Four focus group discussions were conducted with the local council chairpersons 1 (LC 1) and village health teams (VHTs) in the two Sub Counties. Key informant interviews were conducted with the Kitgum District Health Officer, in-charges of HC IIIs, and LC III chairpersons of the two Sub Counties.
The prevalence of Hepatitis B in Mucwini and Kitgum Matidi Sub Counties
According to the study, 97(41.99%) participants from Mucwini were reported to have had cases of Hepatitis E in their household compared to 63(26.47%) in Kitgum Matidi Sub County.
Two by two table showing proportion of households with a reported member of the family having Hepatitis E by Sub County
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Suffered from Hepatitis E
Table 1 shows a two-by-two table, and the reported prevalence of Hepatitis E is higher in Mucwini Sub County 97(41.99%) than in Kitgum Matidi 63(26.47%) at 95% Confidence Interval (95% CI): χ2 = 1.61, 95% CI:1.39-1.87; p<0.001.
The difference in the prevalence of Hepatitis E in the two Sub counties was discussed by respondents in the vital informant Interviews (KIIs). Ranking the most typical health problems that affected the Sub County in 2011, the LC III chairperson of Mucwini Sub County said, “………………………..Hepatitis E was very serious, followed by malaria, chest infection, and HIV. Many pregnant women had stillbirths and miscarriages due to this yellow disease. Many people in my community resorted to local herbs and traditional healers for the solution.”
The counterpart in Kitgum Matidi said, “Respiratory infection, malaria, and abdominal complaints were major health-related problems affecting the sub-county. Hepatitis E did not affect many of us because the village health team and LC 1 Chairpersons.”
Hepatitis E prevention practices in homesteads in Kitgum Matidi and Mucwini Sub Counties
The report from the study showed that the percentage of homesteads that used pit latrine correctly, ate hot food, and washed hands after latrine use during the Hepatitis E epidemic were higher in Kitgum Matidi compared to Mucwini Sub County. It was not surprising that a more significant proportion of participants from Mucwini had not participated in proper Hepatitis E prevention practices compared to their counterparts in Kitgum Matidi.
Hepatitis E prevention practices in homesteads in Kitgum Matidi and Mucwini Sub Counties in Kitum district.
Reports from the study show that communities from the two Sub Counties responded differently to their communities' infection, prevention, and control practices on Hepatitis E. The differential occurrence of the virus may be related to the community practices to the epidemic.
Figure 2 shows the percentages of homesteads that used pit latrines correctly, ate hot food, drank clean water, and washed hands after using the restroom, higher in Kitgum Matidi Sub County than Mucwini.
A member of the village health team (VHT) in a focus group discussion from Mucwini said, “………..people in our community do not listen to what is always communicated. Other people up to now do not use pit latrines but go to the bushes for defecation, claiming that they have been recommended not to do hard work, for example, digging pit latrines in their homes.”
Another member in the same group from Mucwini lamented, “……the community is used to getting free items like they were previously in the Internally Displaced Peoples (IDP) camps where things were given free even items for digging, jerrycans and soap.”
The laxity in the use of pit latrines was mentioned as a challenge during the critical informant interview with the Mucwini Sub County local council III chairperson who said, “……………. latrine coverage in this Sub County is still low at 45%. Most residents share latrines or use bushes for defecation. Leaders (LC) of communities are relaxed to enforce some byelaws because VHTs are better paid.”
During one of the Focus Group Discussions (FGD), a member of the VHTs from Mucwini said, “we have been advising our community against communal washing of hands during funerals and weddings, but the community here are resistant to these messages and continue to do so even during this epidemic.”
On the other hand, a member of the VHT from Kitgum Matidi said, “We have advised the community against the practice of communal hand washings during ceremonies, and we see communities are following our advice during this epidemic. We are informed that communal hand washings only occur in homes among children before and after eating food”.
In one of the focus group discussions in Mucwini Sub County, one LC 1 Chairperson said, “we have advised community members to dig pit latrines, build standby water stand near the latrine, and encouraged members to use them correctly. We were dismayed to learn that some members have refused to dig pit latrines in many communities and continued to use bushes. In addition, they do not wash their hands after latrine use”.
While in a focus group discussion in Kitgum Matidi Sub County, a councilor said, “Ever since the Hepatitis E epidemic broke out here, many families have heeded to the health advice and have dug many pit latrines in their homes and used them correctly. In addition, they have constructed a water point for washing hands after latrine use. The community’s response has been very encouraging, and this collaboration is helping us reduce the number of new cases of the virus”.
During one of the focus group discussions in the Mucwini sub-county, a member of the VHT said, “We in Mucwini have had problems during the implementation of this epidemic control measures. We should agree to be frank today, especially on issues that affect leaders and health workers. We have been informed that councilors were not supporting our efforts in community health education due to differences in allowances paid to VHTs. This has made us have conflicting messages to the population during this tough time, and community response is feeble.”
On the other hand, a VHT in Kitgum Matidi, in a focus group discussion, said, “We have been having good meetings with the community, the local leaders, and VHTs. These meetings have helped us control the Hepatitis E virus in our community. The infection prevention and control messages have been taken up well by the community”.