The long term good health of populations depends heavily on the continued stability and functioning of the biosphere’s ecological and physical systems. Climate variability affects the spread of vector borne diseases both directly and indirectly. Directly, local or global warming and increased rainfall contribute to the abundance and distribution of vectors such as mosquitoes and ticks although mosquitoes are the most common. Global or local warming leads to increased temperatures allowing mosquitoes to survive cold conditions where they would otherwise have perished. Subsequently, more mosquitoes are alive to breed and transmit disease during the dry and warm season. In addition, mosquito larvae develop much faster at higher temperatures and after ingestion of the virus become more infectious at higher temperatures. Indirectly, other factors such as deforestation and natural disasters like landslides, soil erosion, decreased hygiene and stagnant water beds, increase rapid multiplication and survival of vectors and hence the incidence of vector-borne diseases. This has also increased the incidence of infection by vector borne diseases and their transmission to high altitude villages like Bufukhula. This has affected the population in this high altitude village because they have low immune systems. The indirect impacts of climate variability like landslides and soil erosion also cause injuries and death. Besides that, it causes damage to the local infrastructure where the buildings are damaged hence exposing people to malaria through mosquito bites.
Uganda’s climate has undergone changes in terms of temperature and precipitation, (seen from Bududa temperature and rainfall graph’s in the period 1961-1990 and 2005-2010). Over the last few decades, Uganda as a whole has experienced variation in the frequency and severity of extreme weather and climatic events. This is greatly affecting the health sector at all levels by increasing the incidence and severity of various diseases. Heavy and destructive rainfall that leads to flash floods has led to emergence of water and vector borne diseases such as diarrhea, malaria, cholera, and typhoid fever (Uganda: National Adaptation Programmes of Action, 2007:7). Climate variation has also influenced the local health care system in Bududa (According to key informants. See chapter 4.4.2 below).
48
4.4.1 Altitude and Malaria transmission.
In Bududa district and the three study villages, it was noted that the people settled at the foot slope, (lower altitude village of Buwanabisi) suffer more from malaria as compared to those settled in the middle (Bumakuma) and upper altitude (Bufukhula). This is because of flooding resulting from heavy rain and many areas experiencing stagnant water. The flooding and stagnant water have predisposed the population to increased incidence of malaria through conditions created for mosquito vectors which invade houses especially at night. The local people suffer effects of malaria as they cannot afford to buy insecticides and nets to protect themselves from mosquitoes. "The overall malaria prevalence in the Mount Elgon region showed infection prevalence at 30.3%. At lower altitude, the malaria prevalence was shown to be 14 times greater than at a higher altitude, with infection proportions at 56.7% and 4.0%". See Table 4.2. The difference in malaria prevalence at altitude showed significant association for the respective areas year in general for the region.
(Davis. undated: 32, http://www.cntd.org/pdfs/Davies.pdf ,08/04/2012).
Table 4.3: Proportion at low and high altitude of those testing positive for malaria.
Mount Elgon Region.
Infection % Proportion at Low Altitude. % Proportion at High Altitude. Total % proportion Malaria 56.7 4.0 30.3
Source: (Davis-undated: 32, http://www.cntd.org/pdfs/Davies.pdf, 08/04/2012).
4.4.2 Malaria treatment and health care in Bududa District,
Health care and treatment in Bududa district as regards to malaria diseases starts from individuals who administer self treatment when they feel feverish. Usually the local people use local herbs for treatment especially in families that cannot afford modern drugs and treatment. Those who can afford to buy modern drugs from clinics or may have managed to get drugs like coartem (Anti-malaria drugs) distributed from the hospital use for treatment. When the condition of the fever persists, some of the local people visit the traditional healers who have special herbs for malaria treatment. Others especially those who can afford the bills, visit the nearby clinics and hospital in Bududa town for modern treatment and health care. (Refer to chapter six, 6.2.3 for information on traditional curative measures and malaria). The hospital in Bududa town is a regional referral hospital with 120 beds where
49
malaria patients and patients with several other diseases are admitted when the condition of illness or sickness persists. In the hospital they are usually monitored and cared for by doctors and nurses till they get well and are discharged.
In Bududa district hospital, there is no initial prioritization of diseases but the various diseases can be prioritized in situations where there is increase. For example malaria cases in Bududa district hospital is received daily. About 40% of patients admitted daily (in-patients) are malaria cases (personal information according to the district health officer-focal person in charge of malaria). Although malaria may be prioritized because it is on the increase; the patient can be helped and treated faster if the drugs and medical staff are available (vacancies and work overload is a persistent problem). At the referral hospital in situations where the drugs free of charge are not available, the medical personnel’s will only prescribe the required drugs and the patient buys from the clinics and pharmacies in Bududa town. The drugs are usually available there, however patients have to pay. Those who cannot afford to buy drugs from clinics when admitted in the hospital will be monitored and treated in other ways. Other diseases too like cholera, diarrhea, typhoid fever and respiratory diseases resulting from the climatic variations and the physical environment are handled.
50
CHAPTER FIVE: CERTAIN IMPACTS OF CLIMATE VARIABILITY ON MALARIA OUTBREAK.
5.1 INTRODUCTION.
This chapter explores the impacts of climate variability in influencing malaria in villages of Buwanabisi (lower altitude), Bumakuma (middle altitude), and Bufukhula (upper altitude) in Bududa district, Uganda. The triangle of human ecology model adopted by Meade and Emch (2010) was used as the main analytical tool to discuss the impacts of climate variability (temperature and rainfall) in influencing malaria and other risk factors (population, environment and behaviour). The concept of risk factors of disease, causes of climate variability, climate change and health, controlling and preventing malaria is also used where applicable to help in supplementing and discussing the issues analyzed in this chapter. Information obtained through qualitative methods like field observation, individual and key informant interviews, focused group discussion and informal discussions will be presented in the empirical and analysis chapter five and six.