A crippling lack of handwashing and toilet facilities in Namibia's densely populated informal settlements has led to close to 7 500 hepatitis E infections and claimed six more lives since January.
Meanwhile, fears that the Covid-19 pandemic will spread like wildlife in the country's un
derserviced informal settlements has necessarily taken precedence over the hepatitis-E outbreak response.
The latest situation report on Namibia's drawn-out hepatitis-E epidemic, dated 17 March, shows that hepatitis E deaths rose from 59 in December to 65 by 8 March.
The report states the Covid-19 outbreak has diverted attention from the hepatitis E outbreak response, and “meetings do not discuss hepatitis E anymore.”
By 8 March, cumulative hepatitis E infections rose countrywide from fewer than 7 000 in December to 7 457.
Hepatitis E infections continue to be concentrated in the Khomas Region's informal settlements, the epicentre of the outbreak, where 219 new cases were reported between 13 January and 8 March.
A new hurdle is the depletion of rapid diagnostic testing kits, which is delaying the turnaround time for hepatitis E diagnosis.
The kits were ordered but their arrival was delayed, the report states.
No water, no toilets
“The main challenge in tackling the hepatitis E outbreak, in my view, is the fact that there is no adequate safe water supply and a lack of sanitation facilities, which make it cumbersome to curb the outbreak,” says Emmy-Else Ndevaetela, the incident manager for the hepatitis E response team.
Ndevaetela is the chief health programme officer in the health ministry's emergency preparedness and response subdivision.
She stressed that the battle against hepatitis is a multisectoral task, requiring the input of local authorities and other public and private stakeholders.
Ndevaetela said that even though much effort has gone into spreading the message that hand washing and refraining from open defecation are key to halting the spread of hepatitis E, “if there are no amenities or resources, even if they want to, it might not be an easy thing to do.”
One week ago, the Development Workshop Namibia (DWN) and the Namibian Chamber of Environment (NCE) launched the Covid-19 emergency programme for Windhoek's informal settlements, aimed at providing handwashing facilities to thousands of households.
The DWN and NCE have for months worked with authorities and donors to establish a community-led sanitation programme in affected areas to improve access to water and toilets.
The DWN stressed last week that “Windhoek's informal settlements with more than 180 000 residents are likely to be the first and hardest hit by Covid-19 over the coming weeks in terms of health, and then also economically as the crisis will unfold.”
They said the high population density will make social distancing difficult, and limited access to water and a general lack of good sanitation practices provide challenges for frequent handwashing.
Moreover, the DWN and NCE warned that “poverty and very limited resources will not allow for people to stay at their homes when lockdown measures come into effect.”
The emergency programme is aimed at providing at least 65 000 households with 'Tippy Tap' handwashing units within weeks. On Wednesday the programme was launched in the Moses Garoeb Constituency with the deployment of a team of 15 trained volunteers who set up 55 handwashing units within three hours, to be shared between an average of three households. The DWN said the goal is to install around 130 Tippy Tap units per day, to reach an average of 400 households. This Friday another team of 15 volunteers will start working in Samora Machel constituency, and early next week, two other teams in Tobias Hainyeko and Khomas East constituencies.
“By the middle of next week, a total of four teams with 60 volunteers will, therefore, be installing some 500 units a day, reaching to 2000 families,” the DWN said on Thursday. Over 10 days, this will be 5 000 units reaching 20 000 families, and in 20 days, 10 000 units reaching 40 000 families.