Africhol in Uganda
Since 1979, cholera has been endemic in Uganda. The biggest epidemic was recorded in 1998 (over 38,600 reported cases). While sporadic cholera cases are reported throughout the year, outbreaks are associated with the rainy season and overcrowded refugee camps [International Federation of Red Cross and Red Cresent Societies, Uganda: Epidemic Cholera 2009].
In order to gather high quality data on cholera disease burden in the country, Africhol collaborates with the Integrated Disease Surveillance and Response overseen by the Epidemiology and Surveillance Division (ESD) and the Control of Diarrheal Diseases (CDD) at the Ministry of Health (MoH).
Cholera Epidemiology in Uganda
Since 1995 in Uganda, the annual total number of reported cases ranges from 241 in 2001 to 5,194 in 2006, reaching up to 49,514 cases during 1998.
Thefirst cholera epidemic in Uganda was reported in 1979. In the history of cholera epidemics, 1998 remains the year when the biggest epidemic was recorded. This major outbreak started at the end of 1997 and by the end of June 1998, a total of 38,697 cases and 1,576 deaths had been officially reported. During March-April 2003, the Ugandan Ministry of Public Health reported a total of 277 cases with 35 deaths in Bundibugyo district, with most cases located along the Semliki and Lamia rivers. In 2010, cholera outbreaks were reported in eight districts in the Central and the Eastern Regions, and in the Karamoja sub-Region, with a total of 1,732 cases and 53 deaths.
In Uganda, sporadic cholera cases are reported throughout the year, especially during the rainy season, when waste is often carried into rivers and lakes where people continue to collect drinking water. The major outbreak in Kampala in 1997-1998 was associated with changing weather patterns due to the occurrence of El Nino that year. The cholera situation in the country is exacerbated when overcrowding occurs in some areas due to influx of refugees from neighboring countries.
Annual national summaries from WHO record case fatality rates ranging from 1.1% in 2007 to 13.7% in 1996.
Surveillance of cholera is conducted as part of the IDSR (Integrated Disease Surveillance and Response) and is overseen by the Epidemiology and Surveillance Division (ESD) and the Control of Diarrheal Diseases (CDD) at the Ministry of Health (MoH). The district statistics on cholera cases are collected weekly by the MoH.
Confirmation of cases is performed at the Central Public Health Laboratory (CPHL), located in Kampala. Current national guidelines specify testing of approximately 10 samples from suspect cholera patients to confirm the outbreak and continued testing of a handful of specimens periodically and to confirm the end of an outbreak.
When an important outbreak occurs, the National Cholera Task Force is organized (consisting of the MoH, Mulago Hospital, UN Agencies, the Uganda Red Cross Society and the Federation, and NGO's involved in cholera prevention and control). The Task Force is charged with cholera surveillance, case management, community outreach, Information Education and Communication (IEC), sanitation and logistics.
Existing country documents include national guidelines for the Prevention and Control of Cholera.
Enhanced Surveillance Zones in Uganda
Africhol is collaborating with the national health authorities on investigating outbreaks and enhancing surveillance in selected districts (Mbale, Tororo, Manafwa, Butaleja and Busia).
In the districts lying along the Lake Albert on the western end of the country, cholera has been endemic for a long time and this area was identified as an epidemic-prone zone in the Great Lakes sub-region.