Transcript UMA-envt, water and food safety

ENVIRONMENT, WATER AND FOOD SAFETY
SURVEILLANCE DURING A RELIGIOUS
PILGRIMAGE MASS GATHERING, NAMUGONGO,
UGANDA, 2011
Presented at UMA-UVA Joint Scientific
Conference 15th February 2013
Benard Ngago, Arthur Bagonza, Stella Immaculate Akech, Ben Nsajju, Monday Busuulwa,Monica Musenero,
Chima Ohuabunwo,Olivia Namusisi ,Sheba Gitta Nakacubo, David Mukanga
Corresponding Author: Benard Ngago, African Field Epidemiology Network (AFENET), Plot 4B Mabua Road Kololo,P.O.BOX
12874, Kampala, Uganda. Tel: +256(702)696926; Fax:+256(312)265595,
Email: [email protected]
Presentation Outline
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Introduction
Objectives
Methodology
Results
Conclusions
Recommendations
Acknowledgements
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Introduction
• Every 3rd June, approx. 2 million people
gather in Namugongo, Uganda, for an annual
religious pilgrimage
• This crowd has inadequate sanitary facilities,
unsafe water, and food handling procedures
including meat inspection may not be followed
• We assessed environmental conditions, safety
of water and food consumed and the potential
risk of zoonoses transmission during the 2011
event
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Objectives
• Assess environmental conditions of the religious
event site before and after the event
• Determine the sources and safety of water drunk
by pilgrims during the event
• Assess the safety of food consumed by pilgrims
during the religious event
• Assess potential risks for zoonoses transmission to
pilgrims during the 2011 event
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Methodology
• Study Design :
Cross-sectional study
• Data collection methods
Checklists to collect data on available sanitary
facilities and food handling practices
Semi-structured questionnaire to determine water
sources and usage of the different types of sanitary
facilities
 Key informant interviews to explore availability
of safe drinking water, sanitary facilities and
safety of meat consumed
Water and food samples collected for laboratory
analysis
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Results
297 consenting pilgrims “Sacred” pond where
pilgrims congregate for the
were randomly
main prayers on 3rd June
identified and
interviewed on 2nd June,
a day before the major
event
• From a central point
interviewers took
different directions to
get respondents
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Sanitary facilities
Type
Stances
Pit latrines
22
Water closets 29
Separation
No separation
13 for Ladies
Usage: pit latrines 67%, water closet 24.2%, Bush 8.8%
4/1/2016
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Water sources, and perceptions
How pilgrims sourced drinking
water
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Perceptions about pond water
Pond water- 30.6%
Bottled water- 24.2%
Tap water- 11.8%
Spring water- 9.8%
Others- 21.2%
www.afenet.net
• “Pond water was
not safe for
drinking” 68.3%
• not sure 6.1%
• “Pond water was
safe for drinking”
25.6%
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Uses of the pond water by pilgrims
• Drinking and Bathing
Healing powers
• Washing clothes and
utensils
• Sprinkling on crops
Better yields
www.afenet.net
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Container purchase for pond water
4/1/2016
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Pond water quality, 2011
Parameters
Units
Influent Effluent National
standard
pH
8.5
8.9
6.5 – 8.0
E coli before
event
CFU/100mls
4
7
0
S typhi
Organisms/10mls
0
0
0
C perfringens
CFU/100mls
0
0
0
E coli after
event
CFU/100mls
9
20
0
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Food handling
• 76% (28/37)of eating places did not have
washing facilities
• Most of the eating places 78.3% served the
food apparently hot
• 75.7% of the places had food utensils not
covered
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Food handling-2
• 27% of eating places had food handlers with
appropriate head gear
• 1/37 (2%) of food vendors had been medically
examined and certified to handle food
• Laboratory analysis found the ready- to- eat
food not contaminated
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Zoonosis transmission- Meat
Type of meat
Approx Amount
(tonnes)
Percentage
(100)
Beef
3
54
Pork
1.5
27
Chicken
0.8
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Goat
0.3
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• Slaughtered in bush and at
night
• Not inspected
District Veterinary officer of Wakiso (left) being interviewed by
Dr. Benard Ngago and Ms Stella Akech
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Meat
• Meat at 50% (12/24) of roasting places was observed
and judged to be undercooked
Percentage could be higher according to the KI “a lot of
meat roasting and consumption take place at night and
many consumers are drunk. People eat almost raw meat”
• 55% (13/24) of meat handlers indiscriminately
mixed raw and roasted meat at same time during
preparation
Danger of cross-contamination
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Conclusions
• The grossly insufficient sanitary facilities and
consumption of contaminated pond water
exposed the pilgrims to potential water borne
diseases
• There was high exposure to the possibility of
zoonotic disease transmission through
uninspected and improperly cooked meat
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Recommendations
• Adequate mobile toilets be provided at similar
events and should be placed at strategic
places for pilgrims to use
• The “sacred” pond water should be made safe
by possibly purifying and bottling it for the
pilgrims
• Government should ensure proper inspection
of meat and certification of food handlers
• Public health educational messages be
displayed strategically around the venue for
the benefit of the pilgrims
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Public Health Action
• The findings were disseminated to stakeholders who
pledged to
 provide more toilets
 provide safe water for pilgrims
 certify food vendors
 produce Information, Education and
Communication materials for pilgrims during
subsequent events
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The situation in 2012
Provision of piped water
Provision of mobile toilets
Ministry of health(MOH) provided
mobile van for Public heath
awareness
MOH sent environmental
specialists to provide technical
support for sanitation and
hygiene
A move to provide piped water
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Acknowledgements
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Ministry of Health, Uganda
Uganda Catholic Medical Bureau
RESPOND
AFENET
Namugongo pilgrims of 2011
Co-authors
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THANK YOU
THANK YOU
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