The WASH conditions of fifty two (52) Health Care Facilities (HCFs) in Hoima District was assessed from 14th -23rd November 2016. This assessment was conducted in ten (10) sub counties in the district. Data collection was conducted using the WASH Conditions (WASHCon) tool on a Commcare mobile application comprised of surveys, observations and water quality analysis. The observations and surveys were conducted by trained enumerators using a mobile device and generally took less than three hours with one enumerator per HCF site to complete (depending on the size of the facility). Ten (10) HCFs were assessed for observations and surveys by ten (10) enumerators per day for 5 days i.e. one (1) HCF per enumerator per day for 5 days. In addition, at-least four (4) HCFs were analyzed for water quality by two (2) analysts per day for ten (10) days.
The data collection using the WASHCon tool in Hoima District was conducted from 14th – 23rd November 2016 in conjunction with World Vision Uganda. The data was collected using Commcare application on android mobile devices. The data collection included surveys, observations and water quality analysis on chemical and bacteriological parameters specifically E. coli and free chlorine.
During the bacteriological analysis of the water, aseptic methods were used to avoid contamination of the sample. Test for Escherichia Coli (E.Coli) using the IDEXX Quanti-tray method with Collilert 18 as the reagent and measured using Most Probable Number (MPN) per 100 milliliters (ml) of water. Chemical tests were done using the portable HACH chlorine test kit to measure free chlorine in milligram / liter (mg/l). The data collected from the five domains i.e. water supply, sanitation, waste management, cleaning routine and hand washing facilities was evaluated using the Emory University Center for Global Safe Water, Sanitation and Hygiene (CGSW) scorecard and color coded either red, yellow or green to illustrate the status of conditions.
7.6% of the HCFs i.e. Buhuuka, Buseruka, Lucy Bisereko and Kaseeta were the worst performing HCFs in regards the five domains with an average of ?1.8: indicating the absence of WASH services or presence of unimproved services. Only 3.8% of the 52 HCFs i.e. Kasonga and Bujumbura had basic WASH services and majority of the HCFs i.e. 88% had limited WASH services. In all, seventy eight (78) sampling points from the fifty two (52) HCFs analyzed, twenty four (24) i.e. 30.76% of them tested positive for E.Coli. All the sampling points from all the HCFs in Kyabigambire Sub County had no traces of E. Coli while all those from Buseruka sub county had E.Coli. Most of the water at the HCFs was either rain water or borehole water with no traces of free chlorine and as such only three (3) HCFs i.e. 3.85% had free chlorine levels that were within the acceptable range as per Uganda National standards for portable drinking water.
The high number of HCFs with poor WASH conditions and presence of E.Coli exposes both the patients and staff in the 52 HCFs in Hoima to preventable nosocomial infections thus weakening the health outcome and overall worse experience of care for especially pregnant women. Ultimately increasing the risk of maternal mortality and preventable neonatal deaths and general health.