Uganda cholera outbreak slows, but violence in DRC complicates recovery

ABIDJAN — There has been an 80 percent decrease in the number of new cholera cases reported among a community of Congolese refugees in Uganda’s western Lake Albert region, the World Health Organization told Devex Friday. As recently as Feb. 28, health care workers were identifying roughly 100 new cases a day and as of March 12, that number is down to 20.

The outbreak, which was declared less than a month ago, has sickened at least 1,484 people and killed at least 35, according to the March 9 edition of WHO’s weekly bulletin on outbreaks and other emergencies. Since some refugees settle into host communities and don’t report to refugee settlement sites, the numbers may be higher, according to WHO Uganda Emergency Preparedness Coordinator Innocent Komakech.

But the situation — while fluid — has markedly improved thanks to a rapid response plan that combined a speedy deployment of health workers with effective communication shortly after the first cases were detected on Feb. 15, Komakech said.

About a week later, on Feb. 23, Ugandan health authorities confirmed a cholera outbreak in Hoima district, where Congolese refugees had settled after fleeing ongoing violence in the Democratic Republic of the Congo’s northeastern Ituri province. By the time the outbreak was declared, health teams had already confirmed hundreds of cholera cases.

Now, at 7:30 each morning, a cholera task force comprised of various Ugandan government officials, humanitarian actors, and health workers meet to identify hotspots and plan the day’s response. With the support of community leaders, field response teams organize seminars on food and hand hygiene and water safety to reduce exposure to the illness. Health teams also provide water purification tablets and water treatment demonstrations.

“Our initial response was to ensure that the risk factors for transmission were quickly identified so that those could be addressed and interrupt transmission,” Komakech explained.

Cholera was spreading from one fishing village to the next. In addition to following the pattern, the response team reached out to educate communities beyond the outbreak’s path on prevention.

Then “we had to deal with the issue of the treatment center because [it] was very crowded. There were so many patients, the number of workers were few, the supply flow had difficulties — so we had to move in quickly with supplies and additional health workers,” Komakech said.

He added that the situation “remains quite delicate” given the influx in daily arrivals — between 1,000 and 2,000 refugees per day — and the range of needs, including medical supplies, health workers, and clean water.

Roughly 60 percent of new cases are among newly arrived refugees, Komakech said, so effective communication to arriving groups is critical. And the mortality rate remains high at 2.4 percent — if treated early and properly, this can be lowered to less than 1 percent.

Language barriers remain a challenge, stifling sensitization efforts as Ugandan officials do not speak the local language of arriving refugees. The cholera task force is working on bringing translators to the region, and, in the meantime, identifying arriving Congolese who speak French to translate for other refugees.

In recent weeks, some 42,000 Congolese have taken the daylong boat ride across Lake Albert. Though Uganda’s refugee policy welcomes all those fleeing violence into the country, government-funded health facilities have been overwhelmed by their numbers.

Cholera isn’t new to this fishing community. Outbreaks in 2012 and 2015 were blamed on nearby residents drinking contaminated lake water. Initial WHO reports indicate that this outbreak has also been spread by poor hygiene and inadequate water supply.

Komakech said he is happy with the progress made in monitoring, social mobilization, and case management. An estimated 350,000 doses of an oral cholera vaccine should be delivered in two weeks to further assist in controlling the outbreak.

But he added that the situation persists and WHO’s work in Hoima is far from done. “Time is really important … we really need to scale up our interventions given the quickly evolving context to continue reducing the mortality and getting a handle on this outbreak.”