By Esther Dhafa
Every year on 31st May the World Health Organisation (WHO) and Global Partners celebrate the “World No Tobacco Day”, an annual campaign aimed at raising awareness on the harmful and deadly effects of tobacco use and second-hand smoke exposure, and to discourage the use of tobacco in any form.
This year, the World No Tobacco Day was celebrated under the theme “Protecting youth from industry manipulation and preventing them from Tobacco and Nicotine use”. The 2020 global campaign serves to equip young people with knowledge about the tobacco and related industries’ intentions and tactics to hook current and future generations on tobacco and nicotine products.
Tobacco use and COVID-19
This year’s commemoration came at a time when the world was facing the coronavirus pandemic. This brought forth an opportunity for countries all over the world to step up tobacco control efforts, heighten information sharing on tobacco use and COVID-19, and broaden understanding of the link between tobacco use and COVID-19 infection. It is also an opportunity to accelerate contextualised tobacco control, informed by the WHO FCTC Guidelines on the obligations of member states to counter tactics used by the tobacco industry. This is because the tobacco industry has for a long time deliberately employed strategic, aggressive and well-resourced tactics to attract people to use tobacco and nicotine products.
According to the WHO Fact sheet/Detail on Tobacco published on 26th July 2019, tobacco use continues to kill up to half of its users. The fact sheet adds that it kills more than eight million people each year of which more than seven million of those deaths are the result of direct tobacco use while around 1.2 million are the result of non-smokers being exposed to second-hand smoke.
This year, we emphasise the fact that tobacco use and smoking in particular is a risk factor for COVID-19, an infectious disease that primarily attacks the lungs. As smoking is a leading risk factor for heart disease, lung cancer, reduces immunity and makes us more susceptible to respiratory infections including pneumonia, it is also a risk for COVID-19 infection. This is especially because smokers touch their mouth and face more. A review of studies by public health experts convened by WHO on 29th April 2020 found that smokers are more likely to develop severe cases of COVID-19, compared to non-smokers.
Recent studies have continued to show that smokers who contract the virus are more likely to suffer severe symptoms and even die. Once a smoker has been hospitalised for COVID-19, the outcome is likely to be even worse. Smoking is detrimental to the immune system and its responsiveness to infections makes smokers more vulnerable to infectious diseases like Coronavirus. (Zhou Z Chen P Peng H are healthy smokers’ really healthy? Tob Induc Dis. 2016; 14 (November). Doi: 10.1186/s 12971-).
There are also higher percentages of current and former smokers among patients that need ICU support, mechanical ventilation, or who have died and a higher percentage of smokers among the severe COVID-19 cases (Guan WJ, Ni ZY, Hu,Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020). Smokers are therefore more likely to have severe symptoms of COVID-19, and are more likely to be admitted to an ICU, or require mechanical ventilation or die compared to non-smokers.
Impact of the covid-19 pandemic on tobacco control implementation in Uganda
Since the start of the pandemic, tobacco control efforts have since been significantly impacted. Implementation of tobacco control measures is coordinated under the Ministry of Health (in one of the departments that tackles tobacco use, NCDs, mental health, alcohol and substance abuse), and yet the MOH’s involvement and efforts are entirely directed towards response to COVID-19 as a priority.
The government has also continued to receive donations from tobacco industries (Leaf Tobacco and Merchandise Ltd, Meridian Tobacco Company) towards the COVID-19 National Taskforce/Response as stated in the national address by His Excellency the President on Tuesday 14th April 2020, contrary to Section 22 of the Tobacco Control Act 2015 and the WHO FCTC.
The Government must be weary of donations that compromise public health as it is their duty to protect the public health, laws and policies from commercial and other vested interest of the Tobacco Industry. By donating, the Tobacco Industry is trying to improve their corporate image by showing social responsibility to the population, and sending deceptive messages to the public about Tobacco industry operations and their products. Partnership with the Tobacco Industry also undermines Government’s credibility in protecting people’s health since there is a fundamental and irreconcilable conflict between the Tobacco Industry’s interests and Public Health Policy interests.
This comes at a time when Ugandans are in a lock down for over 2 months now and are at home bored, which makes many of them easily get the temptation to smoke cigarettes or related products, contrary to what the law provides.
Way forward and Conclusion:
As we commemorate the World No Tobacco Day on 31st May 2020 and recognizing the fact that smoking could increase the risk of people contracting COVID-19 more, we call upon Government, young people, and the entire population to;
- Support implementation of the Tobacco Control Act 2015 and the WHO FCTC.
- Join hands to make healthy lifestyle choices through avoid the use of tobacco and related products
- Educating themselves and others to support the Tobacco Control cause through complying with the tobacco control and public health measures in place
Adhering to these will help reduce the morbidity and mortality of cancers caused by tobacco smoke and COVID-19 as well.
The writer is a Programme Officer in the Campaigns, Partnerships and Networks Programme.
MINISTRY OF EDUCATION AND SPORTS
P. O. BOX 7063 Kampala, Uganda
In Uganda, the first case of COVID-19 was reported on March 21st 2020 from a traveler returning home from Dubai. He was intercepted at Entebbe International Airport. Since then, the confirmed cases have risen to 657, with 118 recoveries and no deaths as of 9th June 2020. Most of these cases are “imported” as they are from returning travelers or their contacts. However, there have been a few identified from the community, confirming that there is community transmission in Uganda.
Several measures intended to flatten the pandemic curve in Uganda were adopted, including the closure of schools due to the fact that social distancing was not practically possible in our school setting. These measures have been effective and we applaud His Excellency the President of Uganda for the leadership as well as the COVID-19 task force at the Ministry of Health. The Uganda education system has over 15 million learners with an additional 600,000 attending schools in refugee settlements. In your maiden address to the nation since the closure of schools, you highlighted April 27th 2020 as the tentative date for the reopening of schools and higher institutions of learning.
However, the increasing number of cases of COVID-19 in the country resulted in the extension of the lockdown by 21 days. This prompted your second address in which you noted that schools would not reopen as initially communicated. In the same address, you emphasized the need for continuation of learning despite the delayed re-opening of schools and issued various strategies to facilitate this process including; radio, television, and self-directed learning materials that would be disseminated in the national newspapers.
“On the continuity of learning, I informed you that this happens beyond the four walls of a classroom but reinforced by effective implementation of the whole curriculum. In the present circumstances of total lockdown, the greatest contributors to learning are the parents and immediate family” – Hon. Janet Kataaha Museveni, Minister of Education and Sports.
In his 15th National address on COVID19, the president noted that schools re-opening will only be considered after a month from the 28th May 2020 with only learners in candidate classes being allowed to resume school. Civil Society Organizations advancing the sexual and reproductive health and wellbeing of individuals across Ugandan communities, recognize the timely and monumental strides made by the Ministry of Education and Sports under your leadership to ensure continuity of learning despite the lock down. As these innovative strategies are being adopted across communities, other issues that could potentially impede the successful learning of young people remain partially unaddressed.
The inequalities and inequities further exacerbate the already existing inhibitions to learning as indicated below;
- The proposed methodologies of learning prioritize traditional subjects. However, sexual and reproductive health needs of young people have not been prioritized, including access to correct, age-appropriate, and culturally sensitive information which facilitates informed decision making regarding their health and lives.
- The disruption in the school syllabus could result in work assignment overload for learners in a bid to make up for lost time, which could cause stress and compromise the mental health and wellbeing of both learners and teachers. This may push some children to lose interest in learning due to the pressure, teachers failing to complete the syllabus yet exams can be set from anywhere, leading to low grades, and eventually school dropout.
- Learners from hard to reach areas and those with special needs may experience difficulties in accessing learning materials as disseminated on the various platforms and channels.
- The learners living in child-headed and economically deprived homes are likely to benefit less from the proposed strategies of learning as their priorities are divided between meeting their basic needs and dedicating time to learning- yet accessing the learning materials is close to impossible for most of them.
- The capacity of parents is not strengthened enough to bridge the sexual and reproductive health information gaps and ably support learners during this period to appreciate sexuality education which also includes information on growth, puberty, fertility, dangers of early sex, and pregnancy among others.
Developing and establishing robust crisis response strategies for the learners in candidate classes that have so far been directed by the president to resume school in a months’ time and those still in the during the lockdown and to ensure their overall health and wellbeing. Therefore, the Civil Society Organizations propose that the Ministry of Education and Sports;
- Expedites the passing and implementation of the National School Health Policy to guide and rejuvenate the school health programmes post the COVID-19 pandemic.
- Operationalizes the National Sexuality Education Framework as per the presidential commitment at the ICPD+25 conference in Nairobi, See
- Establish mechanisms of protecting learners and teachers as schools re-open, ensuring that they have masks, hand washing facilities, temperature guns, among others to minimize the spread of the virus.
- That the Ministry revises the school calendar and supports the school administrators to adjust to the revised calendars to avoid panic in schools in a bid to complete the syllabus.
- That the Ministry ensures that all schools have psychosocial support to meet the mental health and sexual reproductive needs of learners and teachers. Train senior women and male teachers on how to provide counselling and deal with the different health needs of young people, including implementation of the Girl child School Re-entry and Retention Strategy to give any girls who may report to school with pregnancies, an opportunity to continue with their studies
- Ensure liaison of schools with nearby health centers and that the test kits for the COVID19 are available and accessible in the various healthcare centres at any time for access by schools.
- Address the unique health challenges of adolescents like sexual and gender based violence, teenage pregnancies, menstrual health and HIV, among others within the learning medium and materials shared for learners.
- That the Ministry of Education and Sports establishes the Operational Standard Procedures and guidelines to direct learning institutions operate amid COVID19 and establish a feasible and coordinated plan to ensure that the public health preventive measures of COVID19 such as installing hand washing facilities , social distancing, and wearing of masks, among others are in place.
- That Ministry of Education and Sports works with operators of the institutions of learning to devise practical measures for school fees payment and opportunities to educate their children amid the financial constraints that the response to COVID-19 has created, as many people have stopped working. Post COVID-19, this will prevent learners from dropping out of school as a result of defaulting on school fees.
We will appreciate your timely response and action.
- Center for Education, Graduate Entrepreneurship and Empowerment
- Center for Health, Human Rights and Development
- Joy For Children Uganda
- Naguru Teenage Center
- Partners in Community Transformation
- Philomera Hope Foundation
- Public Health Ambassadors Uganda
- Reach A hand Uganda
- Reproductive Health Uganda
- Sexual and Reproductive Health Alliance Uganda
- Teach for Uganda
- Uganda Health Marketing Group
- We talk series Uganda
- White Ribbon Alliance Uganda
- Youth Equality Center
A version of this article was originally published in the Daily Monitor on Friday 19th June 2020.
By Collins Muzaale
In February 2020, the government of Uganda under the Ministry of Health announced the outbreak of COVID-19 s. The state under the directives of His Excellency President Yoweri Kaguta Museveni enforced measures to curb the spread of COVID-19, which is reported to be airborne, contagious and easy to spread.
Unfortunately some of the state measures have hindered young people, women and men’s access to health services & rights, living, and finances. Most notable of these measures are the ban on public and private transport, and the ban on the majority of business, as long as they don’t provide essential services.
The above means that everyone who operates different types of business such as taxi drivers, conductors, tailors, bar attendants, shopkeepers are not working but instead staying at home, idle. As a result of this idleness, we have seen an increase in reports of gender based violence (GBV) among men and women and alcoholism. Gender based violence refers to the violence directly against a person because of their gender. While both women and men experience GBV, the majority of victims are women and girls.
In the sub-counties of Mayuge District such as Wairasa and Magamaga, local leaders such as the LC1, LC II and the police agree that there has been an increase in cases reported ever since the President issued the different directives to prevent COVID-19. As Community Health Advocates, one of our objectives is to stop family conflicts and gender based violence in our societies. Therefore, when we heard of these violations happening in our communities, we reached out to the local leaders to identify the likely causes. Some chairpersons at local council level believe that all these violations are as a result of people being idle as they stay at home.
The LC1 chairperson of Kawudu Zone Village, Magamaga town council in Mayuge District, Mr Mohammad Waibi said, “A big number (60 per cent) of men from his village were not staying at home [for this long] but due to the presidential directives, they have been forced to stay at home. These are the very people fighting with their wives and mistreating them.” He further stated that during the COVID-19 lockdown, he has received at least one case every three days, which was uncommon in the past.
Mr Waibi added, “Recently, I received a case of a pregnant woman who was beaten by the husband accusing her of asking him for money for food. I called the husband and he told me his wife knows very well that he had to stop working due to the COVID-19 directives but still insists on asking for money.” The LC1 therefore calls upon the government to lift some of these measures to enable some men go back to their jobs in order for these cases related to gender based violence to decrease. He was grateful to the Center for Health, Human Rights and Development (CEHURD) in collaboration with Community Health Advocates for supporting communities in matters of health, gender based violence and human rights through sensitisation, raising awareness and dialogues.
As Community Health Advocates trained by CEHURD to fight against such human rights violations in our societies, we appeal to the government of Uganda to hear the outcry of the people and adopt a human rights based approach in minimising the spread of COVID-19. This will save lives of people, especially women who are at a high risk of experiencing gender based violence. Failure to do this may unfortunately negatively impact the most vulnerable in the communitings (women/girls) resulting into death due to poor medical health care and increased rape, sexual harassment, poverty due to lack of jobs, family neglect, high health violations, teenage pregnancy, early child marriages, unintended pregnancies due to lack of access to family planning, and discrimination among other issues.
The writer is one of CEHURD’s Community health advocates in Mayuge District.
Earlier this week, the world marked International Day to End Fistula. Edith Sifuna , a programme officer in the CPN Programme discusses the condition and how the response to COVID-19 is an opportunity to create awareness about obstetric fistula.
In May 2020, the World Health Organisation (WHO) declared Obstetric fistula as preventable and can largely be avoided by delaying the age of first pregnancy; the cessation of harmful traditional practices; and timely access to obstetric care. The fight to end fistula, one of the most serious and tragic injuries that can occur during childbirth, could be threatened by the current COVID-19 pandemic. Due to the pandemic, it is expected that 13 million more child marriages could take place by 2030 that would have otherwise as a result of economic pressure. As we marked this year’s International Day to End Fistula under the theme; “End gender inequality! End health Inequalities! End Fistula Now!” it is important that the international community comes up significantly to raise awareness and intensify actions towards ending Obstetric Fistula.
At the beginning of 2020, the World Health Organisation (WHO) confirmed COVID-19 as a public health emergency of international concern. The virus has put a strain on health systems worldwide. Countries including Uganda have put guidelines and directives in place to curb its spread. While these have indeed worked to stop the spread of the virus, they have adverse effects on public health systems, particularly maternal health.
In the midst of all these efforts, there is a danger that may take many women’s lives or inflict permanent physical and social injury. This seldom talked about danger is obstetric fistula. Obstetric Fistula has been placed among the most neglected components of maternal health during COVID-19 yet it is likely to have a devastating impact on the wellbeing of both women and girls of ages 15 to 49 years. Obstetric Fistula occurs as a result of prolonged obstructed labour, which is usually associated with delays in seeking and receiving appropriate emergency obstetric care. This leads to a hole developing either between the rectum and vagina or bladder and vagina leading to odour, infertility and chronic infection.
In Uganda, apart from the low quality health care, fistula cases have been on the increase due to different cultural practices such as child marriages for economic gains by the parents/guardians, child prostitution resulting into early unplanned pregnancies, and traditional practices like female genital mutilation. These have highly exposed women within the reproductive age to complications at delivery as their bodies are not biologically ready to support a pregnancy, increasing chances of complicated child deliveries. This has been coupled with high poverty rates, especially among women, which deters access to quality health care services.
According to a Uganda Demographic and Health Survey (UDHS) report, a reduction in fistula prevalence from three per cent in 2006 to two per cent in 2011 was reported. Notably, 62 per cent of the affected women received treatment. Despite the treatment and efforts to curb the disease, it still affects the health, social, economic and psychological wellbeing of women, gradually affecting their productivity as individuals and the family.
In addition to the effects already mentioned, fistula also leads to inability to hold urine for a long time, persistent abdominal pains, failure to give birth again, low sex drive and discrimination from family, society and premployment.
Despite the fact that Fistula can be prevented and treated, the survivors continue to suffer from shame, rejection, isolation, trauma and stigma from partners and communities even after treatment and recovery. Gender based violence has also been noted to increase as men opt to find other women who are free from fistula. Domestic violence also stems from the economic strain on the family in the form of costs for surgeries to repair the damage, and purchase of recovery materials and equipment like adult pampers and medicines. With this, most Fistula cases go untreated as women are afraid to admit to the condition or too poor to afford the treatment. As women continue staying safe at home, they are likely to give birth at home assisted by traditional birth attendants or while they are trying to access healthcare facilities. These circumstances can lead to obstructed labour.
“COVID19 has increased the effects of fistula due to restricted movement, patients with fistula repairs were not able to access hospitals to have their repairs done as only emergency cases were being handled while others were stranded as they could not go back home after treatment. Fistula cases have increased due to failure to access hospitals early for delivery or antenatal care resulting in obstructed labour complications such as bladder injuries, fistula and morbidity. It was really absurd that a lady lost her baby as she could not reach the nearby health facility in Bussi and receive treatment as a result of restricted movement and she is now suffering from effects of birth complications and fistula. If this woman had accessed healthcare services on time, her baby would have been saved and complications avoided. With the current trend, there will be many cases of women suffering from fistula, childbirth complications and morbidity. It is therefore important that women are given easy access to hospitals despite COVID-19 and the restrictions. Proper structures for management of complications due to obstructed labour should also be put in place. It is important to strengthen community structures to identify, monitor and refer women for treatment.” A Fistula Surgeon!
With all efforts geared towards COVID-19, it is easy to overlook conditions such as fistula. It is therefore necessary that a comprehensive and holistic fistula care and prevention approach is put in place to restore and preserve the confidence and dignity of victims. This can only be realised if the Government and different stakeholders create awareness about prevention and treatment of obstetric fistula in this era, integrating this into the current guidelines. As women continue staying safe at home, they are likely to give birth at home, from Traditional Birth Attendants or along the way while trying to access health care facilities and may be faced with obstructed labour. Health services have become overloaded and maternal health care services somehow neglected as all efforts are geared towards COVID-19.
It is imperative that there is timely access to comprehensive safe delivery services and emergency obstetric care through bridging the unmet need for maternal health care to prevent women from suffering as they perform their natural maternal function. Maternal mortality is a major challenge in Uganda and any set back in the health system will increase the rate at which women die hence the need to come up with quick and effective medical interventions and guidelines for women to easily access health care services to minimize preventable complications due to delay to access health services and information.
In the current COVID-19 situation, it is important that sexual and reproductive health services such as timely obstetric care and treatment for fistula patients are easily accessible. Information on the same should also be available, not to mention the need to strengthen patient referral and follow up mechanisms.
We must therefore stand together to prevent childbirth complications such as Obstetric Fistula. We can do this by providing comprehensive and universal quality maternal health care services and information, and prioritising women with existing fistula conditions in the face of COVID-19. This is because Obstetric Fistula is a serious and potentially tragic condition. A multi-sectoral approach to raising awareness and intensifying actions towards ending it would therefore restore hope, joy and self-esteem among women as they continue performing their maternal right during the COVID-19 pandemic.