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: bngago@yahoo.co.uk 

Presentation Outline• 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

“Sacred” pond where pilgrims congregate for the main prayers on 3 rd June

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• 297 consenting pilgrims were randomly identified and interviewed on 2nd June, a day before the major event

• From a central point interviewers took different directions to get respondents

Sanitary facilitiesType Stances SeparationPit latrines 22 No separationWater closets 29 13 for Ladies

704/20/23

Usage: pit latrines 67%, water closet 24.2%, Bush 8.8%

Water sources, and perceptionsHow pilgrims sourced drinking water

• Pond water- 30.6% • Bottled water- 24.2% • Tap water- 11.8% • Spring water- 9.8%• Others- 21.2%

Perceptions about pond water

• “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 BathingHealing powers

• Washing clothes and utensils

• Sprinkling on cropsBetter yields

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Container purchase for pond water

1004/20/23

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

• 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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Type of meat Approx Amount (tonnes)

Percentage(100)

Beef 3 54

Pork 1.5 27

Chicken 0.8 14

Goat 0.3 5

Meat

• Meat at 50% (12/24) of roasting places was observed and judged to be undercookedPercentage 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

A move to provide piped water19

Provision of piped water

Ministry of health(MOH) provided mobile van for Public heath

awareness

MOH sent environmental specialists to provide technical

support for sanitation and hygiene

Provision of mobile toilets

Acknowledgements

• 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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