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Drastic consequences of diarrhoeal disease

by Bastian Schnabel
More than two million people die from diarrhoeal illnesses every year. Moreover, these infections place an enormous financial strain on families and entire economies – and not only in Uganda. This would be easily avoidable with better sanitation and vaccinations. [ By Bastian Schnabel ]

In developing countries, it is predominantly children under the age of five who suffer from diarrhoea: according to the latest figures from the World Health Organisation (WHO, 2009) around two million children die from the illness each year. By comparison, according to the Ugandan Water and Sanitation Resource Centre, approximately 310,000 people died in Africa as a result of conflicts in 1998. Cholera, in particular, has increasingly become a problem: the prevalence of the infectious disease rose by around 79 % between 1998 and 2006. It is assumed there are currently over 100,000 people infected in Zimbabwe alone.

Diarrhoeal illnesses can cause long-term damage to the development of a country: micro-economically due to financial pressures for medical assistance and the physical deterioration of individuals, and macro-economically due to absences from work and the corresponding consequences for the economy.

As it is assumed that factors such as global warming, chronic water shortage and population growth will lead to more new infections, it is worth investigating how these illnesses influence the socio­economic structures of the affected regions. The Great Lakes region in East Africa is one of the “hot spots” for diarr­hoeal illnesses, with Uganda affected above all. There, between 2003 and 2006, the number of new infections in rural ­areas increased from 4.4 % to 9.8 % and from 2.2 % to 7.3 % in urban areas.

Too little awareness of hygiene

The author studied household and income structures in three different districts in southeast Uganda to find out to what extent these kinds of illnesses burden already poor households in rural and urban areas. Costs for disease prevention, medical treatment – including transport to hospitals, medication, special diets and nutritional supplements – and absences from work by the affected people and their relatives caring for them were taken into account. According to findings by the African Medical and Research Foundation (AMREF), Uganda’s problematic health situation is largely due to the fact that health-care facilities are often far away and it is expensive to reach them.

The main reasons for the high spread of diarrhoeal illnesses are the dire situation of the public health service and water supply, increasing urbanisation and a lack of awareness about hygiene. According to information from the Uganda Bureau of Statistics fewer people are affected in towns and cities than in the country. However, no differentiation is made between slums and the villa neighbourhoods where expatriates often live. The author’s studies show that infections with diarrhoeal pathogens occur more frequently in slums, which can probably be attributed to the precarious sanitary situation and close living conditions. Most slums around the capital Kampala are not connected to the sewage system and there are very few sanitary facilities. Often, hundreds of people share just a few latrines. They also queue up for hours for drinking water because there is only one pipeline.

On average, the occurence of diarrhoeal illness costs around 20 % of a household’s monthly income, while prevention costs up to 10 %. Tap water in urban areas is often undrinkable and large quantities of charcoal and firewood are needed to boil the water, which is not only harmful to the environment but also expensive.

Medical poverty trap

Professional medical treatment costs a great deal of money. With the introduction of the National Health Policy (1999), the Ugandan government abolished the fees for public and state health-care facilities; however, these only exist in the larger towns and cities. Most hospitals are chronically underfunded and there is a lack of qualified professionals. Therefore, many patients prefer to go to private clinics or healthcare centres financed by NGOs. One treatment costs six to seven percent of the monthly household income on average – and often the costs for medicines are also not covered by the public health system. Treatment in the countryside is around 20 % more expensive than in urban areas because there are fewer public facilities and distances to reach them are longer.

Absences from work impact less dramatically on the private budget because the people affected only take short-term leave from work, unlike those with diseases such as yellow fever or malaria. Since many poor people work in the informal sector or in agriculture, family members can take over their work. This is especially common in places where the majority makes a living from farming.

Medical treatment, nutritional supplements and disease prevention cost people with diarrhoea most dearly. By comparison, medication, transport and absences from work play a lesser role.

The majority (about 35 %) fall back on savings to cover the incurred costs or the reduced income. A further 20% sell property – especially the urban population because they have better access to luxury items such as mobile phones. Others borrow from family members or neighbours, or curb their spending.

Unfortunately, all this has a negative impact on household finances and therefore hinders economic development. Many people become impoverished or lose their livelihood because they have to sell their house and land to pay for treatment. This medical poverty trap also sets back the overall development of a country.

Diarrhoeal illnesses can be prevented easily and effectively by:
– expanding the water/wastewater and public health systems,
– enhancing hygiene and sanitary measures at national level, at schools and in rural areas, and
– establishing vaccination programmes, for example against rotavirus, the leading cause of fatal diarrhoeal infections among children. Vaccinations reduce ­infant mortality and are also affordable, as has been proven in Vietnam, among other places.

However, more funding from bilateral and multilateral donors is necessary to implement these measures effectively.