#J S=J S = 8`#J=87 8S · 2020. 10. 12. · prof essionals, t he public, implement ing part ners and all st akeholders. I n t his issue, we are ... Y es, we are excit ed t o hear f

PUBLIC HEALTH &

ENVIRONMENT

BULLETIN

THEME : KAMPALA 'S HEALTH AND ENVIRONMENT IN THE MIDST OF COVID-19

IN THIS ISSUE

DIRECTORATE OF PUBL IC HEALTH AND ENV IRONMENT

V O L . 1 . | I S S U E 1 | J U N E 2 0 2 0

EXECUTIVE DIRECTOR'SMESSAGE01

PUBLIC HEALTH &ENVIRONMENTDIRECTOR'S MESSAGE

02

MEDICAL SERVICES03

POLLUTION & AIRQUALITY

09

PUBLIC HEALTHEMERGENCIES12

HEALTH EVENTS13

SANITATION &ENVIRONMENT14

https://www.kcca.go.ug @kccaug @kccaug| 0800 99 00 00 | [email protected] | |

INFORMATION & COMMUNICATIONSTECHNOLOGY (ICT)18

ACKNOWLEDGEMENTS20

M E S S A G E S

PAGE | 01

Executive Director's Message

Eng. Andrew KitakaAg Executive DirectorKampala Capital City Authority

We are aware of the many hardships that this unusualand difficult time of COVID-19 and lockdowns haspresented to our environment, public health services,businesses and lifestyles. It is important now more thanever we all work together and support each other.

Together, we not only set out to deliver qualityservices to the people of Kampala with an accountableand admirable image, we also set out to build capacity toprepare, respond and manage all public health threats orrelated events, COVID-19 inclusive.

There are encouraging signs countrywide with lowcommunity transmission, no deaths and remarkablerecoveries. We can comfortably attribute these positiveindicators to our efforts towards preventive measuressuch as hand washing, social distancing, face mask use,risk communication, efficient leadership and decisionmaking. However, we must continue to prioritize ourenvironment and public health by continuing to heed allorders from the public health officials.

Kampala Capital City Authority and our partners willcontinue to serve the public and ensure that we continueto build a safe and healthy Kampala City. We are proudto associate with this bulletin as it serves as acomprehensive source of environment and public healthinformation that is influential for capacity building andauthoritative action by all relevant stakeholders.

Dear Reader, We welcome you to the inaugural volume and issue ofthe KCCA-Public Health and Environment Bulletin.

The main aim of this Bulletin is to document andcommunicate the works, achievements, and keychallenges with regards to Kampala’s Public Health,Environment and other related events. The end goal is todisseminate this information to the policy makers, healthprofessionals, the public, implementing partners and allstakeholders.

In this issue, we are excited to share with you a widevariety of articles focusing on Kampala’s health andenvironment in the midst of COVID-19 including: articleson medical services, environment, sanitation, pollutionand air quality, GIS and mapping. In a special way, wealso present articles from some of our manyimplementing partners, information on Public HealthEmergencies and upcoming Health days.

While thanking you, we invite you to share with us yourideas and feedback. Yes, we are excited to hear fromyou and ready to extend our Bulletin family. For furtherinformation with regards to anything in this bulletinplease contact any of us: [email protected],[email protected]

Enjoy your reading!!Thank you.

E D I T O R I A L T E A M

Daniel Ayen Okello

Najib Lukoya Bateganya

Director Public Health & Environment

Deputy Director Public Health &Environment

Sarah Zalwango

Manager Medical Services

Christopher Oundo

Supervisor Medical Services

Alex Ndyabakira

Epidemiologist

Elizabeth KatanaEpidemiologist

Editorial Team's Message

M E S S A G E S

PAGE | 02

Given these turbulent times of COVID-19 and inobservance of the upcoming World Blood Donor Day, we should take some time off and donate some blood.

Blood donation is essential because we need to maintain adequate supply in the blood banks as security for the many patients that will need transfusions.

We can visit the Uganda Blood Transfusion web page (https://www.ubts.go.ug/), to find the nearestplace to donate blood in your area.

Donate blood to save bleeding mothers, cancer patients, anemic children and accident victims.

#SAFEBLOOD

SAVESLIVES.

2020 will be remembered as a dynamic year in theworld of public health, environment andpreparedness for public health emergencies.COVID-19 has presented us with the challenge ofresponding and adjusting to a modern-day pandemicthat has had unique approaches such as institutionalquarantine, closing of borders andeventually a lockdown in Uganda.

Public Health & Environment Director'sMessage

Dr. Daniel Ayen Okello Ag . Director Public Health & Environment

dokelloa@kcca .go .ug

World Blood Donor Day

The team at Kampala Capital City Authority has investedsignificant efforts and resources in the COVID-19response, environment and public health in general. Theactivities have spanned from community riskcommunication, social mobilizations, trainings for staffand health workers, ensuring continuity of essentialservices in Kampala including operating a toll-free callcenter to respond to all medical emergencies during thelockdown, prioritizing transportation for mothers in labor,coordination of a public ambulance system, wastemanagement, upscale of water, sanitation and hygienecoverage, assisting vulnerable groups such as streetchildren, community surveillance and tracking of COVID-19 suspects, among others.

In this inaugural volume and issue of our quarterly publichealth and environment bulletin, we document andpresent to you key write ups from our efforts, challenges,and lessons learnt from supporting and sustainingKampala’s health and environment in the midst ofCOVID-19.

In this turbulent and difficult era of COVID-19, we hopethat we have been able to diligently serve, monitor, buildcapacity, communicate, promote public health andnurture a healthy, conducive and sustainable communityand environment in Kampala city. This bulletin is adocumentation and communication of our works,achievements, challenges and advancements to thepolicy makers, health professionals, the public,implementing partners and all relevant stakeholders.

Finally, I would like to thank you, the contributors, thereaders and editorial team, for your interest in thisbulletin and I encourage you to send us your invaluablefeedback and ideas.

Following confirmation of the first case of COVID-19on 21st March 2020, the president and MoH passeddirectives and guidelines to contain and limit its spread.Key directives in Uganda’s COVID-19 lockdown such assuspension of private and public transport have had aneffect on access to health facilities and health servicedelivery. It’s undeniable that all Ugandans have beenaffected, however, pregnant women, mothers in labor,children due for immunization and post-natal motherswere expected to experience greater challenges in theCOVID-19 lockdown. To ensure continuity of maternaland newborn health services, KCCA put measures to,ensure mothers, especially those in labor, and theunborn and the new born children that needed urgentmedical attention, were able to access health servicesand facilities.Interventions On March 25, 2020, a 24-hour call centerwas set up and disseminated widely to respond to allpublic concerns during the COVID-19 lockdown through atoll-free line 0800990000. Clients who called in werelinked to either ambulance services or community pick upservices with the advice of a clinician. Ambulances wereprioritized for emergencies such as mothers in labor whilecommunity vehicles were utilized for routine servicesincluding antenatal care services (ANC) and immunizatio-ns. Both the ambulances and community vehicles werestrategically deployed in different locations across all thefive Kampala divisions; like police, health facilities respo-nd to emergencies in a timely manner and all these wereoffered to the public free of charge. In addition, two vehicles were allocated per facility to transport staff to andfrom their homes to places of work to ensure there washuman resource to respond to the emergencies. Whereasother deparments such as OPD, eye clinic, dental,

A functional interfacility referral system was set up whereKisenyi and Kawaala HC IVs were allocated an ambula-nce due to the client load they handle, averagley 25 to 30deliveries per day. For close monitoring of the ambulanc-e drivers, a register was introduced at the two facilities totrack their movements. Other four ambulances were leftmobile to handle the emegercies from other KCCAfacilities (Komamboga HC III, Kisugu HC II and Kitebi HCIII). Besides these interevtions, the KCCA MCH depar-tment went a head to condcut dialogues with all the 5KCCA maternity centers and 4 PNFP hospitals(Lubaga Hospital, Mengo Hospital, Nsambya and IHK) tounderstand causes of emergecies, complications anddelays around maternal /perinatal death reviews.

ResultsAs of 7th May 2020, KCCA 24-hour call center hadresponded to 1,025 Emergencies and 2,075 communitypicks for clients who needed access to routine medicalservices such as cancer treatment, dialysis etc. 992 (96%)of the 1,025 emergencies transported were mater-nal andnew born health management ie labor, miscarria-ges, andimmunisation. In regard to the interfacility referrals, in themonth of April alone, a total of 265 referrals from the lowerunits for further management were made. 27 % of thereferrals were from Kitebi HC III, 26% from Kisenyi HC IV,21% from Kawaala HC IV, 15% from Komamboga HC IIIand 11% from Kisugu HC III. In a period of four months(Jan-April), Kampala registered a total of 25,689 healthunit deliveries with KCCA contri- buting 34% (8,666).The table below shows a trenddeliveries in Kampala Against KCCA facilities for Jan toApril 2020

M E D I C A L S E R V I C E S

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(continued on next page)

BackgroundFollowing the declaration of COVID-19 as a pandemic bythe World Health Organization in March 2020, theKampala Capital City Authority (KCCA) joined efforts withthe Ministry of Health (MoH) and stake holders to prepareand respond. It is evident worldwide that the response toCOVID-19 requires joint efforts beyond public healthjurisdiction, but rather multi sectoral approaches andcollaborations of stakeholders and governments.

*Correspondence: [email protected]

Directorate of Public Health and Environment, Kampala Capital CityAuthority, Kampala, Uganda MaNe Project, Directorate of Public Health and Environment, KampalaCapital City Authority

1

2

Authors : *Clara Kokunda , Sarah Zalwango , Douglas Akii-

Bua , Daniel A . Okello

1 1

2 1

Maternal Health Care Management AtKCCA Health Facilit ies during COVID-19Pandemic

reduced the human reources due to transport restrictions,maternal and child health (MCH) departments retained alltheir staff to continue with service delivery.

Lastly, a WhatsApp platform was created to assist innotifying emergency cases; identifying which health facilitywas ready to receive and manage the emergency and torequest for ambulance services in time. Theatres atKisenyi and Kawaala HC IVs were functionalized andboosted to reduce the bulk of emergencies on referralfacilities such as Kawempe Hospital and to improve out-comes of emergencies by reducing the time to intervene.


PAGE | 04


Figure 1:Trend of deliveries in Kampala against KCCA HF- Jan to Apr 2020

From the dialogue discussion held, two QI projects wereinitiated per facility; to reduce emergency through properantenatal care and early identification of emergenciesduring labour through correct use of partogragh to monitormothers during labor.

ConclusionWhile COVID-19 has affected Kampala’s medical servicesin several ways, it has also presented opportunities toexamine the effectiveness of our health systems andapproaches as a city. Health facilities will implementquality improvement projects aimed at early identificationof risky mothers either at ANC or at labor. The riskymothers will be linked to be assessed by specialist eitherin Kawaala and Kisenyi HC IVs. KCCA plans to scale upmanagement of maternal health emergencies at all healthfacility levels with inter-facility linkage systems in aphased manner with an aim to reduce patient flow at thehigher-level facilities.

Digital use of Public and Private Ambula-nce Systems to Increase Timely Accessto Care during COVID-19 Lockdown andBeyond

*Correspondence to: [email protected]; [email protected]

Background Since January 2020, COVID-19 has had several effectson the health systems of many countries and cities world-wide, Kampala inclusive. Some of the lockdown directivesincluding curfew and the banning of both private andpublic transport have had a significant impact on thehealth care system and service delivery. The lockdownresulted in limited access to Maternal and child healthservices, and care for clients with acute and chronicmedical illnesses. Consequently, some of the patientswho were unable to or delayed to access health careduring the lockdown either could have died or developedcomplications. These negative ramifications have high-lighted the need for reliable and efficient emergencymedical services thus re-emphasizing the extremeimportance of enhancing digital health technologies forfaster and better health care access and utilization.

The InnovationThe USAID-funded Kampala Slum Maternal and NewbornHealth (MaNe) project and KCCA are developing a digital

The benefitsThis innovation will improve emergency medical servicesin Kampala especially through facilitating timely access totransportation from community to health facilities, andtimely referrals between facilities. This service is alsoenvisaged to improve equitable access to health care.Unlike before and during COVID-19, using this simpli-fied application, KCCA is igniting a self-service healthcare system where any resident with a health emergencycan directly access a range of ambulances without burea-ucratic procedures. KCCA is aware of cost as a barrier tousing ambulances by many of the urban slum dwellersand is planning a public-private partnership to help sub-sidize the transport of those who can’t afford while publicambulances hosted on the system will be completely free.

In addition, Kampala’s medical services are dominated byprivate health facilities and very few of them own ambu-lances. Before and during COVID-19, some of the privatefacilities may not have been able to attend to some comp-licated cases since they cannot easily refer them whenneed arises due to lack of ownership or inaccessibility ofambulances. Access to ambulance transport options willtherefore give them the confidence and boost to offer careto all clients and use this ambulance system during refer-rals. Therefore, the small private clinics won’t be press-ured to invest in purchase of ambulances or any othervehicles to transport their clients during referrals becauseof the assurance that an ambulance will be a click or callaway from reach.

system to facilitate remote access, request, deploymentand tracking of public and private ambulance trans-portation for all medical emergencies including commu-nity evacuations to health facilities, and referrals betweenhealth facilities. Using the ambulance online/digital app-lication, all Kampala residents will know all the obtainabletransport options including what ambulance is available,the services it offers, cost estimates of using it based ondistances to be covered. All public, private not for profitand private ambulances in Kampala will be hosted on thisreal-time Kampala Digital Emergency Transport System. Itwill be linked to the emergency call and dispatch centreset up by KCCA through the MaNe project, to identify bestpositioned health facilities and nearest ambulances tohandle the medical conditions at hand.

ConclusionThe USAID support through the MaNe project, thisKampala digital emergency transport application system isseen as one of major technologically innovativeresponses to improve emergency medical services bypreparing and launching KCCA into digital based healthcare access to avoid future reoccurrences amidst

Kampala Slum Maternal and Newborn Health (MaNe) Project, Directorateof Public Health and Environment, Kampala Capital City Authority,Kampala, Uganda Directorate of Public Health and Environment, Kampala Capital CityAuthority, Kampala, Uganda

1

2

Authors : *Andrew Magunda , *Henry Kaula , Daniel A . Okello1,2 1,2 2


PAGE | 05

possible pandemics, enhance digital access to healthservices and reduce typical delays in seeking care formedical and non-medical emergencies in Kampala.

BackgroundUganda confirmed the first case of COVID-19 on March21, 2020. In response to COVID-19, amongst otherinterventions, a coordination mechanism through establi-shment of a toll-free call center system was set up atKCCA to facilitate rapid case identification, tracing ofcontacts of confirmed cases and responding to otherhealth emergencies including road traffic accidents, acuteillnesses, women in labor, among others. This came inhandy as the lockdown resulted in restricted movement ofpublic and private vehicles and as such authorized publicmeans of transport including ambulances and communitypickup vehicles needed an efficient coordination mecha-nism. The KCCA call center was set up at City Hall onMarch 25, 2020 utilizing the available resources includingthree desk phones and computers with nine dispatchersworking in 8-hour shifts. We aimed to ensure the continu-ity of essential medical services and to build the public’strust in public health authorities during the COVID-19pandemic.

*Correspondence to: [email protected]; [email protected]

Coordination of Toll-free Emergency CallCenter and Ambulance System during theCOVID-19 Lockdown in Kampala

MethodsTwo toll-free numbers were made available and were0800990000 and 0204660998 and public awareness wasmade through constant media coverage, short videosabout the toll-free line and the 24-hour operationalizationof the services. The call center was manned by team oftrained personnel that comprised of volunteer socialworkers as call attendants, epidemiologists, clinicians andor nurses. A training model was developed to train the callcenter team with working standard operating proceduresand referral guidelines to be used during call processing.Software was designed where patient data was captured,triage and sorting of the calls was done to prioritize theneed for urgent medical evacuation. A directory of thesurveillance teams on ground and the stationed vehiclesand ambulances were made available to the call centerstaff.

ResultsAs of 7th May 2020, KCCA team, the team hadresponded to a cumulative number of 7,681 calls, 882(11.5%) COVID-19 related and 6799 (88.5%) non-relatedcalls including 14.6% (992/6,799) as Maternal andnewborn issues, 71.0% (4,830/6,799) were requests forambulances and community pick up vehicles, 3.7%(249/6,799) calls related to violation of the presidentialdirectives, 5.9% (398/6,799) called in asking for food aidamong other calls. 30% (1,450/4,830) of the emergencycalls resulted in dispatch of an ambulance service.

A deployment plan was established in order to coverareas within a radius of 40 Kilometers from the Kampalacity center and this included Mukono, Wakiso and Mpigi.Responses were categorized according as COVID-19 andnon COVID-19 related emergencies. The ambulanceswere reserved for high risk emergencies such asobstetrics, pediatric, accidents; while community pick upvehicles were reserved for chronic medical conditionssuch as those requiring dialysis, chemotherapy, antenatalcare (ANC) or patient reviews. HIV/AIDS clients werecatered for by coordinating delivery of drug refills to theirhomes with provision their ART numbers to the InfectiousDiseases Institute (IDI) team. The call attendantsresponded to calls using the guidelines set up, the callerwould be triaged and according to the condition orcompliant, one of the following steps was taken; 1)Medical advice was given through the medical control orsupervising clinician, 2) The ground surveillance teamwas alerted and linked to the location in case of asuspected COVID-19 patient, 3) An available ambulanceor community pick up vehicle was dispatched to effecttransport to the nearest health facility or interfacilitytransfer of clients, 4) All the calls were documented anddaily summaries generated.

ConclusionThe call center has contributed a great deal in keepingintact the health care seeking and coordination of medicalemergencies in addition to COVID-19 surveillance andresponse. This call center can be a benchmark forestablishment of other call centers countrywide especiallyat the regional referral Hospitals. The call center with allits successes is also registered a number of challengesincluding lack of a switch board in order to be able toreceive multiple calls, lack of a tracking system to locatethe caller and few ambulances are available to respond tothe large volume of emergency calls.

AcknowledgementsSt John’s Ambulance Service, Uganda Police AmbulanceService, Nissan Motor Care Uganda and Kiira MunicipalCouncil Ambulance

Authors : *Douglas Akii Bua , *Doreen O . Alaleit , Elizabeth

Katana , Sarah Zalwango , Daniel A . Okello

1,2 2

2,3 2 2

Kampala Slum Maternal and Newborn Health (MaNe) Project, Directorateof Public Health and Environment, Kampala Capital CityAuthority, Kampala, Uganda Directorate of Public Health and Environment, Kampala Capital CityAuthority, Kampala, Uganda Uganda Public Health Fellowship Program, Ministry of Health,Kampala, Uganda

1

2

3

BackgroundSince January 2020, the country has registered anupward trend in the maternal deaths with Kampalacontributing about 30% of the cases as of March 2020.The maternal death trends in Kampala from the DHIS2indicates a rise in numbers over this period. Some ofthese deaths could be due to delays at the different levelsof care.KCCA operates the Public Health facilities of Kitebi HC III,Kisugu HC III, Komamboga HC III, and the two HealthCentre IVs of Kisenyi and Kawaala herein referred toas the “2Ks”. These perform deliveries in addition to othermaternal, neonatal, child and adolescent health services.The cases that cannot be managed at the 2Ks are oftenreferred to Kawempe National Referral Hospital. Amidstthis COVID-19 pandemic, Kampala Capital CityAuthority(KCCA) upscaled the capacity of these facili-ties to perform caesarean sections through boostinghuman resource and logistical support. The performanceof cesarean section in these facilities will help to reducethe load and waiting time for mothers who would ideallybe referred to Kawempe National Referral Hospital andlikely improve both the maternal and neonatal outcomes.We sought to determine the extent to which these twofacilities are performing cesarean sections, representingreferrals to the National referral Hospitals averted. Wecompared the output from each of the 2Ks in terms of thenumber of cesarean sections performed and owing to thefact that these two facilities only perform cesareansections only during day, the cases that require cesareansections during the night shift are referred.


PAGE | 06


*Correspondenceto: [email protected]

The 2ks: Cesarean Sections in Kawaalaand Kisenyi HCIVs during COVID-19Pandemic

MethodsWe abstracted data from the theatre registers for the 2Ksfor the months of February- to April 2020 with indicationsfor both Elective and Emergency Cesarean Sections. The2Ks were purposively selected due to their ability to doCesarean Sections, and the high volumes of cases thatare handled. We reviewed all the cesarean section casesirrespective of whether they were referrals in or decisionsto perform the cesarean section made at the facility. Thefacilities were enhanced with catalytic supplies andarrangement to have anaesthetic officers available toprovide safe anesthesia.

We did not explore other parameters such as thetechnique used or the type of anaesthesia given for theprocedures. Data was summarized and analyzed usingMicrosoft Excel.

ResultsThere was general increase in the number of thecesarean section cases done at both Health Centers IVswith Kisenyi HCIV having more cesareans done. Theemergency cases by far superseded the elective casesespecially during the Month of April 2020 for bothfacilities. In the period under review, these two facilitiesaverted 178 referrals for Cesarean section at KawempeNational Referral Hospital and 95 cases in the month ofApril alone. There was an increasing trend over theMonths for Kisenyi HCIV as compared with Kawaala witha slight trough in the Month of February 2020 as noted inthe figures 1 and 2 below

Figure 1:Cesarean Sections at Kawaala HCIV for the months of Feb, March and April 2020

Figure 2:Cesarean Sections at Kisenyi HCIV for the months of Feb, March and April 2020

Kampala Slum Maternal and Newborn Health (MaNe) Project, Directorateof Public Health and Environment, Kampala Capital City Authority,Kampala,Uganda Directorate of Public Health and Environment, Kampala Capital CityAuthority, Kampala, Uganda

1

2

Authors : *Douglas Akii Bua , Doreen O . Alaleit , Sarah

Zalwango , Daniel A . Okello

1,2 2

2 2

ConclusionFunctionalizing the operation theatres at the 2Ks has to agreat extent reduced referral to Kawempe NationalReferral Hospital. This shows the capability of thesefacilities to handle maternal and newborn emergencieswith the output depicted.The 2Ks are delivering these outputs even when thetheatres are functional only during the day shift and not atnight. Operationalizing of the theatre for 24-hourcoverage will further reduce the referrals to KawempeNational Referral Hospital since most of these cases canbe handled at the level of Health center IV. The outputwas even higher at the peak of the COVID-19 outbreakamidst all the existing challenges including humanresources, equipment and some consumables to enhanceoperations.

BackgroundTuberculosis (TB) is caused by a bacteria Mycobacteriumtuberculosis and often affects the lungs. Despite being apreventable and curable disease, 1.5 million people diefrom TB worldwide each year – making it the world’s topinfectious killer. According to the World healthOrganization, Uganda is among the high burden TB/HIVcountries in the world. About 1 in every 5 TB cases inUganda are in Kampala City. Kampala had over 8000active TB patients and a treatment success rate of 92%by the end of Jan-March 2020 quarter. USAID Defeat TBproject has since September 2017 been supportingKampala Capital City Authority (KCCA) to increase TBcase notification, case detection, and treatment outcomesthrough health system strengthening. The world is battling with the COVID-19 pandemic sinceDecember 2019 with Uganda reporting a first case inMarch 2020. Several measures were instituted acrossthe country in response to the pandemic. Among suchmeasures was the national lockdown coupled with thesuspension of public transport and restrictions onmotorcycle use which could affect TB patients’ access tomedicines and adherence to TB treatment. To ensurecontinued assess to TB medicines and other services,Defeat TB with KCCA initiated specific interventions withinKampala.

InterventionDefeat TB project together with KCCA’s directorate ofpublic health disseminated Ministry of Health COVID-19guidelines to all TB treatment centres in Kampala. Usingthe guidelines, health workers were oriented on how toeffectively integrate COVID 19 control measures with TBcare activities at the facility level. To ensure continuity of TB services during the lockdown,clients flow and health worker’s role allocation at healthfacilities was revised. Health workers focused onperforming roles essential for effective tracking of TBpatients drug refills. Telephone airtime was provided tohealth workers for communicating with patients andbetween health facilities to ease drug refills. Healthworkers listed patients due for TB drug refills andreminded them of the refills. Those unable to pick drugsfrom health facilities due to travel difficulties shared theirlocation details. TB drugs were delivered to patients’homes or neighborhood using Motorcycles and or DefeatTB project cars, for those within the radius of 30kilometres. Defeat TB supported health workers to reviewTB drug stock prior to each clinic day. In case of lowstock, TB drugs were redistributed between facilities toensure availability at all health facilities. For continuity of TB diagnosis services, Defeat TB projectcontracted 3 hub riders to reinforce movement of samplefrom the community and between health facilities. Inaddition, distribution of TB diagnosis logistics like, sputummugs were done to TB diagnostic units that were runninglow on them.


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Guaranteeing Treatment for TB Patientsin Kampala during the COVID-19Pandemic in Uganda

Key ResultsAccess to TB medicines by TB patients remained above80% during the first month of the lockdown for patientsreceiving TB care at KCCA health facilities. At 10 random-ly selected, high volume TB facilities, the weekly propor-tion of patients expected to receive TB drug that receivedthem remained high at a weekly average of 88.75%during April 2020 (figure 1).

USAID, Defeat TB Project, Kampala, Uganda Directorate of Public Health and Environment, Kampala Capital CityAuthority, Kampala, Uganda

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2

Authors : *Herbert Kisamba , Sylvia M . Nakibuuka ,

Christopher Oundo , Kenneth Mutesasira , Abel Nkolo ,

Daniel A . Okello

1 1

2 1 1

2

Figure 1


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Figure 1:Trend in expected TB patients receiving Drug refillsat 10 high volume facilities during April 2020

Similarly, monthly retention of TB patients on treatmentremained comparably high during the first month (April2020) of national lockdown as had been during a fewmonths before the lock down (figure 2).

Figure 2:Trend in expected TB patients receiving Drug refillsat Kitebi HC III before and during the lockdown

In the process, learning has emerged about; health careworker role allocation, patient locator approaches in thecommunity and TB patient support systems in the comm-unity. All this has been useful for provision of TB careservices.

ConclusionThe coordinated efforts of KCCA staff and Defeat TBproject coupled with cooperation of TB patients hasensured TB patient retention on treatment during theCOVID 19 pandemic in Kampala. The lessons learned will continue to guide TB patient retention in Kampala and other neighboring districts.

Public health emergencies (PHEs) are usuallyunpredictable and as such, preparing for them requiresmaintenance of stockpiles of medical supplies required forthe response.


Electronic Management of MedicalSupplies - a Case for Active Stockpiling for Preparedness

This allows immediate deployment of these supplies, alsocalled Medical Counter Measures (MCMs), as soon as thePHEs occur.The Covid-19 pandemic has clearlyhighlighted the importance of MCMs.Stockpiling is one of the strategies the Ministry of Health(MoH) has established for management of MCMs. Thisrequires health facilities, district stores and centralwarehouses to have parallel inventory systems thatseparate MCMs from supplies used for routine services toensure the MCMs are reserved for PHEs. MoH also has aweb-based electronic Emergency Logistics ManagementInformation System (eELMIS) which tracks the locationand stock levels of different MCMs throughout the supplychain. COVID-19 is a novel disease and definitely not onthe MoH list of priority diseases for PHE preparedness.However, most of the supplies required for its response,such as Personal Protective Equipment (PPE) and dis-infectants, are already among the MCMs required formany other highly infectious diseases on the list, such asthe Viral Hemorrhagic Fevers (VHFs), stockpiling well forthese probably would have prepared us better for theCOVID-19 response. Without stockpiles, the first possibleoption is using supplies for the routine services. Thisapproach is limited because many supplies are either notroutinely stocked at the health facilities or stocked in smallquantities owing to much lower need for routine services.In addition, such diversion can deplete supplies rapidly,thereby creating a shortage for the routine services.Stockpiling overcomes this by ensuring an immediateresponse to a PHE and can be mounted without the needto encroach on supplies for routine services. The secondpossible option is to order supplies through the NationalTask Force (NTF), using the eELMIS. This is a systemwhich was set up with ensuring swift ordering and deliveryof supplies as one of its objectives. During the covid-19pandemic, National Medical Stores (NMS) were unable tosupply all the items required in sufficient quantities due tothe ongoing global logistical shortages and challenges. Tobridge the gap, our third possible option is to undertakeprivate procurement. However, commodities are still inshort supply and highly overpriced on the market, partlydue to the breakdown in supply chains as lockdowns wereimplemented, and panic buying by the public. Once theCOVID-19 pandemic is contained, it would be wise touse any leftover commodities to establish stockpiles ofMCMs. We can utilize the eELMIS and MoH supply chainsystem to source MCMs that will be used to establishstockpiling for PHEs to ensure better preparedness. Inaddition, we can upscale trainings for supply chain mana-gement of MCMs to health facilities to enable them esta-blish and manage stockpiles in anticipation of PHEs.

Directorate of Public Health and Environment, Kampala Capital CityAuthority, Kampala, Uganda Uganda Public Health Fellowship Program, Ministry of Health, Kampala,Uganda

1

2

Authors : *Julius Mubiru , Elizabeth Katana , Daniel A .

Okello

1 1,2

1

In 2019, KCCA joined the Bloomberg’s Partnership forHealthy Cities. This Partnership is supported byBloomberg Philanthropies in partnership with the WorldHealth Organization and Vital Strategies, a prestigiousglobal network of 70 cities including Kampala whosemayors have committed to saving lives by preventingNon-Communicable diseases (NCDs) and injuriesincluding cancer, diabetes, heart diseases and chroniclung disease through proven interventions.

P O L L U T I O N & A I R Q U A L I T Y

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*Correspondence: [email protected] [email protected]

KCCA and Bloomberg’s Partnership forHealthy Cities Strive to Create a“Smoke-free” Kampala

assist Kampala to make public places smoke free,healthier and helping the citizens to give up the deadlyhabit.For more information visit:partnershipforhealthycities.bloomberg.org

According to the World Health Organization, Tobacco killsmore than 8 million people each year. More than 7 millionof those deaths are the result of direct tobacco use whilearound 1.2 million are the result of non-smokers beingexposed to second-hand smoke. It is estimated that over80% of the world's 1.3 billion tobacco users live in low-and middle-income countries. In commemoration of thisyear’s World No Tobacco Day, please continuouslyencourage a smoker to quit. Studies show that whensmokers become aware of the dangers of tobacco, mostwant to quit. WHO urges influencers in pop culture, onsocial media, in the home, or in the classroom who reachand connect with youth to expose the tobacco industries’manipulative tactics to create a new generation of tobaccousers. We need to empower youth to stand up to BigTobacco by dispelling its lies and refusing to use itsproducts.


The Effect of COVID-19 Lockdown on AirQuality in Kampala city, Uganda.

BackgroundExposure to ambient air pollution increases morbidity andmortality, and is a leading contributor to the burden ofmany global diseases. In 2016, World Health Organization(WHO) estimated that air pollution accounted for 4.2million deaths globally and 36,000 deaths locally. Airpollution disproportionately affects cities in the developingworld, where pollution levels usually exceed WHOguideline limits. Although many substances are known topotentially contaminate air, the WHO has

Authors : *Elizabeth Katana , *Alex Ndyabakira , Angella

Nshimye , Andrew Kitaka , Daniel A . Okello

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Directorate of Public Health and Environment, Kampala Capital CityAuthority, Kampala, Uganda Uganda Public Health Fellowship Program, Ministry of Health, Kampala,Uganda Executive director’s office, Kampala Capital City Authority, Kampala,Uganda

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Authors . Alex Ndyabakira * , Elizabeth Katana , Sadam Yiga ,

Andrew Kitaka , Daniel A . Okello

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Uganda Public Health Fellowship Program, Ministry of Health, KampalaUganda Directorate of Public Health and Environment, Kampala Capital CityAuthority, Kampala, Uganda. Executive director’s office, Strategy management and businessdevelopment, Kampala Capital City Authority Executive director’s office, Kampala Capital City Authority, Kampala,Uganda

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World No Tobacco Day

According to the Tobacco Atlas, more than 10,637Ugandans are killed by tobacco-caused disease everyyear much as smoking is prohibited in Kampala’s publicplaces. In its first phase of the partnership, KCCA isfocusing on creating a smoke-free city with a target toreduce the prevalence of smoking in public places by 95%by December 2020. We are proud of this partnership as ithas provided technical assistance to this cause, designedappropriate interventions, communication and publicrelations support, networking and capacity building to

In this Partnership, each of the 70 member cities includingKampala selected one of the 14 interventions to preventNCDs and injuries: create a smoke-free city, ban tobaccoadvertising, raise tobacco taxes or fees, tax sugary drinks,set nutrition standards for foods served and sold in publicinstitutions, regulate food and drink marketing, createhealthier environments, reduce speeding, increasemotorcycle helmet use, reduce drink driving, increaseseat-belt use, promote active mobility, prevent opioid-associated overdose deaths, public health data andmonitoring systems.

Majority of the world’s population is living in urban settingsand 68% of the world is expected to live in cities by 2050.NCDs and injuries kill almost 46 million people globallyeach year. They are responsible for 80% of global deaths.Through this partnership, cities are uniquely positioned totransform the fight against NCDs and injuries byimplementing policies to significantly reduce exposure torisk factors. Cities and their leaders play a critical role indeveloping, implementing and enforcing policies to createhealth environment for healthier populations.


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ResultsUsing the data from the KCCA headquarters monitoringstation, the mean (± standard deviation (SD)) ambienttemperature over February-May period was 25.6 ± 0.16 °C(maximum 29.4 °C, minimum 21.8 °C). Mean humidity was71.6% ± 0.61 (maximum 82.9%, minimum 45.0%).Archived temperature and humidity data from the other 24monitors show a similar average temperature and humidity.The concentrations of PM2.5 show a drastic declinebeginning immediately at lockdown (Fig. 1). The 24-hourmean concentration of PM2.5 during the pre-lockdownperiod (February-March 20th) and during lockdown (Apr-May 8th) period is 51.8 ± 2.9 μg/m3

Figure 1:A graph showing ambient air concentration of PM2.5 against time.

ConclusionLockdown due to COVID-19 pandemic resulted inimmediate significant reduction in ambient air pollution,and improved air quality in Kampala city. The sustainedlow air pollution levels throughout the observation periodconfirm adherence to lockdown restrictions. Thisdemonstrates the significant contribution that automobilesand industries make to the air quality in Kampala city.Emissions controls for automobiles and industries can goa long way to reducing air pollution. Strategies that canreduce the number of automobiles and plants/industries inKampala city can greatly improve air quality.

Air Pollution Monitoring in Kampala city


Executive director’s office, Strategy management and businessdevelopment, Kampala Capital City Authority Uganda Public Health Fellowship Program, Ministry of Health, KampalaUganda Directorate of Public Health and Environment, Kampala Capital CityAuthority, Kampala, Uganda Executive director’s office, Kampala Capital City Authority, Kampala,Uganda

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Authors : *Sadam Yiga , Alex Ndyabakira , Najib L . Bateganya

,Daniel A . Okello , Andrew Kitaka

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identified carbon monoxide (CO), particulate matter (PM),ozone (O ), nitrogen dioxide (NO ), and sulfur dioxide (SO )as the pollutants with greatest public health importance.

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WHO relies on the air quality index (AQI) to assess thestatus of ambient air in cities. The ambient air concentrations of PM, CO, O , NO , and SO are weighted toconstruct the AQI. Typically, 50 is the AQI cut off for airconsidered healthy for all people, and values exceeding100 are considered unhealthy. PM of diameter <2.5 μm(PM2.5) is considered more hazardous to health thanlarger PM due to its potential to cross from the lungs intothe blood stream. During the COVID-19 pandemic, Uganda institutedmultiple measures to reduce the risk of transmission ofdisease. These included a ‘lockdown,’ starting on 18March 2020 and modified over time, that drasticallyreduced the number of automobiles and plants/industriesoperating in the city. We used this unique opportunity toassess the air quality in Kampala city and the impact ofthe lockdown.

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MethodsWe assessed AQI, including PM2.5 and NO at 25different sites of different land use areas in Kampala from1 February to 9 May, 2020. Air pollutant concentrationswere measured over 24-hour periods using 25 air qualitymonitors of clarity, Node-s (Cellular) model, stationed insuch a way to cover different land use patterns in the city.The monitors can assess PM2.5 concentrations in therange of 0-1000 μg /m , NO in the range of 0-3000 partsper billion (ppb), and have real-time temperature andhumidity gauges in the range of -200C to 70 0C and 0-100%, respectively. The operations of the monitors can bevisualized on a computer via the internet. Data weredirectly downloaded from the monitors through a webapplication using a laptop computer. For this analysis, weused data from the monitoring station at Kampala CapitalCity Authority (KCCA) headquarters. Data analysis wasconducted using STATA 13.

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and 28.1 ± 1.6 μg/m respectively, representing a 41%drop in PM2 levels during the lockdown. However, the 24-hour mean concentration of PM2.5 during lockdown, 28.1± 1.6 μg/m remains above the WHO cutoff of 25 μg/m .The mean concentration of NO reduces by 85% duringlockdown. Comparing pre-lockdown and lockdown periodthere was a 34% improvement in air quality in Kampalacity. The mean air quality index during the lockdownperiod was 117.6, which exceeds 100, the WHO cutoff forsensitive people. Comparing lockdown period (Apr-May2020) with the same period of Apr-May 2019, shows thatthe drop in pollution levels is unique to lock down period.

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Kampala City is a fast growing City with a residentpopulation of 1.5 million and day population estimated tobe 3 million people. This has affected heavily the City’sservices through urban planning, pressures on roads byheavy traffic jams, poor waste management, industries inresidential areas among others. These factors serve asdrivers for air pollution in the City.

With support from European Union, KCCA developed amonitoring network to collect data on air pollution andidentify sources of air pollution so as to developinterventions to reduce the emissions for public health andenvironment protection. Five air quality monitoring siteswere selected from each of the five divisions ofKampala, making a total of 25 air quality monitoringstations. The sites were selected based on land usepattern, level of traffic, access, security and populationdensity in the area (Figure 2).

Figure 2:Distribution of continuous air quality monitoring stations in Kampala Capital City Authority

Monitoring air quality and implementing interventionsto reduce pollutant sources are key to achieving clean airfor Kampala. This will be beneficial to public health but willalso improve the City’s competitiveness to attract tourismand investment opportunities that contribute to improvedlocal economic development.

References WHO, 2016 Ambient air pollution: a globalassessment of exposure and burden of disease WHO Global health observatory data

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Estimates by WHO show that 91% of global populationlives in areas with air quality that exceeds the guidelineslimits . In addition, 4. 3 and 3.8 million annual deaths areestimated to be due to outdoor and indoor air pollutionrespectively . Uganda is not an exception to healthimpacts caused by poor air quality. In 2016, WHOestimated that Uganda had 13,416 and 23,364 ambientand indoor air pollution related deaths . The deathswere as a result of diseases caused or exacerbated byexposure to air pollution.

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Clean air is essential for good health, however due todrivers burning fossil fuels in vehicles, industry energyusage, dusty roads, open waste burning among othersour air gets polluted with external substances like dust,gases, liquids among others. Air pollution can be bothoutdoors (outside buildings) and indoor in buildings wherewe spend time home, offices, hospitals, classroomsamong others. To help us understand the risk of airpollution, World Health Organization (WHO) throughevaluation of various scientific evidence identifiedkey pollutants with significant impact on human health.These include Particulate matter (PM) with sizes less than2.5 and 10 microns; nitrogen dioxide (NO ), ozone (O )and Sulphur dioxide (SO ) from combustion of fossil fuelsin vehicles, industries; dust and open burning of waste.

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A mix of measures by various stakeholders includinggovernment, the public and development partners will berequired to ensure clean air for Kampala City. KampalaCapital City Authority (KCCA) in collaboration withMakerere University and United States governmentEmbassy, have been collecting and analyzing air pollutiondata using passive and continuous monitors. The resultsshow high levels of particulate matter 2.5, 10 and NOpollution both exceeding WHO guidelines limits. Thesources of particulate matter have been identified as dust,vehicle emissions and open waste burning. Indoor airpollution is mostly due to use of biomass for cooking.Nitrogen dioxide emissions are mainly from vehicles, andsome stationary sources including industries around theCity. Areas with high traffic in Kampala have high levelsof NO due to vehicle emissions (Figure 1).

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Figure 1:Baseline NO levels in selected sites in Kampala city, 2018

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Public Health Emergencies

Aside COVID-19 Pandemic, other Public HealthEmergencies have occurred from January to May 2020.

UgandaFebruary 2020, 8 laboratory confirmed cases of yellowfever in Bullisa (3), Maracha (1) and Moyo (4); including 4deaths (Case Fatality Rate of 50%)

April/May 2020, Ebola Virus Disease in TheDemocratic Republic of CongoMay 2020, Measles in BurundiMay/April/February 2020, Middle East RespiratoryCoronavirus (MERS-CoV) in The Kingdom of Saudi

April 2020, Measles in MexicoApril/March 2020, Dengue fever in FranceApril 2020, Yellow fever in Ethiopia, Republic of SouthSudanMarch 2020, Middle East Respiratory Coronavirus(MERS-CoV) in QatarMarch 2020, Measles in The Central African RepublicFebruary 2020, Dengue fever in ChileJanuary 2020, Middle East Respiratory Coronavirus(MERS-CoV) in The United Arab Emirates

Elsewhere

Arabia

COVID-19 Community Surveillance:Experiences from an Urban Setting inKampala City


COVID-19 was declared a global pandemic on March 11,2020. Uganda confirmed its first case on March 21, 2020.Ministry of Health (MOH) instituted a number of strategiesto curb its spread. These included active search for all atrisk people such as international travelers and contacts forscreening and testing, banning of cross border movementof people, and restrictions on mass gatherings. In theKampala urban division of Makindye, active COVID-19community surveillance was initiated on March 23, 2020.

Coordination meetings were hosted routinely andremotely, most of the time via internet on a WhatsAppplatform dubbed “Makindye COVID-19 response team”.The surveillance activities were part of the divisionCOVID-19 response that was coordinated by the divisiontask force.

The task force was broad based comprising fifteenmembers of which six were surveillance officers (amongthem nurses, laboratory & data personnel), two werehealth inspectors/educators, two Data officers, two socialworkers, two clinicians (physician and clinical officer) andone laboratory officer. Response phone numbers for thedivision medical officers and Kampala Capital CityAuthority (KCCA) emergency response center toll-free/hotline numbers were disseminated widely to the commu-nity through mass media and on KCCA website/ socialmedia platforms, to enhance response to calls and alertson COVID-19 suspects and high-risk travelers. Incomingcommunity alerts were continuously shared in the divisionsurveillance WhatsApp group and dispatched to the teamsto initiate response. In addition, MOH shared a list of high-risk travelers and contacts of confirmed cases for followup. The teams were reconstituted with members from theUPDF to boost the exercise. In the community, the villagehealth team member (VHT) introduced the team to thehousehold head before surveillance activities could pro-ceed. A daily report was com-piled and submitted to theKCCA central command center.By May 7, 2020 we had responded to 205 communityalerts, tracked 485 high risk travelers and 14 contacts ofconfirmed cases. We collected 117 samples from comm-unity alerts, 232 from high risk travelers and 14 fromcontacts of confirmed cases.

Figure 2:Laboratory personnel picking samples in one ofthe urban centers as part of the surveillance activities.

The key challenges faced by the teams included incorrectphone numbers that were given by the Ministry of Healthfor some of the high-risk travelers and contacts.

Authors : *Louis Nyende , Yahaya Kayemba , Alex

Ndyabakira , Daniel A . Okello

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When the team called or sought to verify the numbergiven, the names were different. Some of the contactsswitched off their phones and this made tracking difficult.Other contacts out rightly refused sample collection.In the future, for similar epidemics, we should considerupscale of online or remote platforms for adequateplanning and trainings for community surveillance teamsand enhanced communication strategies that can ensureand promote community acceptability.

Hepatitis Day Message

Hepatitis B is a potentially life-threatening liver infectioncaused by the hepatitis B virus (HBV). It is a major globalhealth problem, estimated to have resulted in 887,000deaths in 2015. It can cause chronic infection and putspeople at high risk of death from cirrhosis and liver cancer.A safe and effective vaccine that offers a 98-100% protec-tion against hepatitis B and is readily available country-wide. Preventing hepatitis B infection prevents the develop-ment of complications including the develop-ment of chro-nic disease and liver cancer.

World Malaria Day Message

According to the World Health Organization, in 2018, 6countries accounted for more than half of all malariacases worldwide: Nigeria (25%), the Democratic Republicof Congo (12%), Uganda (5%), and Cote d’Ivoire,Mozambique and Niger (4% each). In commemoration ofthe World Malaria day on 25 April, 2020, the need forcontinued investment and sustained political commitmentfor malaria prevention and control was highlighted. Duringthis year’s Malaria day celebrations, WHO underlined thecritical importance of sustaining efforts to prevent, detectand treat malaria, alongside all other endemic illnessessuch as TB, HIV/AIDS, Typhoid, Hepatitis B, etc. whileaggressively responding the COVID-19 pandemic. TheMinistry of Health’s National Malaria Control Program(NMCP) has tackled urban malaria control in Kampala cityby upscaling interventions that included filling puddles,introducing larvivorous fish in water bodies such asponds, streams etc., improving drainage, vector controlthrough spraying and use of appropriate insecticidetreated nets and advocating for malaria control funding.

World Air Quality Awareness Week(May 4-8, 2020) Message

This celebration encourages countries and most especia-lly cities and urban centers such as Kampala to careabout pollution and air quality. The goal of this year’scelebration was to encourage cities to check their AirQuality Index (AQI) daily. Kampala Capital City Authorityin partnership with Makerere University and the USEmbassy are closely monitoring Kampala’s air quality inreal time. This is to ensure that we have reliable andaccessible data that can be used as a vital step to improv-ing Kampala’s air quality and helping city dwellers takeactions to protect their health especially in the mostpolluted areas.


Achievements The WASH task force ensured that all KCCA facilities(the KCCA headquarters, 8 KCCA Health Centres, 5urban division administrative offices, 2 stores, 1 mech-anical yard, 1 guest house, employment Bureau) wereinstalled with hand washing stations and supplied withwater and liquid soap. For each facility a staff was nomi-nated to ensure the hand washing stations are replenish-ed with water and soap at regular intervals and all peopleaccessing the premises were required to wash hands.Standard operating procedures (SOPs) were put in placeto guide hand washing. In addition, 343 locations acrossthe city were identified where hand washing stations weresupposed to be installed. These were selected based onhigh concentration of transient populations. These loca-tions included entrances to markets, passenger pick uppoints, busy bus stops and taxi stages. All premisesaccessible to the public were required to install hand-washing stations at the owner’s cost. These were routine-ly inspected by KCCA to ensure adherence to the hand-washing SOPs. Our actions are attracting both new andold partners joining in the drive to avail hand washingfacilities. We are standardising designs for both fixed andmobile hand washing stations as new and innovativedesigns come up.By mid-May, out of the 343 points identified, only 75(22%) have been successfully installed with Handwashing stations of capacities ranging from 150- 500litres. The distribution of public hand washing stations inthe city is shown in the map below. It can be observedthat there are many hand washing stations, evenly distri-buted across the city compared to the pre-COVID-19pandemic era. The map does not include private install-ations. This has resulted into improved hand washingpractices among the people in the city.

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Upscaling Coverage of HandwashingFacilities in Response to the COVID-19Pandemic in Kampala

Background Proper hand washing is known to provide primaryprevention against a wide range of diseases. There isindisputable evidence that regular hand washing withsoap and water or alcohol-based sanitizers prevents thespread of COVID-19. Improved hygiene through handwashing with soap and water can single-handedly reducethe risk of diarrhea by (42-48)% (Mbakaya et al., 2017).Following the confirmation of the first case of COVID-19 inUganda on 21st March 2020, there have been enhancedcampaigns and intervention strategies to improve handwashing practices among dwellers of Kampala city. Thisarticle presents the approaches we designed and implem-ented to scale up access to hand washing facilities inhighly congested urban environments within KampalaCity. In addition, the authors provide some critical insightson the sustainability of scaling up the hand washingfacilities and campaigns during and the beyond COVID 19pandemic

Approaches for Scaling Up the citywide Handwashing Campaign First, the Water, Sanitation and Hygiene (WASH)subcommittee of the Kampala city COVID-19 Task Forcewas established coordinated by the Directorate of Publichealth and Environment. The task force comprised ofenvironmental health officers, epidemiologists, medicalofficers, social workers, health inspectors, communicationspecialists, together with multiple partners. The teammade hand washing a priority intervention having beenidentified as a key COVID-19 prevention measureglobally. The key intervention strategies included: Identification of vulnerable communities who included thetransient public and communities in the informal settle-ments; mobilization of internal and external resources forimplementation of priority interventions; Identifying locat-ions to place handwashing stations in public spaces;Installation program was done in corroboration with theCovid-19 Task forces within each Kampala division.

Figure :The distribution of public hand washing stations in the city

Directorate of Public Health and Environment, Kampala Capital CityAuthority, Kampala Uganda Uganda Public Health Fellowship Program, Ministry of Health, Kampala,Uganda

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Ndyabakira , Eva Nalwanga , Daniel A . Okello ,

Najib L . Bateganya , Allan Nkurunziza

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hazardous waste are generated, including infected masks,gloves and other protective equipment, together with ahigher volume of non-infected items of the same nature.Unsound management of this waste could causeunforeseen negative effects on human health and theenvironment. The safe handling, and final disposal of thiswaste is therefore a vital element in an effectiveemergency response. The following trends in wastegeneration have been observed since restrictions tocontain COVID-19 pandemic were instituted. The case ofKampala is no different from measures taken by othercities to respond to the current coronavirus epidemic,clustered around six categories: Communication andawareness raising, Workplace and commuting; Socialdistance; Vulnerable groups; Local service delivery andSupport to business. Within its mandate, KCCA hasguaranteed municipal solid waste management, with morefocus on free collection services in the vulnerableresidential parts of the city but not necessarily separatedfor specific types of waste.

Conclusion The coverage of public hand washing facilities at targetedpoints in Kampala city during COVID-19 was low at only22%. Nevertheless, the Hand washing practices amongKampala city dwellers have improved remarkably due toincreased risk communication and social mobilization.Some of the challenges that we have encounteredincluded ensuring consistent and sustained supply ofwater, poor drainage systems and ensuring that thebeneficiary institutions consistently provided amenitiessuch as soap amenities such as soap, water, sanitizersetc. Beyond COVID-19 pandemic, there is need forinnovative strategies to sustain these practices andimprove provision of amenities.


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Acknowledgements Appropriate Technology Centre (ATC), Map Uganda,Water Aid Uganda, VIVA CONAGUA, MOVIT Uganda,Water for People, Uganda Water and Sanitation NGONetwork (UWASNET), Uganda Hand Washing Initiative,National Water and Sewerage Corporation (NWSC),UNICEF, Rotary Uganda and many other partners andcommunity members.

References Mbakaya, B. C., Lee, P. H., & Lee, R. L. T. (2017). Hand HygieneIntervention Strategies to Reduce Diarrhoea andRespiratory Infections among Schoolchildren in DevelopingCountries: A Systematic Review. International Journal ofEnvironmental Research and Public Health, 14(4).https://doi.org/10.3390/ijerph14040371


Solid Waste Generation Trends duringCOVID-19 Pandemic in Kampala city

Introduction World Health Organization (WHO) declared the ongoingCOVID-19 a public health emergency of internationalconcern in January 2020. Uganda confirmed the first caseon 21st March 2020 and a number of measures wereinstituted to curb its transmission effective from 19thMarch 2020. The current COVID-19 pandemic raises newchallenges regarding municipal waste managementpractices and procedures. It is not uncommon that duringsuch an outbreak, many types of additional medical and

Figure 1:Free collection services in the residential parts of the city to minimize heaps of illegal dumpsites and

open burning of unmanaged garbage incommunities

In addition, landfill-based waste picking activities andresource recovery have been suspended.

Figure 2: Wastepickers-free waste disposal operations at Kiteezi Landfill

Directorate of Public Health and Environment,Kampala Capital CityAuthority, Kampala, Uganda Uganda Public Health Fellowship Program, Ministry of Health, KampalaUganda

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Ndyabakira , Obed Lutakome , Jude B . Zziwa ,

Najib L . Bateganya

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Citing adaptability and flexibility in our operations sincemid-March 2020 in keeping operations going, more sothan following a pre-existing plan, this article aims toexplore the solid waste generation trends in Kampaladuring COVID-19.

1. Reduction in waste generatedWhen the central government banned public/privatetransportation and instituted a lockdown on 1st Aprilrequiring people to stay home, non-essential commercialactivities were severely negatively affected. The drasticreduction in commercial activities in the central business(CBD) and surrounding suburbs grossly reduced commer-cial waste generation. Over all, the lock down due toCOVID-19 pandemic has led to 20% reduction in waste(fig 1).

Figure 3: Trend in waste collection in Kampala shows a 20% drop over the last two months(March and April 2020)

2. Increased domestic wasteThe generation of waste is directly accompanied by theland use pattern. The stay-home polices policiesestablished in the country, have led consumers toincrease demand for online shopping for home delivery.Consequently, organic and inorganic waste generated byhouseholds has increased. With limited waste segregationat source, mixed non-homogenous waste with low qualityfor recycling is collected for disposal at the landfill.

3. Reduction in wasterecycling Waste resource recovery from collection trucksand landfills has always been a major source of inputs forthe recycling industry. As a result of the COVID-19pandemic lockdown, recycling activities were stopped, asauthorities have been concerned about the risk of COVID-19 infested waste material spreading among wastehandlers (including recyclers).

Figure 4: These landfill waste pickers’ smiles didn’t lastlong as their work could not continue amidstthe COVID-19 public health guidelines

Conclusion There has generally been a reduction in solid waste gene-ration during the COVID-19 lockdown in Kampala. Muchas this reduction in waste generation is temporary, it couldhave an impact on the total concentrations of greenhousegases in Kampala’s atmosphere. On the other hand, theincrease in medical waste generated during the COVID-19 pandemic control such as contaminated masks andgloves, used or expired medications can easily be mixedwith domestic non-hazardous municipal solid waste.However, safe management of these should ensure thesecritical waste materials are segregated, collected, treatedand disposed of separately by competent specializedoperators.

*Correspondence:[email protected]

The Impact of COVID-19 PreventionMeasures on Markets in Kampala city

Introduction The coronavirus disease (COVID-19) was first announcedin Wuhan city, China and was subsequently importedacross the globe. By early May, there were 3.9 millioncases with 270,720 fatalities (7%). Having declared thefirst COVID-19 case on March 21 2020, Uganda had 121cases by May 11th. Ministry of health in Uganda institutedseveral measures to prevent the spread of the virus.

Directorate of Public Health and Environment, Kampala Capital CityAuthority, Kampala, Uganda Uganda Public Health Fellowship Program, Ministry of Health, Kampala,Uganda.

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Peter Ssetenda , Alex Ndyabakira , Najib L . Bateganya

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One of the major key measures was to decongestcrowded areas, such as schools, markets, places ofworship, bars and public transport. In fact, a lockdownwas finally effected to further restrict movement of people.However, due to the anticipated socioeconomic and wel-fare issues associated with the lockdown, food marketswere included among essential services and allowed tocontinue operating, albeit with strict measures guided bythe Ministry of Health. These standard operating proce-dures (SOPs) included strict observance of social distanc-ing, hand washing and practicing of safe sanitation. Justlike other markets in the countrywide, the markets inKampala mainly deal in agro-based food products fromfarms and nonfood items. The markets are comprised oftemporary wooden structures and some items are sold onbare ground exposing them to potential contamination.The markets tend to attract many people from within andoutside Kampala city hence the characteristic overcrowd-ing. Besides the numerous vendors and customers, othercategories of people who routinely transact in the marketsinclude suppliers, loaders and off loaders of produce/goods, cleaners and members of the market committees.This has led to an overwhelming market population thatstrains the existing but inadequate space and sanitaryfacilities (figure 1).


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Figure 1

In this article we present some of the approaches KCCAhas taken to reorganize the markets and enforce COVID19 measures to reduce risks of transmission and foodcontamination. Crowded food stalls were reorganized totwo-meter distance a part, hand washing facilities wereplaced at all market entry points and all markets inKampala were fumigated against mosquitoes and othercrawling insects. It is envisaged the transformation ofthese essential work spaces can be a benchmark formaking them safer for the vulnerable high populationgroups that operate therein.

MethodsWe disseminated SOPs on COVID-19 prevention fromMOH widely within Kampala city through communityradios, speakers mounted on media vans, mass andsocial media and using posters in all markets. Risk comm-unication was done by a trained team from KCCA head-quarters. We issued directives on mandatory social dista-ncing between traders and customers. The City Authorityalso installed hand washing facilities with soap to themarkets and ensured constant water supply to all points atall times. The markets were routinely fumigated andvendors who sleep in the markets were supplied withinsecticide-treated bed nets. We used photo voice todocument the process. The markets were closely moini-tored and nuisance notices served to the managementcommittees to ensure compliance with the SOPs.

ResultsOvercrowding has been extensively reduced. Spacingbetween the vendors has increased to four (4) meters.Easy access and movement within the market setting hasbeen achieved. The market management committeeshave also been empowered to enforce hygiene measuresrelated to reducing risk of COVID-19 transmission. Road-side market/vending around Kalerwe market was elimina-ted. Improvement in the market sanitation following erect-ion of makeshift stalls especially in Kalerwe market hasgreatly reduced the risk of food contamination (figure 2).

Figure 1. Top & Bottom: A section of Kalerwe Market in Kawempe Division before the Covid-19 outbreak. This puts the marketpopulation at risk of various forms of infections such as, waterand food borne diseases.

ConclusionThe COVID-19 pandemic prevention measures havepositively impacted on the sanitation and hygiene ofmarkets in Kampala city thereby reducing the risk ofCOVID-19 transmission coupled with other WASH relateddiseases. However, there is need to design innovativestrategies to sustainably maintain the gains achieved suchas foot operated hand washing containers, effectivemanagement of long ques or crowds, improved access tomasks, etc.

Both the ‘who’ and the ‘when’ of disease patterns arerelative to and often dependent on the ‘where’. GeographicInformation Science, Software, Systems (collectivelyknown as GIS) and technologies are one of the responsetools epidemiologists use in defining and evaluating the‘where ‘. In essence, making the location a holy grail incombating the outbreak. The spread of COVID-19 like anyother disease is inherently spatial. GIS synthesizessophisticated algorithms, spatial analysis, geo-statisticsand modelling, making its technology a powerful tool forthe prediction of disease patterns and parasite ecologyassociations. Its ability to access, share and utilize satelliteand remote-sensing data has made possible even widerunderstanding of health processes, population and of theirlinks to the environment. This has consequently enabledpublic health professionals to evaluate and quantify therelationships between health-related variables and enviro-nmental risk factors at different geo-graphical scales. Tosupport the public health response to COVID-19 pandemic, GIS provides a set of tools for surveillance, situationalawareness, logistics, and communication. The resultantmaps and location intelligence provide deeper understa-nding and insights needed to address rapidly changingconditions around the impacted areas making the invisiblevisible. In this case, GIS is used to observe, understandand guide response to the pandemic (as shown in figures1 and 2).

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Figure 2.Top & Botttom Improved spacing between the established Kalerwe Market stallsVendors in Nakasero market, Newly


Leveraging Geographic InformationSystems (GIS) to Effectively Respond toCOVID-19 Pandemic in Kampala city.

Figure 1: The KCCA Based country monitoring GIS Dashboard

Figure 2: The KCCA City wide COVID-19 infectionsmonitoring dashboard by division

In a recent vulnerability study by the KCCA GISSection, Institution of Surveyors Uganda (ISU) andDepartment of Geomatics and land managementMakerere University, the vulnerability to COVID-19 in theGreater Kampala Metropolitan Area (GKMPA) was scaledto the parish level as shown in figure 3).

Authors : * Ivan Bamweyana , Elizabeth Katana ,

Patrick Ojirot , Moses K . Atwine , Daniel A . Okello

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Directorate of Public Health and Environment, Kampala Capital CityAuthority, Kampala, Uganda Uganda Public Health Fellowship Program,Ministry of Health, Kampala, Uganda Directorate of Physical Planning, Kampala Capital City Authority, Kampala,Uganda

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This was useful for COVID-19 related policy decisionssuch as distribution of food and relief items during lockdown.

Figure 3: Greater Kampala Metropolitan Area COVID-19Vulnerability Mapping

Emphatically, for a GIS to effectively be used forresponse, there is need to; i) Map the cases -Mapconfirmed and active cases, deaths, and recoveries toidentify where the infections exist and have occurred. ii)Map the spread-Time enabled maps can reveal howinfections spread over time and where you may want totarget interventions. iii) Map vulnerable populations-COVID-19 disproportionally impacts certain demographicssuch as the elderly and those with underlying healthconditions. Mapping social vulnerability, age, and otherfactors help you monitor at-risk groups and regions youserve. iv) Map your capacity- Map facilities, employees orcitizens, medical resources, equipment, goods, andservices to understand and respond to current andpotential impacts of the epidemic. v) Communicate withmaps-Use interactive web maps, dashboard apps, andstory maps to help rapidly communicate your situation toenhance situational awareness. Effective GIS responsesurveillance systems are therefore pivotal in; providingearly warning systems for public health emergencies,assess the impact of interventions or evaluate progresstowards specied goals, and monitor trends in thedevelopment and proliferation of health threats, informingthe prioritization of issues, allocation of resources, publichealth policy and strategies. The leveraging of GIS insupporting and closely monitoring the COVID-19response at KCCA can be explored through this link,https://coronavirus-response-19-ctf-kcca-gisservices.hub.arcgis.com/


The Contribution of the 21st CenturyCommunication Technology in Uganda’sResponse to COVID-19

Communication is an essential and indispensable compo-nent of preparedness and response to public healthemergencies. Given many previous public health emerge-ncies over the years, Uganda is now far more preparedthan in the past, even when we are more interconnectedas a global village with evolved, efficient and bettercommunication systems of the 21st century dubbed as“Cambrian explosion of communications technology”(BNPP Australia, 2017). Communication systems of thisera including social media platforms, televisions, radio,mobile phones etc. are by far fast evolving with improvedefficiency, creativity, innovation, multi-sectoral collabo-rations, artistry, curiosity, imagin-nation, personal expre-ssion, adaptability, reliability and accessibility comparedwith the 20th century technology of the 1900’s.

20th century systems were majorly analog and nearlyinaccessible by many Africans including post mails, radio,analog TVs, among others. The inefficiency of theseanalog communication systems of the 1900s, coupledwith inadequate accessibility in Africa, have beensomehow associated with the poor documentation andinvestigation of large influenza pandemics in the pastincluding the devastating “Spanish’ influenza of 1918-1919 that is speculated to have wiped out nearly 2percent of Africa’s population in just six months (Okeke,2012; Phillips, Howard, 2014). The presence of improvedand efficient communication systems has been recentlyappreciated and credited with improving the public healthattention, concern and change in Africa’s HIV/AIDSpandemic of the early 1990’s.

In Uganda’s COVID-19 response, the state leaders, publichealth authorities, public and stake holders have engagedin variety of information generation and communicationefforts to continuously inform the general population,encourage them, built trust and also monitor the progressof events. Soon as China notified the World HealthOrganization of an outbreak of a pneumonia of unknownorigin, risk communication efforts were upscaled forseveral weeks to ensure the public could access and useall the important information before Uganda confirmed herfirst case of COVID-19 on March 21, 2020. The COVID-19lockdown has required many Ugandans to adjusttheir routines remarkably regardless of social inequalities,economic status, physical and mental incapability, etc.hence the need for rapid generation and routine dissemi-nation of information. However, we cannot ignore theundeniable positive contribution of the 21st centurycommunication systems in Uganda’s COVID-19 responseand preparedness.


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Authors : *Elizabeth Katana , Alex Ndyabakira ,

Geoffrey Amanya , Richard Migisha , Daniel A . Okello

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Lately if Ugandans want to freely air out their opinions orconsume information, they are presented with a wide rangeof possibilities such as, social media platforms, mobilephones, landline phones, TV, radio, electronic mail, postmail, etc. The online connected world has presented us withpossibilities for growth and instant delivery of commu-nication during the COVID-19 lockdown. The Ministry ofHealth (MoH) and government officials frequently and freelydistribute official and crucial information through socialmedia platforms such as Twitter and Facebook. The publickeeps track of the lockdown and presidential directives atthe comfort of their homes mainly through Television,radios, web searches and social media platforms.Digital systems have allowed the continuity of essentialservices during the lockdown including electronic bankingservices and payment of utilities, some people are able towork from home using their personal laptops, onlineshopping and deliveries, electronic distribution of schoolpackages through newspapers and web pages, and manypublic health surveys and researches have been conduct-ed through online and web platforms. Improved communi-cation systems have also contributed positively to theaccess to quality health care by Ugandans and epidemicresponse by MoH over the years, with the ability to commu-nicate risks, diagnose and pick up early warning signalsand symptoms of many epidemic prone diseases. TheCOVID-19 Task Force at KCCA has been able to trackcontacts of confirmed cases and high risk travelers usingGPS locators, utilized Mobile apps like the Go App for datacollection and management, coordinated ambulancedispatches and referrals using online platforms such asWhatsApp, used technology and mobile devices to linkhealth facilities, trainings for health workers and meetingshave been conducted successfully on online platforms andalso logistics have been managed electronically. Whilst being able to positively contribute on theCOVID-19 response, this evolution of communicationsystems and complexity of some can also bring forth somenegative unintended effects. The spread of rumors, myths,gossip, conspiracies unreliable and false informationpauses a challenge on public health efforts that canpotentially pull down the positive contribution of some ofthese platforms. The increased access to health informationon several communication platforms has been linked withthe recent rise in poor use of medicines such as antibioticsto treat infections leading to antimicrobial resistance whichhas been a turning point for public health and communica-tions in the 21st century.

Moving forward, public health authorities should considerupscale of legal channels that can effectively verify infor-mation and address the possible negative contribution ofthese communication systems as we expect communica-tion technology to probably evolve more in the comingdecades. Some the COVID-19 response strategies thatwere not easy to execute such as institutional quarantine,self-isolation, contact listing and tracing, etc. can beevaluated to cater for the public’s expectations andopinions, to allow better risk communication in a futuresimilar epidemic. For successful prevention and manage-ment of future outbreaks, it will be wise and important toinvest in primary and community healthcare systemsformally linked with adoption of some of the 21st commu-nication technologies such as Whats-App, Facebook,Twitter, Email, etc., with deep insight into local publichealth communication needs, and trainings for communityhealth care providers.

ReferencesBNPP Australia. (2017, September 1). The Coming CambrianExplosion in Technology.BNPP AM - Australia - Institutional and Financial Consultants. https://www.bnpparibas-am.com.au/Institutions-Consultants/coming-cambrian-explosion-technology/

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Acknowledgements

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Please visit the KCCA COVID-19 Response Hubhttps://coronavirus-response-19-ctf-kcca-gisservices.hub.arcgis.com/

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