
Typhoid fever update 2009 (01) 20090710.2472
Typhoid fever - USA: (TN) cluster 20090608.2120
2008
----
Typhoid fever update 2008 (08) 20081229.4095
Typhoid fever update 2008 (07) 20081118.3640
Typhoid fever update 2008 (06): Canada (BC) ex India, alert 20081026.3386
Undiagnosed illness, fatal - Uganda: (KS), typhoid susp. 20080814.2524
Typhoid fever update 2008 (05): Philippines 20080312.0999
Typhoid fever update 2008 (04): Philippines 20080305.0901
Typhoid fever update 2008 (03): Philippines 20080303.0875
Typhoid fever update 2008 (02): Philippines, Fiji 20080204.0450
Typhoid fever update 2008 (01) 20080128.0358
2007
----
Typhoid fever update 2007 (14) 20071203.3893
Typhoid fever update 2007 (13) 20070905.2928
Typhoid fever update 2007 (12): Algeria 20070829.2842
Typhoid fever update 2007 (11) 20070716.2286
Typhoid fever update 2007 (10) 20070627.2072
Typhoid fever update 2006 (09) 20070427.1373
Typhoid fever update 2007 (08) 20070412.1226
Typhoid fever update 2007 (07) 20070315.0912
Typhoid fever update 2007 (06) 20070305.0776
Typhoid fever update 2007 (05) 20070215.0570
Typhoid fever update 2007 (04) 20070209.0507
Typhoid fever update 2007 (03) 20070123.0301
Typhoid fever update 2007 (02) 20070119.0254
Typhoid fever update 2007 20070116.0205]
...................................jfw/mj/be

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[alert]

Re: Undiagnosed illness - Uganda - Typhoid suspected

Please rename and move this thread. This is confirmed as typhoid.

http://eafr.promedmail.org/

TYPHOID FEVER - UGANDA (02): (BUKWO)
************************************
A ProMED-mail post

http://www.promedmail.org

ProMED-mail is a program of the
International Society for Infectious Diseases

http://www.isid.org

Date: Mon 17 Aug 2009
Source: Monitor Online [edited]

http://www.monitor.co.ug/artman/publish/regional-special/Typhoid_kills_20_in_Bukwo_89764.shtml

Despite efforts by the government to combat typhoid in Bukwo
District, fresh reports indicate that the disease is still spreading in the
district and that at least 20 people have succumbed to it.

The Ministry of Health Field Epidemiologist, Dr Luswa Lukwago, who
has been on research and surveillance in the district, confirmed to
Daily monitor the new development on the epidemic.He said: ?Over 20
people have been reported dead and on average every
family has about four cases.? ?Although we have treated the
disease, recent research and surveillance indicates that the disease
is still
in Suam, Kapkorosoy, Kapkuripson and Kabei sub-counties,? he added.

Dr Lukwago said this after making a presentation of the disease
status report to the district team on Wednesday [12 August 2009]. He
said many cases never receive adequate treatment and others who fled
to Kenya came back. ?We have been treating patients
using chloramphenicol and ceftraxone but the two drugs ran out of
stock, forcing many to seek traditional means,? he said.

Dr Lukwago said the poor latrine distribution in the district and
the free movement across the border points between Uganda and Kenya is
responsible for the disease spread in the wake of shortage of
drugs.Bukwo has 57 per cent latrine coverage in the district and most of
them are open structures that leave the human waste exposed. Also
about 400 cases are believed to have fled to Kenya after the
disease broke out in the villages surrounding River Bukwo and are
now returning. He revealed that because many people died without getting
medical attention, they have lost faith in the local health system
and have now turned to Kenya where they believe they will receive better
medical services.

The World Health Organisation Public Health Specialist, Dr
Mary Amongin, confirmed the disease is still spreading in Bukwo, claiming
about 22 people and leaving about 32 bed-ridden in Bukwo Health Centre.

[Byline: David Mafabi]

--
Communicated by:
ProMED-EAFR
< promed@promedmail.com >

[The typhoid outbreak rages on in Bukwo district with over 20
deaths now reported in the district since mid June 2009. The situation is
bound to worsen given that the health facilities have run short
of drugs. In addition the risk of the epidemic spreading to other areas
will persist until measures are put in place to improve access to
safe water and disposal of human waste.

Bukwo District in eastern Uganda can be located on the map at

http://www.coetzee-uganda.com/index_files/District_Map_of_Uganda.htm

and the HealthMap/ProMED-mail interactive map at
http://healthmap.org/r/00BK - Mod.JFW]

[See also:

TYPHOID FEVER - UGANDA: (BUKWO) SUSPECTED 20090720.200669

[alert]

Re: Undiagnosed illness - Uganda - Typhoid suspected

http://eafr.promedmail.org/

ProMED-EAFR:East Africa

View printable version
Published Date
2009-08-25 10:32:16
Subject
PRO/EAFR> Typhoid fever - Uganda (03): (Bukwo) conf
Archive Number
20090825.201422
Full Text
TYPHOID FEVER - UGANDA (03): (BUKWO) CONFIRMED
**********************************************
Date: Sun 23 Aug 2009
Source: The New Vision (Uganda) [edited]

http://www.newvision.co.ug/D/9/34/692217

Update on the typhoid outbreak in Bukwo, Uganda
-----------------------------------------------
Business continues at Suam near River Bukwo on the Uganda-Kenya
border, despite the outbreak of typhoid. Moses Kiptai, a resident,
says despite the deaths, life goes on. "Our ancestors began drinking
from this river hundreds of years ago. They produced our parents, who
have lived here for several years. We too, shall drink this water and
will survive," he says as he scoops water from the fast flowing river.

A team of doctors from Makerere University School of Public Health
funded by the African Field Epidemiology Network (AFENET) to
investigate the epidemic outbreak confirmed it was typhoid.

"According to our preliminary investigations the epidemic broke out
around [13 Jul 2009] after the 1st case was reported at one of the
markets near River Bukwo. The outbreak started from Kenya in early
June [2009]," says Dr Luswa Lukwago, the health ministry field
epidemiologist who headed the team.

The team was in the district for a week and visited the affected
families, villages, and hospitals where patients were admitted.

Lukwago says the vessel for contamination is River Bukwo. "We
discovered that every home had at least 4 patients. This means there
is a lot of house-to-house infection."

The epidemic would have been contained if the community maintained
hygiene. "The area is littered with faeces that flow into the river
where people fetch water for drinking," said Lukwago.

The district health officer, Collins Satya, says: "We have registered
over 600 cases of typhoid and 17 deaths. The majority are children
and youths."

The Bukwo district chairman, John Chelangant, says: "We are lucky the
epidemic has not reached the camps, we would have registered more deaths."

He urges the Government to help the district increase its safe water
coverage, which is estimated at only 10 percent.

"We have utilized UGX 15m [approx. USD 7300] out of the UGX 56m
[approx. USD 27 300] allocated for the health budget this year [2009]
and yet the financial year has just began," he says.

The resident district commissioner, Christopher Chepkurui Songhor,
says the population in Bukwo needs to be sensitized on the need to
maintain personal hygiene.

"When we tell them to boil water, they say it loses taste. We need to
teach them not to plough near the river banks and the significance of
latrines in every homestead," he said. The latrine coverage in Bukwo
is less than 50 percent. Steven Mangusho, the district health
inspector, says 80 percent of the people in the district do not wash
their hands.

Mangusho said the situation is aggravated by the fact that health
inspectors at the sub-county are inadequately facilitated. "Movement
in this area is too hard. When it rains, the roads are impassable and
communities are flooded and yet the means to reach the affected areas
are inadequate," he said.

Carolyne Araptai, the secretary for social services, said efforts for
the district to fill posts in health centre IIIs has hit a snug.
Chelangat said the district council had passed a resolution to add
UGX 300 000 [approx. USD 146] to the doctors' salaries as an
incentive. He said over 10 health centres had been closed due to lack
of manpower. But the team recommends that they be re-opened,
promising to solicit support from the World Health Organisation for
emergency kits for the typhoid outbreak.

AFENET supports the health ministry and the School of Public Health.
It was influential in responding to the [ebolavirus] outbreak in
Bundibugyo and the swine flu outbreak in Uganda.

[Byline: Patrick Jaramogi]

--
Communicated by:
ProMED-EAFR


[This recent update confirms that the cases are due to typhoid fever,
though the nature of lab tests undertaken isn't clarified. The
epidemic continues to escalate with 600 cases including 17 deaths due
to typhoid fever reported in this border district of Bukwo. The
report indicates that similar cases were first reported in adjacent
communities across the border in Kenya, which all share the River
Bukwo but to date there is no information on the extent of the
problem in the nearby communities located in Kenya.

There is need to address the challenges pointed out in the report and
these include: poor access to safe water and sanitation facilities;
poor attitude of communities towards adopting good personal hygiene
and recommended water treatment methods; and poor access to health
services in the district.

Bukwo District in eastern Uganda can be located on the map
athttp://healthmap.org/r/00BK. - Mod.JFW]

[see also:
Typhoid fever - Uganda (02): (Bukwo) 20090818.201314
Typhoid fever - Uganda: (Bukwo) susp 20090720.200669

For additional background information on typhoid, available from the
general ProMED-mail list, the postings below can be found at
http://www.promedmail.org. - Mod.JFW]

Typhoid fever update 2009 (01) 20090710.2472
Typhoid fever - USA: (TN) cluster 20090608.2120
2008
----
Typhoid fever update 2008 (08) 20081229.4095
Typhoid fever update 2008 (07) 20081118.3640
Typhoid fever update 2008 (06): Canada (BC) ex India 20081026.3386
Undiagnosed illness, fatal - Uganda: (KS), typhoid susp. 20080814.2524
Typhoid fever update 2008 (05): Philippines 20080312.0999
Typhoid fever update 2008 (04): Philippines 20080305.0901
Typhoid fever update 2008 (03): Philippines 20080303.0875
Typhoid fever update 2008 (02): Philippines, Fiji 20080204.0450
Typhoid fever update 2008 (01) 20080128.0358]
...................................jfw/mj/be

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