Poor Housing Increases TB Infection

By Joe Nam, New Vision, published November 07th, 2011.

A study carried out in Makindye Division in Kampala, Lira Municipality and Wobulenzi town council has established a co-relation between poor housing and prevalence of tuberculosis in urban centres.

The research carried out by International Medical Foundation engaged 1,366 adults in 1,366 households. The majority of the respondents live in slums in conditions of what is considered poor housing.

“…we don’t have the capacity to stay in good houses. We stay in houses we can afford to pay for. We stay in houses without windows and our roofs leak. When you think of going back to the village, then you think about the hard life there…the places in which we live are surrounded by drainage channels, which flood, making it easy to contract diseases. However, we find ourselves in a situation we have no control over…” a respondent in Makindye says.

The survey found that awareness of TB was high in the population, mainly through some form of contact with a TB a patient. Myths and remarkable deficiencies in knowledge of TB cause, symptoms, transmission and prevention, however, abound.

The survey also found that although majority of slum dwellers are well within reach of a health facility, significant barriers in terms of actual service delivery exists due to lack of drugs, absentee health workers, prohibitive user fees and lack of transportation to health facility, hampered treatment of TB. TB-related stigma was found to be high in communities, with negative perceptions towards persons with TB due to association with HIV/AIDS.

The study recommended planned housing in urban centres for low-income earners, participatory engagement with slum dwellers to improve their environment, enforcement of the Public Health Act minimum standards in the construction of toilet facilities and improving access to medical care.

The study also recommended pegging of TB screening to HIV testing programmes due to the tendency to take HIV AIDS testing more seriously. Uganda is among the 22 countries in the world with the highest number of TB cases, with 100,000 new infections annually.

Tuberculosis Health Needs Assessment (2/2)

A key element of this study was to assess the housing as well as socio-economic determinants amongst slum dwellers.

1,366 households were surveyed in 3 low income settlements; one in the urban slums within Kampala and the other 2 in rural settings as a comparison.

As indicated in the previous posting there is a need for closer collaboration between the various agencies responsible for TB and for Housing.

Kisugu TB health needs assessment

Some of the survey findings are:

  • 66% did not own their property
  • 48% of properties had just one room, which on average was just 12 m2
  • Average of 5 people per property
  • Average of 3.8 people sleeping per room
  • 66% used a communal latrine

Kisugu TB health needs assessment

We don’t have the capacity to stay in good houses. We stay in houses we can afford to pay for, which exposes us. We stay in houses without windows; mosquitoes bite you and with leaking roofs.

When you think of going back to the village, then you think about the hard life there…the places we stay in are surrounded by drainage channels which flood and this makes it easy to contract diseases.

However, we find ourselves in a situation we have no control over.

Slum dweller, Kampala.

For a copy of the full report please email: imf@img.co.ug

Tuberculosis Health Needs Assessment

Target TB Logo


International Medical Foundation and Target Tuberculosis (Target TB) recently completed an assessment of how housing conditions and socio-economic factors affect vulnerabilities for Tuberculosis (TB). A total of 1,366 households were surveyed in 3 low income settlements within Makindye Division Kampala, Lira District and Luwero District.

Kisugu TB health needs assessment

Uganda is ranked 16th out of the 22 high TB burden countries by the WHO, and is one of only two of these high burden countries with increasing mortality. Population as well as urban growth has been increasing dramatically over the last 20 years, with much of this settlement unplanned. Two previous studies in Ugandan slums have shown higher prevalence of TB.

The study found that whilst the majority of those surveyed live within 5km of a health facility they were often unable to seek care due to a lack of drugs or health workers at these facilities, the cost of transport to and from the facility, the cost of drugs or being asked to pay a user fee even though such care and treatment is meant to be free at government health centres.

Lowofu TB health needs assessment

Those surveyed mentioned the stigma and discrimination experienced by those infected:

…you know TB and HIV/AIDS are more or less the same, so when one has TB, they feel ashamed of going to health centres in our community here…

Personal Health Adviser, Luwero.

The study highlighted crowding, poor ventilation and use of bio fuels, amidst a high TB and HIV burden, as important opportunities for partnership between the National TB Programme and the Housing and Environment sectors.

For a copy of the full report please email: imf@img.co.ug


IMF Working with Kasese Cobalt Company Limited

For three years International Medical Foundation has been working with Kasese Cobalt Company Limited to provide basic health services to the poor living in three communities close to the KCCL facility in Kasese, West Uganda.

This programme has been supported by Health Initiatives For The Private Sector, a USAID funded project.

Together we have provided HIV voluntary counselling and testing to 2,925 adults, of which 560 tested positive. We have enrolled 444 onto our treatment and care programme and currently 136 are receiving anti-retroviral therapy, ART.

Those enrolled are able to have regular health checks, including a CD4 test which provides a clinical indication of the strength, or weakness, of their immunity system. When the CD4 count has fallen to a given threshold the client is then started on ART. They are provided with insecticide treated bed-nets to help prevent malaria, are screened for TB (those living with HIV are very susceptible to TB) and provided with family planning supplies.

Anti-retroviral drugs and test kits are supplied by the Ministry of Health, free of charge to the programme. The equivalent cost of these is about half of the total cost needed to the run the full programme. KCCL and IMF split the cost of staff, transport, facilities and, importantly, the cost of drugs for the treatment of opportunistic infections and CD4 tests. HIPS provides the bed-nets, family planning supplies, TB lab equipment and training for the clinical team and peer educators in the community.

The partners also, from time-to-time, need to meet the cost of buying ARVs when there are stock-outs and supply is not being provided by MoH. This is a key issue that must be addressed by such programmes and unfortunately one that may continue to get worse. It is inevitable that some rationing of ARVs will need to take place as only half of those that should be on ART are currently enrolled and being treated. This position would worsen significantly if Uganda was to adopt the most recent WHO guideline which recommends the start of treatment at a CD4 count of 350. We are still using the previous guideline of 250.

The programme is, we think, a good example of how companies and agencies can work together, sharing cost, resources and expertise, to provide life-changing health services to those that need it most.

Shortlisted for BMJ Group Awards

We are pleased to note that the TB project at IHK has been shortlisted for this year’s BMJ Group Awards under the “Getting Evidence into Practice” category.

Thanks to Dr. Richard for making the submission.

TB is a significant health issue in Uganda and our project, supported initially by Suubi Trust and then by Target TB, has implemented a new TB Lab and completed a clinical trail for the MOT/MODS diagnostic method. You can read more detail about this in the submitted report by clicking here.

Essentially this method enables the team to diagnose TB in about 7-10 days at a cost of just $5. This compares to either the gold standard MGIT test which can cost up to $70 per test or low cost methods that can take about 40 days for a result.

Our thanks to VSO for it’s support over the last few years, first with Dr. Mark who got us started and then Dr. Grania and Dr. Richard who between them managed the clinical trial and the integration of the TB Lab into IHK’s community based health programme Touch Namuwongo.

Read our other Blog posts about this project by clicking here.

Advent: Day 10 Dr. Richard

Photo by VSO/Ben Langdon

This is Dr. Richard as many of us will remember him, enjoying being with the kids on Hope Ward. He made a huge difference in his time with us as a voluteer with VSO. There are more photos of him on the VSO website here.

Even after their VSO stint was finished, Richard and Patricia continued to help, encourage and support us. They came back for an extra 3 months to help us move into a larger health facility in Lira, northern Uganda and are now helping to raise funds for our maternal and child health programme there.

Here’s what Dr. Richard says about working with VSO:

“I hadn’t realised VSO would want people of my age. All my VSO contacts went overseas straight out of university, so I was a little tentative when I contacted VSO and said “I’m an old git, I have reasonable health and these talents, are you interested?” And I really did expect them to say no but was pleasantly surprised.”

Advent: Day 4 Aldo

This photo reminds me of a special day when I had the chance to visit Joyce, one of our Aldo clients in Lira. This visit taught me that it is not just the poor that fall though the holes in the safety net (which by the way doesn’t really exist). Joyce had a good job, income and a family network, until she fell ill with TB. Click on the photo above to read more.