Waterborne diseases burden, determinants and health system gaps in Eastern Uganda: a mixed-methods baseline study in...

Waterborne diseases remain a major public health challenge in Eastern Uganda, driven by inequities in water access, sanitation quality, hygiene practice and health system constraints. A baseline study to characterize disease burden, WASH conditions, and care-seeking behaviors in the Busoga sub-region was conducted in Jinja City and Jinja and Iganga Districts.

Data were triangulated from District Health Information System, household surveys, and Water, Sanitation and Hygiene assessments in schools and health facilities, complemented by observations, focus group discussions, and key informant interviews. Quantitative data were analyzed using STATA, while qualitative data were transcribed and thematically analyzed.

There was higher waterborne disease incidence in Jinja City (5.4%), Jinja District (5.3%), and Iganga (4.6%). However, household surveys confirm 3.8% incidence reported in the program supported villages and 5.9% in the non-program supported villages. Access to improved water sources was highest in Jinja city (72%) and lowest in Iganga (53%), while regular household water treatment remained limited (23%-41%). Although sanitation coverage appeared relatively high (75%-81%), qualitative and school data revealed major quality and equity gaps, including overcrowded school latrines. Handwashing practices were inconsistent, with only 32% of households observed to have soap and water at designated handwashing stations, and only 45% of schools and 46% of health facilities consistently having soap and water available. Waterborne diseases incidence was associated with non-program support villages (RR = 1.72, 95% CI: 1.20-2.45, p = 0.003), use of unimproved water sources (RR = 1.85, 95% CI: 1.30-2.65, p = 0.001), no treatment of water (RR = 1.78, 95% CI: 1.25-2.55, p = 0.002), use of shared sanitation or open defecation (RR = 1.69, 95% CI: 1.15-2.50, p = 0.01), lack of a handwashing facility (RR = 2.10, 95% CI: 1.45-3.05, p < 0.001) and finally education at secondary level was protective (RR = 0.60, 95% CI: 0.40-0.90, p = 0.01). Qualitative findings further highlighted mistrust of piped water quality, cost barriers to soap and water treatment, normalization of childhood diarrhea, overcrowded shared sanitation, and reliance on herbs or drug shops before seeking formal health care.

Waterborne diseases remain high but preventable in Busoga. Strengthening access to safe water, improving sanitation and hygiene infrastructure, and addressing behavioral and health system barriers are critical to reducing disease burden.