Emerging and reemerging epidemic-prone diseases among settling nomadic pastoralists in Uganda.
Epidemic-prone diseases have traditionally been uncommon among nomadic pastoralists as mobility allows already dispersed populations to migrate away from epidemic threats. In the Karamoja region of Uganda, nomadic pastoralists are transitioning to an increasingly settled lifestyle due to cattle raiding and associated civil insecurity. In attempts to reduce conflict in the region, the Ugandan government has instituted disarmament campaigns and encouraged sedentism in place of mobility. In Karamoja, this transition to sedentism has contributed to the emergence and reemergence of epidemic-prone diseases such as cholera, hepatitis E, yellow fever, and meningococcal meningitis. The incidence of these diseases remains difficult to measure and several challenges exist to their control. Challenges to communicable disease surveillance and control among settling nomadic pastoralists are related to nomadic mobility, remote geography, vaccination and immunity, and poor sanitation and safe water access. In addition to improving gaps in infrastructure, attracting well-trained government health workers to Karamoja and similar areas with longstanding human resource limitations is critical to address the challenges to epidemic-prone disease surveillance and control among settling nomadic pastoralists. In conjunction with government health workers, community health teams provide a sustainable method by which public health programs can be improved in the austere environments inhabited by mobile and settling pastoralists.
New York-Presbyterian Hospital/Columbia University Medical Center, Department of Medicine, 177 Fort Washington Avenue, New York, NY 10032, USA. Electronic address: mjc2244@columbia.edu.
Matthew J
MJ
Cummings
Ministry of Health, Department of National Disease Control, Epidemiology and Surveillance Division, PO Box 7272, Kampala, Uganda.
Joseph F
JF
Wamala
World Health Organization, Karamoja Field Office, PO Box 4, Moroto, Uganda.
Innocent
I
Komakech
Ministry of Health, Department of National Disease Control, Epidemiology and Surveillance Division, PO Box 7272, Kampala, Uganda.
Mugagga
M
Malimbo
Ministry of Health, Department of National Disease Control, Epidemiology and Surveillance Division, PO Box 7272, Kampala, Uganda; Makerere University School of Public Health, Department of Epidemiology and Biostatistics, PO Box 22864, Kampala, Uganda.
Luswa
L
Lukwago
D021821:Communicable Diseases, Emerging / Q000453:epidemiology*; D058872:Epidemics; D063426:Human Migration; D006801:Humans; D015994:Incidence; D014171:Transients and Migrants; D014454:Uganda
Cholera; Hepatitis E; Meningococcal meningitis; Nomadic pastoralism; Uganda; Yellow fever