Our Work: Better Disease Management in Central Uganda

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For years, Ester Nakamya struggled with stigma. A health assistant at Kasana Health Centre in Luwero, Uganda, her job was to educate people about TB and encourage them to be tested and treated if they were infected.

But TB was not well understood and that made her job difficult.

“Someone with TB was assumed to be promiscuous. People believed that TB was fatal and you would die very quickly,” she says.

Compounding the problem, the links between TB and other diseases, such as HIV/AIDS and malaria — the diseases responsible for the greatest number of deaths in Luwero — were not well delineated. Patients were often tested and treated for one disease but not necessarily all three.

Yet research shows that half of all TB patients in Uganda are also HIV-positive, and nearly a third of AIDS deaths are the result of TB-related complications. Likewise, an HIV-positive person is more likely to die from malaria, and malaria can increase viral loads and the risk of mother-to- child transmission.

When a person is infected with multiple diseases but diagnosed and treated for only one of them, they are much less likely to recover. This in turn reinforces the perception that TB and HIV/AIDS are devastating, terminal illnesses.

“People who were infected [with TB] didn’t want to go to the hospital,” says Ester. “They were ashamed, and they saw no point.”

Yet when treated at the same time, TB and malaria can be cured and HIV/AIDS can be managed effectively. In 2006, with support from AstraZeneca, AMREF launched MAT, an integrated disease management programme in central Uganda.

Designed to tackle all three diseases simultaneously, MAT trains village health volunteers like Ester to collect data using questionnaires translated into local languages and then feed them into the district health management information system.

Health authorities in the Luwero and Kiboga districts now have a more accurate picture of the local disease burden and are thus better able to manage drug supplies and allocate resources.

Through an integrated referral system, the MAT programme also helps government health departments to work more seamlessly together, taking a big-picture approach to disease management.

Two years into the five-year pilot programme, AMREF and Ester have already seen changes, both in the health of patients and in overall attitudes towards TB and HIV.

“People seek treatment more often now,” says Ester. “I was touched to hear one of my patients tell me that ‘Tetukyali babisi ku ndwadde zi namutta ng’edda,’ meaning, we are no longer ignorant about the killer diseases like before.”