Once while on assignment in one of the northern districts, I felt an insurmountable urge to use a restroom.
The locals were kind enough to point me in the direction of a hut. I rolled up my trousers’ hems and hastened my steps to empty my almost bursting bladder. But I was in for a shock. There was no pit latrine; this was just a flat muddy floor with slime and urine spluttered all over.
At the sight, even my previously misbehaving muscles tensed up and held my waste in check. I dashed out of the ‘latrine’, tripping over a soft lumpy object, which turned out to be poop deposited at the hut’s door step.
Sadly, the residents have no clue that this unhygienic practice promotes the spread of Hepatitis, a devastating inflammation of the liver. According to Dr Isa Makumbi, the head of the Emergency Operations Centre (EMOC), Hepatitis is caused by a group of hepatitis viruses including, A, B, C, D and E viruses.
Dr Makumbi says they all lead to the inflammation of the liver.
“Hepatitis is considered mild when it lasts less than six months and chronic when it lasts longer,” Dr Makumbi says.
Hepatitis A is caused by the hepatitis A virus (HAV).
“The virus is transmitted through the faecal-oral route where people do not wash their hands after using the toilet and touch or prepare other people’s food when they are infected,” says Dr Jane Ruth Aceng, the Health ministry’s director general of health services.
The HAV may also be transmitted through infected blood and drinking contaminated water. Majority of the Hepatitis A patients remain without symptoms.
Dr Aceng says unlike Hepatitis B, C and D, Hepatitis A does not develop into chronic hepatitis and most people infected usually recover with no permanent liver damage.
Hepatitis B is caused by the hepatitis B virus (HBV) found in blood and body fluid such as semen. It is spread through unprotected sex with an infected person, piercings by sharp instruments such as needles and clippers that have been used by an infected person.
The virus has an incubation period of four to 25 weeks. Its symptoms include nausea, fatigue, jaundice and poor appetite, but Dr Aceng says these may be mild so much that the carriers of the virus may not be aware.
However, for some people, the infection becomes chronic, leading to liver failure, liver cancer or cirrhosis. “HBV is a hundred times more infectious than HIV and 70 per cent of people who get infected with it will be affected with cancer of the liver and 30 per cent will have dry livers,” Dr Fred Okuku, an oncologist at the Uganda Cancer Institute, says.
World Health Organization (WHO) estimates that more than two billion people have had hepatitis B infection and 600,000 of these die annually. Dr Okuku advises people to avoid sharing sharp instruments, practise safe sex, and sterilise sharp instruments used on them.
Hepatitis C is caused by the hepatitis C virus (HCV) found in blood and certain body fluids. Like the HBV, it is spread through contact of blood or body fluids from an infected person. Babies born to mothers with Hepatitis C can get infected during childbirth.
“Hepatitis C is not spread by casual contact, kissing, hugging, sneezing, coughing, breastfeeding or sharing utensils or cups,” Dr Makumbi says.
It is caused by the hepatitis D virus (HDV), a virus that needs the hepatitis B virus to reproduce it. Chronic Hepatitis B virus carriers are at risk of infection with HDV.
It is spread by having unprotected sex with a Hepatitis D infected person or contact with his or her body fluids.
A WHO document says: “Since no effective antiviral therapy is currently available for treatment of type D hepatitis, liver transplantation may be considered for cases of acute and end-stage chronic hepatitis D.”
This is caused by the Hepatitis E virus (HEV) and more severe in pregnant women resulting in abortions, premature babies and death. Like Hepatitis A and C, patients of Hepatitis E remain asymptomatic.
“Only between 30 and 50 per cent develop symptoms such as fever, abdominal pain, nausea, jaundice, vomiting and loss of appetite,” Dr Aceng says.
It is spread through poor personal and food hygiene, contact with infected blood and drinking contaminated water. Currently, the disease is prevalent in Napak district, having been confirmed on December 1.
As of March 17 this year, 983 patients and 24 deaths were registered by the health ministry; 14 of these deaths were of pregnant women.
It has also spread to Kotido, Abim, Moroto, Amuria and Katakwi districts.
Dr Aceng says major drivers of the disease include open defecation that leads to contamination of water bodies and poor hand-washing practices.
“A vaccine against HEV is still under assessment,” she says.
Although patients with HEV recover on their own, she advises washing of hands before eating and after visiting the toilet, proper human waste disposal and boiling of drinking water.
The article appeared in Observer on April 1st, 2014.