Uganda's Ministry of Health is facing serious financial and health system constraints as it battles to contain an outbreak of Marburg haemorrhagic fever that has killed eight people in the country's southwest.
According to the Uganda Virus Research Institute, as of 27 October, nine patients - five in the southwestern district of Kabale, two in the western district of Ibanda, and two in the capital, Kampala - had tested positive for the highly infectious viral fever.
Seven student nurses who attended to a Marburg patient at Ibanda Hospital, since deceased, have been quarantined for at least 21 days. A total of 436 people who have been in contact with Marbug patients have been listed for close observation in the districts of Kabale (where the outbreak was first detected on 19 October), Ibanda, Mbarara, Rukungiri, Kabarole and Kampala.
From the same family as the Ebola virus, Marburg causes severe headaches and malaise, followed by bleeding from multiple orifices. According to the US Centers for Disease Control and Prevention (CDC), the fatality rate for Marburg is between 23 and 90 percent. The virus, for which there is no vaccine or specific treatment, is transmitted by direct contact with the blood, body fluids or tissues of infected people.
The health ministry has drawn up a 1.85 billion Uganda shilling (about US$740,000) supplementary budget to set up temporary isolation facilities and wards, purchase drugs and protective gear, pay health workers allowances, and pay for funerals, which are being handled by health officials.
"We are constrained. We continue to lobby for support, not only financial but human resources, to address the situation," Christine Ondoa, Uganda's health minister, told IRIN. "We have approached the treasury for a supplementary budget for a faster response to the outbreak. We hope to get a positive response. We appeal to partners to come in."
"We urge the treasury to release supplementary funds to the health ministry to help reduce the risks," said Joaquim Saweka, the UN World Health Organization (WHO) country representative for Uganda. "The funds will help the ministry to implement its intervention plans. If the funds are not allocated, their efforts will be worthless."
On 31 October, Ugandan legislators called for the suspensions of public gatherings, celebrations and meetings in Marburg-affected districts.
On 29 October, the health ministry dispatched a team of experts to the southwestern region to help boost local health workers' efforts to contain the spread of the disease. It has also set up a field diagnostic laboratory at Kabale Referral Hospital and established temporary isolation facilities and wards in Mbarara, Ibanda, Kabarole, Rukungiri and Ibanda to accommodate suspected and confirmed cases.
But a severe shortage of trained health workers has undermined efforts to contain the disease; just 63 percent health worker positions in the country's public health sector are filled.
"The health workers are overwhelmed and stretched with the outbreak. We are struggling to contain it. The facilities are overstretched," Patrick Tusiime, the Kabale District Health Officer, told IRIN.
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Matters have been further complicated by an ongoing strike by an estimated 150 health workers at Mbarara Referral Hospital - the largest referral facility in the region - who walked out on 19 October over unpaid salaries.
Looking for a cause
Ruth Aceng, the director general of health services, says the government has embarked on studies to establish the causes of the frequent haemorrhagic fever outbreaks in the country.
"We call upon the public to remain as calm as possible; measures are being undertaken to control the situation," Aceng told reporters on 29 October. "We are doing surveillance and studies on birds, bats and monkeys. We want to know the causes of these frequent epidemics."
Marburg was last reported in Uganda in 2008. The outbreak comes less than a month after the country was declared Ebola-free, after an outbreak in the western district of Kibaale in July killed some 17 people. The health ministry is also working closely with authorities in neighbouring Democratic Republic of Congo to ensure an ongoing Ebola outbreak in the norteastern province of Orientale does not cross over into Uganda.