BY NAMIGANDA JAEL
Joyce Kabyanga is a vibrant young mother of two. I happened to bump in to her as she exited the immunization center at the Kasese Municipal health centre III, where her nine months old baby girl had just received her first dose of yellow fever vaccine for free.
“People have been paying a lot of money to receive this vaccine but my child is one of the lucky few pioneers to be enrolled on this free vaccination program. I am so happy and thank the government for this initiative,” Kanyanga says.
She adds that she got to know about the introduction of the new vaccine for children not only through a community sensitization exercise but also through various radio talk shows that were hosted on many community radio stations. This is after the government of Uganda introduced the yellow fever vaccine to the routine immunization program.
According to Dr. Fred Nsubuga, the senior medical officer at the Uganda National Expanded Programme on Immunization (UNEPI), yellow fever has a single dose vaccination that lasts a life time.
“Previously it was a travel requirement for travelers and Ugandans had to pay about USD 25 to get a shot but the Government of Uganda together with its global partners are now rolling out the first phase of a nationwide mass vaccination campaign to eliminate yellow fever by 2025,” he says.
The yellow fever vaccination has not been part of Uganda’s immunization program but was included in the routine national immunization program by the ministry of health in October, 2022 following a recommendation by the Uganda National Immunization Technical Advisory Group. The vaccine is rolled out in high risk border areas and is administered to babies at nine to 12 months. Dr. Nsubuga reveals that this first phase is being carried out in six high risk regions but the free service for adults is yet to be rolled out.
Uganda is prone to disease outbreaks, including Yellow fever which last occurred in March this year in the central and south Western regions. On 6th March 2022, the Uganda Ministry of Health announced an outbreak and by April 25th, a total of seven suspected cases tested positive for yellow fever. These cases were reported from Wakiso district, Masaka, Kasese and Moyo.
Due to the potential of epidemic spread in Uganda and the risk of spread to neighboring countries, Kasese being at the border with Democratic Republic of Congo (DRC) and also being host to many refugees was put on high alert.
In March this year, the Government through the line ministries, Ministry of health and the Ministry of information, communication and technology (ICT) and national guidance embarked on a nationwide sensitization campaign to spread information amongst the population due to the limited or lack of information available at the time.
According to the World Health Organization (WHO), yellow fever is an epidemic-prone mosquito-borne vaccine preventable disease caused and transmitted to humans by the bite of infected Aedes and Haemagogus mosquitoes. Once contracted, the yellow fever virus incubates in the body for three to six days.
The majority of infections are asymptomatic, but when symptoms occur, the most common are fever, muscle pain with prominent backache, headache, loss of appetite, and nausea or vomiting. In most cases, symptoms disappear after three to four days.
According to the Kasese District Health Officer, Dr. Baseka Yusuf, when a case was confirmed in the district, they immediately engaged the population in a mass sensitization exercise. This is because there was very limited information about the disease among the population.
“We targeted our health workers especially in the areas that we knew were first to be affected. Since we are at the border, our Village Health teams were equipped with enough information to spread at the outreach centers but also at the village levels in a door to door exercise,” he explains.
Dr. Baseka says they also sensitized them through the mass media, especially radio stations where health experts attended talk shows and engaged directly with the listeners through direct call-ins with various queries and inquiries that receive immediate responses.
“Besides the radio sensitizations, we continue to engage the populations through community gatherings with drama performances which help us convey the messages and it is here that most people get sensitized about the available services for instance the newly enrolled yellow fever vaccine on the national routine immunization program for babies at nine months,“ he notes.
The routine vaccination followed the recent outbreak bringing the number of vaccines administered at routine immunizations to 14. “The Uganda National Expanded Program on Immunization is already supplying us with the yellow vaccine. When this young generation starts school at three years, they will all be vaccinated, but also the general public is soon starting to get the free vaccination although what we administer now at border points is still paid for, at a subsidized fee,” Dr. Baseka reveals.
He emphasizes that it was very important for them to engage the community through community-based surveillance and through emphasis on the signs and symptoms and the mode of transmission. Through this the communities are able to report immediately any suspected cases to the authorities who then alert their stand-by laboratories to swiftly confirm if it is indeed a yellow fever case so that it is handled with utmost care to prevent further spread.
After the ministry of health declared a yellow fever outbreak earlier this year, the ministry activated the Public Health Emergency Operation center. They also deployed rapid response teams to affected districts where all cases were reported to determine the extent of the outbreak, identify the at-risk population, conduct a risk assessment, initiate risk communication and community engagement activities and implement integrated vector control measures.
However, despite an earlier imminent plan to introduce the yellow fever vaccine in October, followed by phased mass vaccination campaigns (PMVCs), the vaccine is not yet rolled out for the masses due to funding gaps and a shift in priority areas arising from the current Ebola outbreak.
Kabyanga says it is a relief that children are now being protected from any possible out breaks. She is thankful that the Village health team was able to reach out to her and her peers with information regarding the new inclusion on the routine immunization because now they know better to not miss out on this opportunity for their babies.
Due to the risk of an epidemic spread in crowded urban areas that are common hubs for travelling residents. The authorities, especially in Kasese in collaboration with border towns like Bunagana, carried out sensitizations in these centers. This is due to the frequent population movements between Uganda and DRC.
“Because the national campaign carried general preventive measures, we decentralized the campaign for our district Kasese because we had our own unique needs and approaches as a boarder community,” he says.
Dr. Baseka says their efforts to sensitize the populations have not been in vain because they have been able to contain the 2022 outbreak with just a single confirmed case in his district as well as the overwhelming response from the communities who keep reporting any suspicious cases and symptoms.
“Mothers are also responding well to the routine exercise, we have not met any serious resistance as was the case with the COVID-19 vaccine,” he says, adding that since the vaccine was introduced on the routine vaccination in Kasese, not less than 150 babies receive the vaccine across all the health centers where immunization is carried out on a daily basis.
“When the vaccine was introduced at the beginning of October 2022, there was a very low turn up of ten to fifteen mothers but with our outreach sensitization campaigns, mothers started flocking health centers and the numbers have gradually increased, by the third week, we had reached 50 respondents and now at our 7th week, we are looking at 150 babies with the numbers still growing,” Dr. Baseka observes.
He says, populations in areas like Kasese are low income earners and thus suffer the wrath of having to treat illnesses, especially breakouts of such preventable diseases and, therefore, as the district leadership, they decided to take it upon themselves, to support communities and families to ensure healthy populations that would ultimately thrive in their various economic activities.
“Disease can drain financially, so if we can sensitize our people to take action now by embracing vaccination against diseases like yellow fever, we shall continue to spread the message,” he adds.
According to the Masaka District Health Officer, Dr. Nakiyimba Faith, vector control would be another crucial way of controlling any possible outbreaks and spread of yellow fever in the urban centers of Masaka. However, there are still limitations to this measure because spraying the mosquitoes which spreads yellow fever might actually end up doing more damage to the eco system and other species.
As a general precaution, WHO recommends prevention of mosquito bites including the use of repellents and insecticide treated mosquito nets. However, the highest risk for transmission of yellow fever virus is during the day and early evening to which Dr. Nakiyimba stresses that it has been a challenge.
She, however, notes that through their sensitization campaign, the populations most of whom spend their days in the gardens are being urged to put on long clothing when they go about with gardening.
Dr. Nakiyimba says they’ve tried all outreach measures to encourage the population to take precaution through vigorous sensitization campaigns, especially through the health workers who set up outreach centers where they educate the people about the disease and its symptoms.
However, challenges are that the symptoms are similar to other illnesses and sometimes the public is reluctant to seek proper medical attention from the centers, especially during an outbreak and this usually cripples their efforts of ensuring early detection and quick response.
The WHO African Regional Offices have been active in terms of surveillance and coordination with all stake holders as well as giving funds needed to facilitate all their focal persons at the various affected areas. Health workers are fully equipped with information, logistics and protective gears to enable them go about their work when the general public reports and cases as well as continuing with the sensitization campaigns as they move door to door at grass root village level.
According to Dr. Nakiyimba, despite the current Ebola outbreak in the country that seems to be taking all the resource, there was a program already in motion by the government to make people aware of yellow fever symptoms and signs and this is still ongoing as planned.
With these, the public is educated through simple means such as simple dramas in their native languages with an aim to educate them about the stages they need to take, including rapidly seeking medical attention if presenting signs and symptoms suggestive of yellow fever infection and to ensure a change in behavior around other people to avoid infecting them, too, as the health workers also monitor these contacts to rule out any infections among them.
However, according to Jalia Nakitto a resident of Nyendo Masaka, there has been some information about the disease in the market where she works at Nyendo town but she seems skeptical about the whole arrangement.
When asked why, she says,“These diseases are just manufactured by government with the help of those “whites” to make us sick and keep us weak as they devise means of making millions through manufacturing their useless vaccines.”
Dr. Nakiyimba notes that sadly, such beliefs which result from propaganda and fake news being disseminated on social media are some of the challenges the government and other development partners still face while educating the public about such deadly diseases.
According to Dr. Sarah Zalwango, the Deputy Director Public health and Environment, Kampala, the government chorological data keeps being updated and thus enables them to get ready for any cases that may arise.
“We have surveillance systems and structures in place so we are monitoring the data of the cases that are being reported. Some are reported erroneously in terms of wrong statistics of mistaken diagnosis but we clean them up. We have data that comes in weekly on Monday. This chorological data keeps us on high-alert so that in case of anything we just reach out to the facility and follow up on the cases,” she re-affirms.
Dr. Zalwango says that as they spread out information about the yellow fever disease to the public through media campaigns, they are always on standby to respond to any out breaks that may arise, stressing that this mechanism has proven effective when the country had an outbreak at the beginning of this year 2022.
“This exercise is a national campaign and we always coordinate with all regional centers in our constant surveillance, however, different local government leaderships have adopted their own mechanisms depending on the dynamics in their respective populations,” Dr Nakiyimba asserts.
These messages are designed for target populations. For instance, messages meant for urban populations like those of Kampala Metropolitan area are different from those of rural areas like Kasese and Masaka, she notes.
The time frame in all these regions for such campaigns also differs and is mostly dependant on the availability of resources. Often times district leaders have ended up depending on volunteers who keep working even without proper facilitation from the districts. “These ones are sometimes supported by partners like the Red cross and World Vision,” Dr. Baseka says.
“There is an on-going search for diseases and outbreaks of this nature and always on alert to pick up any cases because the health workers are not only educated and sensitized but also protected medically as they are prioritized when it comes to vaccination and other necessary preventive medications or treatment in cases of infections,” he says.
Faith Nyakaisiki is a Village Health Team member attached to the Uganda Red Cross Society currently volunteering as a peer health educator in Kasese district. Nyakaisiki has been carrying out out-reach activities at Kyanzuki Village, Nyakabingo Parish in Nyakabingo sub-county throughout this campaign.
She says, some days she rides a motorcycle with a loud speaker on which she announces the available services at the Nyakabingo health center II. “People always stop me with inquiries and I take that opportunity to educate them all about the yellow fever disease as well as other relevant issues at hand,” Nyakaisiki says.
She adds that she has been doing this for two years now and has noticed a big difference in how people positively take in such information. “They gladly make inquiries, their curiosity and inquisitiveness gives me so much joy. I am always happy to help them and sometimes follow up their cases to the health center,” Nakaisiki adds.
Asked about the challenges she meets, she says, the limited resources cripple her abilities in this field which she refers to as her calling. “I would do this for the rest of my life because am passionate about saving lives and humanitarian work but the financial constraints, the bad weather, dusty and impassable roads and some few individuals who are still superstitious make my work hard,” Nyakaisiki explains.
She wishes for consideration of peer health educators at the district’s budget allocations because health matters must always be considered a priority area.
According to Dr. Mubunga Julius, a health worker in charge of the border point between Uganda and DRC, the vaccination service is currently being managed by a private practitioner on authorization of the ministry of Health under the stewardship of the District Health Officer’s office. He says it is very suitable to store the vaccine at the facility because the vaccine has specific standards required for storage especially in terms of temperatures for it to stay potent.
“The vaccine is picked at the facility to the border point, like I said the distance matters. We have managed to attract quite a number of people to take it up compared to the past where we would go for days without a single person walking in for the vaccine yet this is a high risk area being a border point. We now receive 40-50 people monthly, depending on the inflow. We have held a vigorous sensitization exercise to educate people about the importance of the vaccine and it is perhaps starting to pay off,” Dr. Mubunga notes.
He reveals that the campaign is spearheaded by a well trained and equipped team of district health educators. “The message is being spread at the vaccination center and other health facilities but we have also gone beyond the Kasese borders to places like Fort Portal so that people in neighboring areas can also access this vaccine,” the health worker says.
Dr. Mubunga also notes that the other medium that has been helpful is the use of radio talk shows and spot adverts. However, the challenge for radio spot adverts is the limited resources in terms of financing yet they have found it as the most effective because it reaches far and wide.
However, he says people are still being rigid about vaccination as they still believe the myths and propaganda surrounding it. But being at a border point, most people travel out to DRC and have now understood the benefit of vaccination through these constant sensitization campaigns.
Dr. Mubunga is optimistic that with all the information spread through these vigorous mass sensitization campaigns, when the mass vaccination exercise kicks off before the end of this year 2022, the drive will be nearly 100% a success.
This story was first published in Metro FM 90.8