Image 1: Downtown Kampala
Source: http://theconversation.com/why-kampala-holds-single-biggest-growth-opportunity-for-uganda-52230
In 2015, a typhoid outbreak broke loose in the city of Kampala, Uganda (Murphy, et al., 2017). The epicenter was Nakasero - downtown Kampala and the city’s most populated city district. The culprit was contaminated water. On February 6, a 42-year old man died of severe abdominal pain, jaundice, and a high fever. Initial testing of the ill man suggested typhoid and after a complete epidemiological survey in the epicenter of downtown Kampala, researchers were able to conclude that the mysterious disease was indeed serovar Typhi. Typhoid fever is a bacterial infection caused by Salmonella enterica serovar Typhi and most often transmitted by fecal matter. In most cases, contaminated water or food sources are the most common pathways of transmission.
In the environmental survey conducted in Kampala following the outbreak, researchers gathered that the street-vended beverages and unprotected water sources had fecal contamination (Kabwama, et al., 2017).
Image 2: Street vender drinks
Source: https://theugandan.com.ug/chaos-kampala-vendors-forced-off-streets-police-kcca/
With further analysis, it became evident that there was a linear relationship between the number of street-vended drinks consumed by an individual in downtown Kampala and the probability of contracting typhoid. In a separate study conducted by Murphy et al., 2017, of the 122 samples taken, 12 tested positive for Escherichia coli, conductivity, and free chlorine. All samples had acceptable levels of free chlorine set by the WHO, which is at below .5 mg/l. Conductivity levels were highly elevated, suggesting that untreated groundwater was present in samples.
CASE STUDY - On October 2004 in Nek Muhammad, a rural village located 25 km from Karachi, Pakistan, an outbreak of severe fever and diarrhea infected 300 people in the span of 2 days (Farooqui, Amber & et al., 2009). Researchers discovered that a well filled with fecal matter, dead amphibians, and garbage was the only source of water for this village of 500 people. After conducting microbial analysis, it was concluded that samples taken from the well tested positive for Salmonella enterica serovar Typhi. Unfortunately, this particular typhoid outbreak claimed the lives of 3 individuals and left several hundreds of people weak and susceptible.
Undeniably, water and human health have an unbreakable link. In order to maintain an acceptable level of human health, water and sanitation needs must be met and guaranteed irrespective of an individual's socioeconomic status. It is not only access to water that must be promised, but also access to regularly maintained clean water. Now, for many Americans and Brits, it’s really difficult to fully comprehend the inseparable relationship between water and human health. We turn on the faucet and have clean drinking water. Our toilets, without fail, flush each time we use the bathroom. Our showers turn on after a quick twist of the valve. We can wash our clothes and dishes at any time of the day or week. But in most places around the world, running water is difficult to acquire and clean water, a luxury. The burden of disease from unsafe water usually manifests itself in the form of diarrheal disease but can also take form in diseases such as schistosomiasis, trachoma, ascariasis, and other parasitic diseases (WHO Comparative Quantification of Health Risks, 2004). Estimates suggest that the disease burden from unreliable water, sanitation and hygiene (WASH) amounts to 1.73 million deaths each year. Of the total deaths, around 88% can be accounted for by diarrheal diseases.
But this is something that could be prevented - the burden of disease can be diminished significantly by improving water accessibility and safety.
But this is something that could be prevented - the burden of disease can be diminished significantly by improving water accessibility and safety.
Figure 1: Transmission pathways of diseases to the human body
Source: WHO Comparative Quantification of Health Risks
References
Murphy, J.L., et al. (2017). Environmental Survey of Drinking Water Sources in Kampala, Uganda During a Typhoid Fever Outbreak. Applied and Environmental Microbiology, Vol. 83, Issue 23, 1-11.
Kabwama, Steven, et al. (2017). A large and persistent outbreak of typhoid fever caused by consuming contaminated water and street-vended beverages: Kampala, Uganda, January - June 2015. BMC Public Health, Vol. 17, Issue 23, 1-9.
Pruss-Ustun, Annette, et al. (2004) Comparative Quantification of Health Risks. WHO, Vol. 1, 1324.
Farooqui, Amber. (2009). Investigation of community outbreak of typhoid fever associated with drinking water. BMC Public Health, Vol. 9, Issue 476.
Interesting post. You may find it easier to put hyperlinks to references cited in the blogpost rather list them at the end.
ReplyDeleteHi Dr. Taylor, Thanks for the suggestion!
DeleteHi! I really enjoyed this post as in my own posts I am trying to look at gender and water issues unique to rural and urban contexts, and this post showed how such devastating outbreaks can occur in both these context with the spread typical of the different environments. After it was found that the Kampala outbreak was driven by street-vended drinks do you know if any regulatory bodies for quality testing were put in place to stop a similar event in the future? Or did the informality make such impossible?
ReplyDeleteHey! Thanks for the comment!
DeleteThere are no public health codes in place regarding the drinks people sell on the streets of Kampala because street-vending in Uganda is actually illegal under KCCA (Kampala Capital City Authority) law! But this is not something that is well enforced. The only way to prevent this from happening, as I see it, is to provide clean drinking water to the citizens of Uganda.