Uganda recorded its first case of the novel Corona virus disease 2019 (COVID-19) on 21st March 2020, and the first death on 23rd July 2020. In March 2020, the Government of Uganda put in place measures to mitigate the likely impacts of the pandemic including a national lockdown, as well as suspension of public and private transport, educational institutions, religious, political and other social gatherings. Other preventive methods promoted by the Ministry of Health include use of face masks, maintaining social distance, and hand hygiene. Currently, the country has started vaccinating the population against COVID-19 beginning with vulnerable and high-risk groups such as frontline health workers, teachers, security personnel, and the elderly.
Water, Sanitation and Hygiene (WASH) is an Environmental Health field that is critical for preventing several oral-faecal diseases such as diarrhoea, cholera and typhoid, as well as aerosol transmissible diseases including COVID-19. WASH measures promoted by the Ministry of Health to prevent the spread of COVID-19 include frequent washing of hands with water and soap as well as use of alcohol-based sanitisers. Evidence suggests that hand washing with soap alone can reduce acute respiratory infections by 30%. As a measure to prevent the spread of COVID-19 in Uganda, hand washing facilities have been installed at entry points of many communal places such as markets, schools, hospitals, churches and shops. However, with relaxation of many lockdown measures by government and the recent reduction in the number of COVID-19 cases in the country, the implementation of these measures seems to be gradually reducing.
Globally, 40% of households do not have hand washing facilities with soap and water, and only 19% of people wash their hands with soap after defecating. Although more people are currently practicing good hand hygiene because of the fear of COVID-19, past experience and evidence has shown that this may only be a temporary stimulus. Indeed, current hand washing practices may dissipate as soon as the threat about the virus further reduces. The availability of soap for handwashing has been scarce in many places, and access to water is not satisfactory as safe water coverage in rural areas is 68%, while the population using an improved drinking water source in urban areas is 70.5%. Access to water not only affects handwashing practices of households but also institutions such as schools, markets, and other work places. With schools having resumed teaching candidate and semi-candidate classes, improved WASH services including hand hygiene in these institutions is crucial in preventing the spread of COVID-19 and other diseases.
The Ministry of Health and World Health Organization have advocated for the use of alcohol-based sanitizers in addition to hand washing in the fight against COVID-19. However, most of the population in the country cannot afford sanitizers, while others may even find it hard to buy soap particularly in rural areas. Hand washing with soap and running water for at least 20 seconds as recommended is also affected by the water indicators of quality, quantity, coverage, continuity and cost which all need to be given attention during the ongoing pandemic and beyond. The key stakeholders needed to improve access to safe water across the country include the Ministry of Water and Environment, Ministry of Health, and other implementing partners.
Although the likely fecal-oral transmission of COVID-19 has been noted to be low, some studies have shown that the virus can be traced from fecal sludge and anal swabs of some of the cases. Therefore, proper disposal of human excreta is important in response to the pandemic as more evidence continues to be generated about the disease. According to the Ministry of Water and Environment, access to some form of sanitation is at 78% and 89% in rural and urban areas respectively. In addition, 22% and 12% of the rural and urban populations respectively still practice open defecation. Therefore, there is need to increase access to latrine facilities to reduce the spread of oral-feacal diseases. Since the transmission of COVID-19 can also occur from contaminated surfaces and objects, used tissues and face masks if not properly disposed of might result into more cases. The importance of proper management of waste including such materials that may contain the virus is crucial to reduce the spread of the virus throughout the country.
Amidst the COVID-19 pandemic, there has been an emergence of numerous handwashing innovations in Uganda such as pedal-operated and automatic taps. Although such innovations are welcome, many of them are expensive and not easily accessible. Indeed, the uptake of these innovations has only been for a few privileged individuals and institutions predominantly in urban settings, with the rural population continuing with using traditional facilities for handwashing. This situation calls for innovators and other stakeholders to explore development of innovations that are low-cost, easily accessible, and suitable for use in rural settings across the country. Such innovations would be instrumental to improve and sustain handwashing practices during the pandemic and beyond.
Sustainable WASH interventions and behaviours including hand hygiene should be integral to any development agenda, including for containment of COVID-19 and preventing future epidemics and pandemics. There is need to build capacities of various stakeholders including government bodies, non-governmental organisations, and other developmental partners to design, implement and evaluate robust WASH services that are accessible and affordable for all. With the ongoing COVID-19 vaccination and reduced cases in the recent past, there seems to be hope that we may have seen the worst of the pandemic. To avoid possible resurgence of spread of infections including a second wave of COVID-19 requires continued efforts by all stakeholders to ensure the entire population observes the recommended measures for preventing the spread of the disease including improved hand hygiene in addition to wearing face masks and social distancing.
Dr. David Musoke
Makerere University School of Public Health
Other contributors to the article are Prof. Lawrence Mugisha, Pius Jemba and Catherine Opondo.