Presented at UMA-UVA Joint Scientific Conference 15 th February 2013

1. 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

2. Presentation Outline • Introduction • Objectives • Methodology • Results • Conclusions • Recommendations • Acknowledgements

3. 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

4. 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

5. 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

6. Results “Sacred” pond where pilgrims congregate for the main prayers on 3rd June • 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 www.afenet.net

7. Sanitary facilities Usage: pit latrines 67%, water closet 24.2%, Bush 8.8%

8. Water sources, and perceptions How pilgrims sourced drinking water 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% • Pond water- 30.6% • Bottled water- 24.2% • Tap water- 11.8% • Spring water- 9.8% • Others- 21.2% www.afenet.net

9. Uses of the pond water by pilgrims • Drinking and Bathing • Healing powers • Washing clothes and utensils • Sprinkling on crops • Better yields www.afenet.net

10. Container purchase for pond water

11. Pond water quality, 2011 www.afenet.net

12. 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 www.afenet.net

13. 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 www.afenet.net

14. Zoonosis transmission- Meat • Slaughtered in bush and at night • Not inspected District Veterinary officer of Wakiso (left) being interviewed by Dr. BenardNgago and Ms Stella Akech

15. Meat • Meat at 50% (12/24) of roasting places was observed and judged to be undercooked • Percentage 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 www.afenet.net

16. 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 www.afenet.net

17. 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 www.afenet.net

18. 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 www.afenet.net

19. The situation in 2012 Provision of piped water Provision of mobile toilets Ministry of health(MOH) provided mobile van for Public heath awareness MOH sent environmental specialists to provide technical support for sanitation and hygiene A move to provide piped water

20. Acknowledgements • Ministry of Health, Uganda • Uganda Catholic Medical Bureau • RESPOND • AFENET • Namugongo pilgrims of 2011 • Co-authors www.afenet.net

21. THANK YOU THANK YOU www.afenet.net