Bukwo makes headway in rabies fight

“When I saw blood, I immediately rushed to Bukwo General Hospital. The dog did not belong to the area and the doctor suspected that I had been bitten by a rabid dog,” she said on February 23, 2024.

She added: “At Bukwo General Hospital, I was told that vaccines were finished and was directed to a health facility across the Uganda-Kenya border, where I received five doses over a five-day period.”

Ms Cheptoyek is among over 200 residents across nine sub-counties and four town councils in the district who were bitten by dogs between May and December 2023, according to authorities.

The Acting District Health Officer, Dr Godfrey Barteka, says at least four patients succumbed to rabies between August and December last year, with the first case recorded at Bukwo General Hospital on August 28.

“That patient presented features suggestive of rabies and was referred to Mbale Regional Referral Hospital which confirmed that the patient had contracted rabies. He later passed away,” said Dr Barteka.

Dr Barteka says rabies manifests as a fever, general body weakness, and agitation, among other symptoms but subsequent cases were “sporadic” while citing a boy who died after being bitten by a dog at “some unknown time”.

“After a few days, the boy developed signs of rabies and was given first treatment and referred to Mbale regional referral hospital around October 2023,” Dr Barteka further explained.

Intervention
Bukwo is one of the districts that experienced zoonotic diseases, those transmitted between species from animals to humans and vice versa. The hotspots for rabid dogs included the sub-counties of Suam, Chepkwasta, Kapsarur, Kortek, Brim, Chesower, and Kaptererwo.

But Dr Barteka theorises that because some of the aforementioned sub-counties border conservation areas, there is a likelihood that it is where wild animals like foxes hibernate, and later interact with domestic dogs.

He, however, says the situation is now calm. They have contained the rabies, dog bites, and are now doing surveillance through Village Health teams (VHTs).

Other intervention measures, according to Dr Barteka, were reactivating the response team, making a number of undertakings, informing the district leadership, chaired by the Resident District Commissioner (RDC), chatting a way forward, and inviting partners for support.

“We have partnered with the Ministry of Health, Uganda Health Activity, and Uganda Learning Activity (both projects in Uganda funded by United States Agency for International Development), and engaged the communities in sensitisation to prepare themselves; this approach is continuous.

“We also got support from the government in the form of vaccines which were delivered in time, posters were shared to create awareness while community engagements were rolled out.

The secretary for health at Bukwo District Local Government, Ms Irene Chebet, said on February 14 that they decreed that all stray dogs be killed to avoid rabies, and at least 150 dogs have been killed in Suam sub-county and Bukwo town council.

The Bukwo District surveillance focal person, Mr Martin Barasa Wamasebu, however, says the rabies incubation period depends on the first aid management, depth and site of the wound, and proximity to the brain.

“The nearer the bite to the brain, the shorter the incubation period,” Mr Barasa, said, adding that about 1,200 people were rallied to fight rabies, while 468 dogs and 21 cats were vaccinated within nine sub-counties.

The Bukwo District animal, disease, surveillance focal person, Mr Peter Opio, said residents were warned against eating meat or animals showing signs of rabies, saying concentration of rabies is in saliva and therefore, they can get the virus.

Mr Opio says because areas around Mt Elgon are grazing fields, residents often went with their dogs to graze from such fields, and ended up picking the virus from there and bringing it to the community.

However, he says they have stopped residents from going with their dogs to the forests or parks, destroyed all dogs which lacked owners or claimants, vaccinated those with owners, and followed up on vaccination adherence with LC1 chairpersons.

Some dog bite victims who have since recovered were traced to Kwirwot health centre III in Kwirwot cell, Suam town council.

The facility serves about 11,000 people, including 4,000 from Suam sub-county and 8,000 from Suam town council, according to the in-charge, Dr Martin Chebet.

“A number of dog bites were recorded at the facility, some positives were confirmed and we lost some people due to delays, but the locals are now informed in case of any bite,” Dr Chebet said.

The area LC1 chairperson, Mr Victor Sangayayi, said his village recorded five victims of dog bites, with none succumbing to rabies, while one death was recorded in neighbouring Rikwoo village.

Challenges
Authorities say the intervention was initially hampered by logistical challenges, including limited vaccines for both humans and animals, which pushed their prices at private practitioners to Shs50,000, which limited victims’ access to the services.

While over 200 people suffered from dog bites, some contracted rabies and others didn’t; however, inadequate manpower made it difficult for authorities to follow, and so was controlling the dogs that were going deep into the national parks.

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