Uganda: Hepatitis E Kills More Pregnant Women in Northern Uganda

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The Monitor (Kampala)

6 August 2008
Posted to the web 6 August 2008

Evelyn Lirri

Pregnant women who become infected with Hepatitis E, an acute viral disease that causes liver failure are at greater risk of death, health experts say. Hepatitis E has been ravaging parts of northern Uganda since October 2007 and has so far killed 97, while the number of those infected has reached 5,779, according to the latest update report from the Ministry of Health.

According to Health Minister Dr Stephen Mallinga, the majority of those who have died are pregnant women. "Because women have lower immunity during pregnancy, cases of Hepatitis E are severe and cause more death among them," he said, adding that the problem is exacerbated by some cultural beliefs that pregnant women should not use latrines. As a result, most of the women will just dispose of faeces in open air which is a good breeding ground for the Hepatitis E virus.

United Nations Children's Fund (Unicef) Country Representative, Mr Keith McKenzie said the higher rate of death from Hepatitis E among pregnant women remains of grave concern.

He said that most of the pregnant women who succumb to Hepatitis E are in their third trimester - this is usually the last phase of the pregnancy up to the time of birth. "This is double mortality because not only are the mothers dying, but their unborn children too. We all need to play an active role to contain the situation," Mr McKenzie said.

According to a World Health Organisation fact sheet on Hepatitis E, overall mortality rate from Hepatitis E ranges between 0.5 to four percent, with more cases registered among pregnant women. "Fulminate Hepatitis occurs more frequently in pregnancy and regularly induces a mortality rate of 20 percent among pregnant women in the third trimester."

A person infected with Hepatitis E develops fever, headache, general body weakness, muscle pains and eventually develops yellow eyes and passes urine of a deep yellow colour. Hepatitis E initially struck Kitgum District in October 2007, but has since spread to the districts of Gulu, Pader and Yumbe.

While it is not easy to get infected with Hepatitis E, the appalling hygiene in the affected districts where many people displaced by the Lord's Resistance Army insurgency live in squalid conditions in camps has fuelled the disease's spread. Dr Mallinga said in one camp for displaced people in Kitgum District, up to 15,000 people were sharing one latrine of six stances.

"The major challenges are inadequate access to safe water, unhygienic disposal of faeces, poor personal and domestic hygiene," Dr Mallinga said, adding that bylaws should be passed at the district and sub county levels to compel households to dig pit latrines.

The situation is made worse by the shortage of health workers, inadequate funding and limited participation of local authorities at the grassroots level in enforcement of bylaws and ordinances that promote good health and sanitation. As a preventive measure, health experts are urging pregnant women to attend antenatal services so that early diagnosis can be made in case infection occurs.

An emergency plan to fight the Hepatitis E epidemic in northern Uganda has already been launched and the Ministry of Health hopes it will help eliminate the virus from the community. The Shs10bn will focus on teaching residents about proper hygiene, improvement of sanitation through construction of boreholes and pit latrines in internally displaced people's camps, and monitoring infected people to ensure they are treated.

WHO says there is no specific therapy for altering the course of acute Hepatitis E infection and prevention is the most effective approach against the disease.

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