Comparison of two communities affected by cholera in kasese district.
Okui, Scholastic Alajo
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INTRODUCTION: Some sub-counties in kasese district, namely Karambi and Bwera have experienced frequent cholera out-breaks since the year 2000 to date. On the other hand, Malibu, Hima, Kukoki and Bugoye sub counties have beed least affected. Indeed Bugoye has not had a reported out-break since 2000. The reasons for this difference are not entirely clear nor have they been explored. This study was therefore carried out to try to establish factors why cholera out-breaks have been frequent in some areas and not others of the same district. OBJECTIVES: The specific objectives were to study the socio-demographic profiles of the residents of two sub-counties (One affected and the other not), assess their socio-cultural practices, their environmental sanitation situations as well as the water sources used, water and food handling practices in households and markets and their cholera carrier status. The antibiotic sensitivity of the cholera organisms responsible for the outbreaks was also assessed. METHODOLOGY: A cross-sectional study comparing the situations of residents of Karambi and Bugoye, purposively selected, using both quantitative and qualitative methods of data collection was carried out in early 2007. Interviews were females of 18 years and above, observations of the homesteads, latrines and markets for sanitation and hygiene, sampling of water as well as of stool from victims that had recovered from cholera in 360 households from 10 randomly selected villages, five from karambi and five from Bugoye sub-counties was carried out. Similary food and water handling practices were observed. Types of water sources were noted. Water samples from both the sources and households were collected suing aseptic techniques. Later, these were analyzed for faecal contamination. Similary stool samples obtained from victims who had recovered from cholera were cultured. If cholera organisms were isolated, sensitivity to commonly used antibiotics was carried out. Focus group discussions with community leaders and key informant interviews with district health officials were also conducted. Data was analyzed using Epi-info 2002 computer software programme and SPSS and compared. Qualitative data was analysed manually. RESULTS: The main findings why cholera remains problematic in Karambi include: the more heterogeneous nature of its community, with 51% being of Uganda and 49$ of Congolese nationalities. This encourages frequent border crossings between the two countires for petty trade, farming and visiting relatives. Bugoye residents were 100% Ugandan. Although the latrine coverage in both sub-counties was high, above 90%, the cleanliness of the latrines in karambim was poorer, with faeces lettered on their floors (difference significant p<_0.004), thus attracting swarms of flies (difference significant p<_0.001). This being associated with consumption of cold foods communally and home-made juices (using un-boiled drinking water) in markets and on the road side (difference significant p<_0.004) as well as eating communally from the same dish (difference significance p<_0.008) and, given that water sources in karambi mainly consisit of ponds, unprotected springs and rivers that are heavily contaminated with faeces (both E.coli and cholera organisms were isolated from R. Mbabaine of karambi), are recipe for cholera transmission. In Karambi, 36% of the cholera victims who had recovered were found to be asymptomatic carriers of cholera organisms, resistant to first line antibiotics. CONCLUSIONS AND RECOMMENDATIONS: Factors responsible for the difference in cholera outbreaks in the two communities are: Heterogeneous community in Karambi that freely crosses in and out of DRC, poor water sources that are heavily contaminated, consumption of cold home made juices and food in markets/roadside, poor hygiene practices and a high carrier status among the Karambi community with cholera organisms resistant to first line antibiotics. RECOMMENDATIONS: 1) The DHO should make an effort to involve communities, local councils, administrators from both counties and the ministry of Health in cholera prevention and control activities. 2) Health officials in the district and sub county should strongly advise households to boil drinking water and that used to make juices. LCs should enforce bye-laws against eating cold cookedfood/drinking home-made juices at market places/roadside especially during cholera outbreaks. 3) Environmental health officers should intensify continuous health education at households on importance of good hygienic practices as well as proper use of latrines, keeping them clean and covered and to desist from defecating in communal water sources.