Healthier Manyattas!
Tackling tuberculosis in North Eastern Uganda one homestead at a time
Seated calmly with two of her kids outside her grass-thatched hut in the village of Natapar-Kocucue in Moroto district, Lucia Pedo recounts how she suffered and overcame the dreaded tuberculosis (TB).
TB is the world’s deadliest infectious disease, infecting nearly 10 million people globally each year. As dangerous as TB is, it is very treatable and ultimately curable. In the past 20 years, more than 63 million lives globally have been saved through TB intervention.
Lucia, a mother of six children, was diagnosed with TB in September 2020 together with her 3-year-old son. Before her diagnosis, Lucia suffered from a prolonged cough and general body weakness. Just like many others in her community, Lucia didn’t understand what was happening, despite her deteriorating health.
“I was coughing a lot and losing weight. I didn’t know what was affecting me. One day the community worker found me here sick and advised me to test for TB. They later found that I had TB,” recalls Lucia.
Through follow-up and contact tracing (the practice of identifying others who may have been exposed) by community health workers, Lucia’s son also tested positive. “My youngest child was also coughing and having night sweats. They tested him and he was found positive. But the rest of the family members tested negative,” says Lucia.
With support from USAID’s Program for Accelerated Control of TB in Karamoja, both Lucia and her son started TB treatment. Lucia has since recovered and resumed work. “I don’t cough anymore, and the pain has gone. My son is also much better now since he completed medication,” Lucia adds.
Mariko Lochoro’s experience was similar. An elder and local official of the nearby Tatawo village, Mariko was diagnosed with TB in 2020. He completed a six-month treatment course before overcoming the disease.
“After I got cured, I decided to start giving advice to the people I lead. I tell them to listen to the advice of the health workers … to test for TB and complete the treatment. [As] an elder and local leader in my community, people listen to my advice and many of them are responding positively,” Mariko explains.
The Karamoja region in northeastern Uganda is a remote pastoralist area with an estimated population of 1.2 million. The region has the highest TB burden in Uganda at a devastating 315 cases per 100,000 people (compared to the national estimate of 154 cases per 100,000). A third of the TB cases reported in the region are children below age 15 — significantly higher than the national average of 12 percent.
Uganda’s Ministry of Health estimates that approximately five out of every 10 TB patients complete treatment successfully. Only three in 10 are cured. Approximately 90,000 Ugandans are infected with TB annually.
A Communal Way of Life
Traditionally, the Karamojong people live communally in enclosed homesteads known as “Manyatta”. Manyattas are surrounded by sharp thorn hedges with small entry points for people and larger entry points for cattle. A typical Manyatta, such as where Lucia lives, has multiple households of about 20 or more individuals sharing the same space. These crowded and poorly ventilated settlements increase the risk of TB transmission.
Recognizing the unique challenges faced when it comes to accessing and delivering TB care to this region, the USAID program is focused on tackling these challenges and reducing TB transmission. It works with community members without formal medical training (known as community-owned resource persons or CORPS), to help identify TB patients in the communities, collect sputum samples for testing, and assist in identifying TB patients who have stopped taking their medication in order to get them back into care.
Simon Peter Lobong is a Village Health Team member and a CORPS covering the Natapar-Kocucue village. He and 264 others received training that included TB health education as well as, how to make referrals, provide adherence counseling, ensure follow-up on patients missing appointments, and mobilize communities for TB screening.
“We are trained to help and identify people with TB in our communities. People know us because we are part of them. But to be trusted, one needs to be a good listener and maintain confidentiality to prevent stigma,” Simon Peter explains.
By working with these CORPS, the project has resulted in a 44 percent increase in the number of TB cases identified in the sub-region. Also, the number of cases successfully treated in the past year has doubled compared to the previous year. As of March 2021, approximately 15,687 people were screened for TB and 966 of these were diagnosed and are on treatment. A total of 479 TB patients who had interrupted their treatment returned to care, while 200 patients continue to receive their medicine from their communities quarterly, through the CORPS.
Through USAID’s innovative, community-focused approaches to TB care, individuals like Lucia and Mariko are not only living healthier and more productive lives — they are helping spread the word so that others can benefit from the same.
The U.S. Government, through USAID, continues to promote prevention strategies, improve patient-centric care, strengthen service delivery, and provide new TB diagnostics and drugs in the fight against TB. USAID leads the U.S. Government’s global TB efforts, working with agencies and partners around the world to reach every person with TB, cure those in need of treatment, and prevent the spread of new infections.
About the Author
Betty Kagoro is a communication specialist at USAID’s Mission in Uganda.
