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Water drainage channels in Kabowa, a village in west Kampala, quickly fill with garbage and human feces. According to Ugandan Ministry of Health officials, many residents here don’t have toilets in their homes. Nakisanze Segawa, GPJ Uganda
Health

Despite Outbreak, Uganda’s Latest Cholera Containment Effort Is Unpopular, Unenforced

Uganda

Ugandan officials have banned the sale of homemade food and drinks in an effort to contain a recent cholera outbreak. The ban hasn’t stopped street vendors – will it stop the disease?

KAMPALA, UGANDA — Narrow drainage channels, often full of rainwater, plastic bags and leftover food, separate homes and shops in Kabowa, an area in the western portion of Kampala, Uganda’s capital. This community is one of the areas in the capital affected by a recent cholera outbreak.

The first case in Kabowa was confirmed on Jan. 5, 2019. Since then, local authorities have recorded 18 additional cases across the capital, the most recent on Jan. 25.

Five days after the first case was confirmed, the Kampala Capital City Authority issued a ban on the sale of homemade drinks and cooked foods to curb the spread of the disease. Cholera is contracted by consuming food or water contaminated by infected feces.

But local business owners are not happy about the ban.

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Homemade drinks made from fruits and tap water are still available in shops and on the streets of Kabowa, despite authorities prohibiting the sale of such items.

Nakisanze Segawa, GPJ Uganda

Isaac Semakula owns a convenience store, where he sells boiled tap water in polythene bags. He also sells homemade drinks called butunda and munanansi. Those drinks, which are chilled and made from fruit, are bestsellers, he says.

The business is his livelihood, he says. His children can attend school because of the money he earns. It’s not possible to give that up to comply with the ban, he says.

“Selling cold drinks supplements the income I earn from selling factory-manufactured commodities in my retail shop,” Semakula says.

Cholera outbreaks aren’t unusual in Uganda. The country has reported cholera cases to the World Health Organization every year since 1997, according to a 2013 study published in the journal PLOS Neglected Tropical Diseases.

The Ugandan government has tried oral vaccines, which offer temporary immunity, and has trained health workers to detect the illness in its early stages.

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Francis Ongole, from the Ministry of Health, collects water samples from a well in Sembule B Zone in Kabowa. The samples will be tested at a lab for Vibrio cholerae, the bacterium that causes cholera.

Nakisanze Segawa, GPJ Uganda

Still, the outbreaks continue. According to UNICEF’s 2018 regional update on cholera, Uganda had the second-highest number of cholera chases in urban areas in eastern and southern Africa, after Zimbabwe.

Some of Uganda’s ranking for 2018 is due to a cholera outbreak in the Kyangwali Refugee Settlement in the western Hoima District, says Joyce Moriku Kaducu, minister of state for health and primary health care. The first case was reported on Feb. 23, 2018. By March, the number of cases had reached 1,747, with 36 deaths.

The majority of those affected by the outbreak were refugees who had just arrived, and they may have contracted the disease before getting to the camp. But Kaducu says unsafe drinking water and poor sanitary practices also played a role in the rapid spread of the disease.

The outbreak ended when health workers used oral vaccinations, Kaducu says.

In total, there were 2,699 cases of cholera in Uganda in 2018 – up from 253 in 2017.

Kaducu says the ban on homemade drinks and cooked food remains the most effective way to get rid of cholera.

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Children in this village often play in puddles of rainwater, as well as drainage channels. Some even collect water for drinking from these places.

Nakisanze Segawa, GPJ Uganda

Residents of Kabowa, like residents of other high-density areas in the city, live in unhygienic conditions, she says. She explains that many homes do not have toilets and there are no public restrooms, so some people defecate in plastic bags or buckets, which they dump in water drainage channels. Those channels are where others get water for cooking and other household chores.

Controlling the sale and distribution of food and drinks isn’t a new idea. All street vending activities in Kampala, including the sale of food, have been banned since 2011. Still, street food is widely available.

Godfrey Bwire, who heads the Control of Diarrheal Diseases department at Uganda’s Ministry of Health, says the 2011 ban was issued in part because of concerns about the spread of infectious diseases, including cholera.

Those concerns have not gone away. In a 2017 report, the Ministry of Health proposed banning the sale of food on the streets during cholera outbreaks.

In Kabowa, authorities’ efforts to curb the spread of cholera haven’t panned out as they thought they would, says Edmit Tagoya, a local council member.

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Posters in Kabowa notify residents of the cholera outbreak, which started in early January, and list preventative measures.

Nakisanze Segawa, GPJ Uganda

Many are still selling cold homemade drinks and cooked snacks, such as samosas, and no one has been punished for it, Tagoya says.

“As long as there is demand for my butunda and samosas, I will continue to supply my customers, who trust my hygiene,” says Esther Nabatanzi, a shop owner.

Nabatanzi says the drinks she makes are popular because they are cheap. She sells butunda for 500 Ugandan shillings (13 cents). Factory-made juices cost anywhere from 1,000 to 10,000 shillings (27 cents to $2.72).

Regan Munyagwa, who buys homemade drinks regularly, is skeptical of the government’s containment approach.

“As long as some households have no latrines and continue to dump their feces in the water drainage channels, cholera will continue to affect the people of the community,” Munyagwa says.

Tagoya agrees. Buying and consuming homemade drinks is a personal decision, he says. Rather than ban the sale of drinks, he says, the government should focus on educating members of the community on the dangers of consuming such items.

Nakisanze Segawa, GPJ, translated some interviews from Luganda.