Drinking untreated water increases risk of mycobacterial infection

Infections caused by mycobacteria (bacteria which are the cause of diseases such as tuberculosis in humans and animals) have a great impact on public health, animal health and the health of ecosystems in rural areas of Uganda. Nevertheless, little attention has been paid to these infections and few resources earmarked to combat them. In order to control infections of this kind, the supply of drinking water needs to be upgraded, environmental hygiene enhanced and information about infection prevention spread amongst the population.

These are the conclusions of Clovice Kankya's doctoral thesis, which is a study of the socio-anthropological, socio-economic and public health consequences of mycobacterial infections. He has carried out analyses of how local knowledge and beliefs/superstitions affect the local population's attitude to mycobacterial infections, seen in the context of social and economic status.

Drinking untreated water from water sources used by both humans and animals and living in close proximity to domestic animals are factors that put people at the highest risk of being infected by mycobacteria. A study of slaughtered animals revealed that there were pathological changes in the lymphatic glands of 9.3% of the slaughtered pigs, indicating infection by mycobacteria, and in 3.2% of these, the bacteria grew in laboratory cultures. This indicates that mycobacteria exist in the environment and that humans, domestic animals and wild animals infect each another.

The social demographic environment and housekeeping habits affect the incidence of infection to a large degree. Mycobacterial infections are called akakonko, akasubba or akafuba due to the chronic coughing and other respiratory problems they cause. The level of knowledge, attitudes, traditions, smoking and many people living close together and using, for example, the same glass to drink from are all factors that lead to a risk of infection between humans.

Drinking untreated water and milk and the use of healers and herbal medicines are the cause of infections transmitted from animals and the environment to humans. The study showed that 65% of the respondents used local healers and herbs, while 35% used modern medicine to treat infections. Ignorance about mycobacterial infections and simultaneous HIV/AIDS infections has also resulted in social stigmatisation and discrimination of sufferers in rural communities.

Clovice Kankya's research uncovered a broad spectre of potentially pathogenic non-tuberculosis mycobacteria (NTM) in rural community environments in Uganda. The above-mentioned risk factors can lead to both humans and animals becoming NTM-infected in these ecosystems.

Clovice Kankya advocates a holistic and interdisciplinary approach ("one health, one ecosystem") in order to combat the increasing incidence of infection between humans and animals. He has therefore used a combination of advanced microbiological methods and anthropological methods in his research.

He proposes that small, local health centres should be established for the treatment of mycobacterial infections. The rural population must be taught how these infections arise, both with a view to avoiding infection, but also in order to reduce the social stigmatisation and discrimination that such infections give rise to. Another objective is to reduce the costs incurred by such diseases, both to individuals and society at large. Kankya therefore recommends the introduction of good environmental and household hygiene and improved management of drinking water systems, where purified drinking water is supplied through closed pipelines.

Kankya's doctoral research was conducted mainly in Uganda, while the laboratory and data analyses were carried out at The Norwegian Veterinary Institute and at The Norwegian School of Veterinary Science. Clovice Kankya defended his doctoral thesis on 13^th December 2011 at The Norwegian School of Veterinary Science. The thesis is entitled: «Socio-anthropological perspectives and the public health implications of mycobacterial infections and management at the human-environment-livestock-wildlife interface in the pastoral ecosystems of Uganda".

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