WINDHOEK – In Namibia, clean water for cooking, drinking and for adopting good hygiene practices is now accessible to more than 84 percent of the population.

However, as cities and towns grow, the demand for essential services for healthy living increases, and so do threats to health, especially among resource-constrained families who grapple with inadequate sanitation, limited refuse collection, pollution from congested traffic and families accessing water from untreated sources. 

This is the view of United Nations Children’s Fund (UNICEF) Chief of Communication, Judy Matjila, who took part in the commemoration of the 2018 Health and Hygiene promotion month last Thursday in Windhoek. According to the Namibia Demographic and Health Survey of 2013, more than 50 percent of Namibians, about 1.2 million people, practise open defecation and nearly one in four children under five is stunted. 

The World Health Organisation (WHO) estimates that 50 percent of malnutrition cases, including stunting, can be associated with repeated diarrhoea as a result of unsafe water or lack of good hygiene practices. The sanitation is equally challenging within schools, notes Matjila. A rapid analysis undertaken earlier this year by the Khomas School Health Taskforce at 22 schools, revealed that the number of water points at schools are sometimes insufficient for handwashing to be practiced all the time and soap is often not available due to limited budget allocation. “We welcome the latest directive from the Ministry of Education, Arts and Culture to make water and sanitation a priority in all schools in Namibia,” adds Matjila. 

Matjila further remarked that when hygiene practices are poor, people succumb to illnesses caused by viruses and bacteria which are picked up when shaking hands in greeting, when touching dirty surfaces, and when going to the toilet or when flies get in contact with food.

“When hygiene practices are poor, food can also become easily contaminated as food preparation is often done in unclean and unhygienic ways,” notes she. Food vendors and the consumers often neglect to exercise good personal hygiene such as handwashing with soap before or consuming food, she adds. “We all love kapana but kapana can be a source of our killing. We need to wash our hands before eating kapana and before cutting the meat,” says Matjila.

Her remarks were made in light of the current hepatitis E outbreak that continues to spread in various parts of Namibia, according to the health ministry in a report availed last week. The Ministry of Health and Social Services declared an outbreak of hepatitis E on 14 December last year. This happened after an increase in cases presenting with acute jaundice, which was observed from around September last year. 

To date, there are 3,630 cases of hepatitis E virus in seven of the country’s 14 regions. So far, 31 deaths have been reported, of which 14 are maternal deaths. Khomas tops the list with the highest number of hepatitis E cases at 2,542, Erongo has 638, Omusati 219, Oshana 81, while Ohangwena and Oshikoto both recorded 56 and Kavango (Andara and Rundu) has 28 cases, according to the most current National Hepatitis E situational report from the Ministry of Health and Social Services which is compiled on a weekly basis. 

Unfortunately, the disease continues to spread. And, although the public health response has been initiated, it has not been able to contain the outbreak of the disease in the country. On the contrary, it has become protracted and is spreading to other informal settlements in Windhoek and other towns in the country, according to the situational report from the health ministry.

Among other interventions, community-led total sanitation is recommended to ensure communities adequately participate in the process of appreciating the need and ownership of constructed water supply and sanitation facilities. “UNICEF has started the process of negotiating with the City of Windhoek which seem to be having an issue as they feel community-led total sanitation may lower the standards of toilet facilities in the town,” according to the report. 

The disease has been most prevalent in densely populated and under-resourced settlements, where toilets are limited and where handwashing with soap continue to be a perennial challenge, Matjila says. To remedy the situation, the Namibian Government with the support from UNICEF, WHO and the United Nations Population Fund (UNFPA) has been engaging communities with critical messages on how to prevent the disease by adopting hygienic practices, says Matjila. 

“We commend the government of the Republic of Namibia and the various municipal authorities for the current efforts to contain this outbreak. Extra support of soap and handwashing facilities has been given to some of these communities and schools that have been affected by hepatitis E and other waterborne diseases. It is our hope that supplies are being put to good use to prevent the further spread of diseases,” says Matjila. 

Festus Alukolo, the vice-chairperson of the Namibia Red Cross Society Governing Board, says hepatitis E is “spreading unabated in various towns and villages and the source of this emergency is the unhygienic lifestyles observed throughout the country, especially in informal settlements”. 

People should embrace the habit of washing hands and refrain from open defecation, advises Alukolo. 
“Let us refrain from littering, let us be committed to keeping our surroundings clean at all times,” adds Alukolo, who also spoke at the official commemoration of the Health and Hygiene promotion month event. The upcoming rainy season increases the risk of an outbreak of waterborne diseases as well as worsening the current spread of hepatitis E. “When it rains, all the rubbish and human waste is washed into or near our homes, thus exposing our families to germs and viruses. This is a disaster that we will always have to be prepared for if we do not change our lifestyles,” cautions Alukolo.