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Monkeypox worry in border districts
Handwashing is one of the best ways to protect you, your family, and your friends from getting sick. PHOTOS | ROBERT MUHEREZA
What you need to know:
- Local leaders and health experts in the Kigezi sub-region have expressed worry about the possible outbreak of the Mpox disease given that the screening methods used by health personnel at the border entry points are insufficient to detect the disease as Robert Muhereza and Felix Warom write.
The apprehension of local leaders in the Kigezi sub-region comes at a time when Mpox has claimed several lives in the neighbouring Democratic Republic of Congo (DRC). On Tuesday last week, Roger Kamba, the DRC’s health minister, said at least 610 people had died due to the disease in his country. The DRC has reported more than 18,000 suspected cases so far.
Several Congolese nationals continue to cross into the Ugandan districts of Kisoro and Kanungu, using both the official border entry points and porous entry points as they flee from armed conflict between their government and M23 rebels.
Annet Dusabe, the assistant district health officer in charge of maternal and child health for Kisoro, says the district has deployed a team of health workers to screen for Mpox disease at Bunagana border.
However, Kisoro District chairperson, Abel Bizimana, says there is a need for the Ministry of Health to boost the screening services with adequate equipment that can detect the disease before its symptoms are seen.
A health worker at Bunagana border post in Kisoro District measures the temperature of some Congolese refugees entering Uganda.
“The health workers deployed at the border posts are using common sense instead of technological equipment to screen for monkeypox. We have not seen the ministry coming to support these people with the required screening equipment. We are worried because the current methods of just observing and looking at the skin of the Congolese refugees crossing into the district are not sufficient to detect the disease in its early stages where the symptoms are not yet visible,” he says.
Need for equipment
Innocent Nkurunziza, the team leader of the health workers at Bunagana Border, agrees, "My team needs a thermo scanner instead of temperature guns if they are to detect the disease at the border thoroughly. We also appeal for constant supplies of gloves, face masks, sanitisers, and liquid soap to cover the overall safety of the health workers.”
Bizimana adds that the lack of a legitimate government at the border areas controlled by the M23 rebels makes bilateral coordination difficult, thus increasing the risk of disease transmission into Kisoro District.
“As a result, we have increased community sensitisation on Mpox disease through radio programmes and activated the existing village health team (VHT) members to provide support in disease surveillance,” he says.
Refugees
Badru Ssebyala, the Resident District Commissioner for Kisoro, says an average of 30 to 80 refugees cross into Uganda through Bunagana every day.
“These refugees are screened at the point of entry and at Nyakabande Refugee Transit Centre before they are given accommodation. People should not worry because we have health workers at the border points. We managed the Covid-19 pandemic and I am sure we will manage Mpox disease,” he says.
Kato Besisira, the assistant district health officer in charge of environmental health for Kanungu, says in a bid to control the spread of the disease from the DRC, the district will soon deploy VHTs in border communities rife with porous border points.
“While we have partnered with volunteers to provide Mpox screening services at Ishasha and Kyeshero border posts in Kanungu District, we need support from the Ministry of Health to facilitate constant monitoring and surveillance at the porous border points,” he says.
Besisira also appeals to the health ministry for material support, especially tents, furniture, temperature guns, and gloves to enhance the safety of the volunteers.
“The Ministry of Health should conduct training sessions on vigilance and standard operating procedures required while screening for the disease, for all VHT members and some health workers,” he says.
Situation in West Nile
West Nile districts that sit at the border enclaves with the DRC and South Sudan are at risk of spread of monkeypox diseases due to the unmanned border points. According to Uganda Revenue Authority, there are more than 350 porous points between DRC, South Sudan and Uganda but only a handful are manned.
Farmers, businessmen and disco revelers travel back and forth in the two countries at any time without screening. Most of them use undesignated border points, hence posing a threat to spread of the disease. This is a great concern for the health teams and district leaders across the sub-region.
As a result, leaders of Pakwach, Nebbi and Zombo districts, which border DRC, have asked the government for emergency funds to combat the spread of monkeypox.
Grace Atim, the Zombo Resident District Commissioner, says since there is free entry and exit by Congolese nationals seeking health services in Uganda’s health facilities, they anticipate that there will be rapid spread of the disease.
“The country needs disaster preparedness emergency funds because monkeypox has been declared a global health risk. We should not relax at the border points because there is uncontrolled movement of people who may not be screened,” she says.
According to the Acting District Health Officer (ADHO) Nebbi, Dr Justine Okwairwoth, since some of the health centres are at the borders, there is a need for emergency funds to facilitate community sensitisation, case detection, follow-up and referrals.
A nurse at Adumi Health Centre IV, who spoke to this publication on condition of anonymity, says, “We at border point facilities sometimes fear to touch some people crossing over from DRC because we do not have gloves, and asking for money from the Congolese to buy gloves is very risky.”
Strategies
In Arua City, the City Health Officer, Dr Pontius Apangu, says, “Much as no case has been reported yet in the city, we have reactivated the rapid response team, engaging in mentorship of health workers in Adumi, Oli, Aroi, Orivu, Ediofe, St Assumpta and Riki health centres to equip them with skills and knowledge in handling cases.”
Dr Apangu adds that his team has also embarked on routine surveillance, orientation of border health workers at Lia border, Odramacaku trading center and Arua airfield.
“We are encouraging facility-based awareness and health education in communities. We are now positioned to respond to this outbreak should suspects be registered in the city,” he says.
Last week, the fears of the outbreak of the disease in Moyo District was laid to rest after the laboratory test results from a suspected case at Laropi health centre III were negative. In Yumbe District, one suspected case was reported, but results returned negative.
Why cross-border collaboration is key
In August last year, health experts from Uganda and DRC agreed to conduct joint border surveillance, case detection, testing of samples of plague, Ebola and other diseases.
Cleophase Ntumba, the in-charge of Biringi district area in Ituri Province says, decries the lack of testing facilities in his country.
“We have only one laboratory that is still under construction in Bunia City, with support from the World Health Organisation (WHO). It is now helping us to test samples. However, if the leaders from the two countries agree that testing our samples be done at Uganda Virus Research Institute (UVRI) in Arua City, it will be of great help in fighting disease outbreaks,” he says.
Initially, the samples collected in eastern DRC were transported to the capital Kinshasa, which usually takes one to two weeks to ascertain the results. This makes it difficult to manage and control outbreaks.
At Elegu border post, health officials say they are carrying out screening of people entering and exiting South Sudan. Last week, one suspected case was isolated at a health centre in Amuru District following the screening exercise.
Appeal
Pascal Ulama, a health analyst Bunia City Equally, says, "We ask the Ugandan experts to help train our personnel in disease surveillance, reporting and control because it will be a great milestone. Since there is a laboratory in Arua City, it will be easy for us to transport samples and manage outbreaks."
On the borders with South Sudan, the district health officer for Moyo, Dr Franklin Iddi, noted that due to the cross border trade with South Sudan, there is need for improved surveillance.
"There is no need to worry at the moment but alertness is key to any health-related interventions. People should continue with prevention measures such as hand washing,” he advises.
The Member of Parliament for Padyere County in Nebbi District, Isaka Otimgiu, also a member of health committee, acknowledged that, “We have noticed gaps in health such as some health centres having dilapidated structures, lack of drugs, late procurement of drugs and staffing challenges, which need to be addressed if emergency cases are to be handled.”
What the Ministry of Health says
The Health Minister, Dr Jane Ruth Aceng said a week ago that: “We want you (health workers) to be vigilant in your area of work so that we put an end to this outbreak. We are all tired after Covid-19 and nobody is much interested in handling outbreaks now. Resources are extremely limited.”
Responding to the issues raised from the border districts, the senior public relations officer at the Ministry of Health, Emmanuel Ainebyoona advised the complaining local leaders to inform the ministry in writing if they are to get timely responses.
Dr Patrick Tusiime, the commissioner for communicable diseases prevention and control, says there is no magic that can stop the spread of monkeypox in Uganda, apart from continued vigilance by the communities and partners.
“It is a combined effort by community members and local leaders. We have district task forces already in place. They can easily swing into action to keep surveillance. Then, the partners will come in to support the districts through the Ministry of Health,” he says.
Dr Tusiime adds that although they are on top of the situation, there are a number of things the ministry needs to fully implement in the response plan.
“It is not that we are at 100 percent readiness, but we are moving on and trying to fix whatever gaps exist. Those worried about the screening equipment should concentrate on identifying suspected cases and the ministry will conduct the testing. We do not mind if the alerts are true or false because this shows that the community is aware of the threat,” he says.
The statistics
According to the National Monkeypox Situation Report of August 23, 2024, Uganda confirmed the first cases of Mpox on July 24, following the confirmation of two case-patients from Bwera Hospital in Kasese District by the Uganda Virus Research Institute (UVRI). The two index cases were treated and discharged.
Last week, two cases were reported from Amuru and Mayuge districts, which are outside the index district (Kasese). The report further indicates that the Case Fatality Ratio (CFR) among confirmed cases still stands at 00/04 (0.0 percent) although 41 active contacts are currently under follow-up.
The report stated, “Activation of District Task Forces (DTFs) starting with Mayuge and Amuru, and 23 high risk districts, updating the national Mpox risk mapping and categorisation in light of emerging epidemiology of the outbreak and pretesting the digitalisation of the Case Investigation Form (CIF) are some of the planned activities.”
The World Health Organisation last Monday launched a six-month plan to help stubborn outbreaks of Mpox transmission, including ramping up staffing in affected countries and boosting surveillance, prevention and response strategies. The organisation expects to roll out the plan from September through February 2025 and it will require $135 million (Shs501b) in funding. The aim is to improve fair access to vaccines, notably in African countries hardest hit by the outbreak.
In mid-August, WHO classified the current Mpox outbreak as a global health emergency. The disease mostly spreads through close skin-to-skin contact, including sexual intercourse, and those affected can develop lesions on the face, hands, chest and genitals.
