Toth Health Centre

Report
July 2011 to June 2012
Location
Village: Aisa Nankusi

Sub-Counties Served: Namayonyi and Nakaloke

County: Bungokho

District: Mbale

Country: Uganda

Contacts
Dr Samuel Kalibala
skalibala@hotmail.com
Page11
 Brief Background

Nakaloke Development Initiative for Communities (NADECO) is a community based organization that was
started in 2008 in Mbale District in Uganda with the aim of enhancing community development and
social services in rural communities. Between January 2010 and March 2011 NADECO carried out needs
assessment, mapping of partners and training of community health workers (CHW) in two sub-counties
of Nakaloke and Namanyonyi. Both sub-counties together have an estimated population of 60,000
people or about 12,000 families.

In April 2011 NADECO started providing HIV Voluntary Counseling and Testing (VCT) together with Family
Planning (FP) at community venues such as places of worship and schools in the eight parishes of the
two sub-counties. The first such service was provided at Aisa Parish in Namanyonyi sub-county on April
2nd 2011 and 62 clients were served.

When Dr Samuel Kalibala the Director of the project shared this information with Dr Miklos Toth and
his dear wife Elena, Miklos and Elena decided to start the Toth Health Center. We are grateful to Miklos
and Elena for this generous gift to the people of this community.

Elena and Miklos visiting us at the Health Center on February 3, 2012

Page11
 General Medical Care

Toth Health Center operates on the first Saturday of the month and provides primary health care
including malaria testing and treatment; HIV testing and counseling combined with provision of Bactrim
to prevent opportunistic infections among people living with HIV; and family planning services.

For the twelve clinics operated on first Saturdays of the month from July 2011 to June 2012 Toth Health
Center treated a total of 1764 patients. In figure-1 the pie chart shows that 825 or 45% of the total
number of patients were older adults aged over 24 years; 758 or 42% were children aged less than 15
years; 157 or 9% were young adults aged 20 to 24 years; and 78 or 4% were youth aged 15 to 19 years.
Page11
 Figure 2 shows that the number of patients treated varied per month, the highest was 182 in October
2011 and the lowest was 117 treated in May 2012. The average per month was 147.

Figure 3 shows that in all age groups there were more female patients than males except among children
aged less than 15 years where the difference was small401 females compared to 357 males.
Otherwise, among the youth aged 15 to 19 years there were 57 females and 21 males; among the young
adults aged 20 to 24 years there were 150 females and only 7 males; among older adults aged over 24
years there were 696 females compared to only 129; and in total during those 12 months the clinic
treated 1,250 females compared to only 514 males.
Page11
 Most of our patients are women and children:
Page11

As can be seen above females are the majority of clients seen in our services. This is mainly because
females compared to males are less likely to have money to seek services in the trading centers where
 medical services are provided for a fee and where transportation is required to reach. We have also
shown that the majority of clients are young children aged below 15 years. This highlights the fact that
this service is reaching the most vulnerable people in these populations, poor women and their children.

HIV Testing

HIV prevalence remains high in Uganda. The latest Uganda AIDS Indicator Survey of 2011 showed that
the national prevalence of HIV was 7.3%. For this reason, Toth Health Center provides HIV testing. Figure
4 shows that the number tested for HIV was highest in the first two months after the clinic was initiated
July (36 tested) and August (20 tested)there after the number tested seemed to decrease. The
lowest number tested was 4 patients in the last month of the reporting periodJune 2012. The average
number tested per month was 14.

Figure 5 shows that in the 2011-12 reporting period of the 171 patients tested for HIV the majority were
females 138 or 81% and males were 33 or 19%.
Page11
 Figure 6 shows that the percent of clients who tested HIV positive varied widely by month but most of
the months the percent was zeromeaning that none of tested for HIV turned out to be positive. The
exceptions were the months of March 2012 (10% HIV positivity), July 2011 (2.8%) and August
2011(3.0%). Taking all people tested for the 12-month reporting period the percent HIV positive was
1.8%. Per the Uganda AIDS Indicator Survey of 2011 the prevalence of HIV was 3.7% in the East Central
Region where Aisa-Nankusi, the community served by Toth Health Center, is located. We should note
that the people choosing to test for HIV at the clinic cannot be taken to be a representative sample of
the population in the community. Hence very little can be drawn from the HIV prevalence at the clinic.

Malaria Testing

Malaria is a major cause of illness and death in this part of the country and yet it can be diagnosed using
a simple test with a microscope and treated effectively using the new Artemesinin Combination
Therapies (ACT). However, this requires a well-supported health facility that has electricity, well trained
laboratory technicians and a good supply of ACT medicines. We thank God for the gift from Elena and
Miklos Toth which has enabled us to provide this life saving service in a remote underserved area such as
this one.

Lab Techs check out a new microscope bought for us by Elena and Miklos:
Page11
 Figure 7 show that over the 12-month reporting period we tested 499 patients for malaria. In this
location malaria is the commonest cause of fever so we test, for malaria, every patient who presents
with a fever. Malaria is a seasonal illness which increases during the rainy period when mosquitoes breed
in ponds and other stagnant water locations. Uganda has two rainy seasons in a year: the first is around
April-June and the second one is around October-November. The figure shows two peaks of malaria
testing, tending to correspond to the rainy seasons: first rainy seasonApril (39 tested), May (39 tested),
and June (53 tested); second seasonOctober (84 tested), November 55 tested, and December (55
tested). The lowest number tested for malaria was 10 in the month of March and the average malaria
testing rate was 42 per month.
Page11
 Figure 8 shows that the percent of patients positive for malaria also tended to correspond to the two
rainy seasons. One peak kind of corresponded to the first rainy seasonMay 51% and June 62%. The
other peak tended to correspond to the second rainy seasonNovember 55%, December 56%, January
57% and February 61%. The lowest malaria positivity rate was 10% in March and the overall rate for the
year was 46%.

Family Planning Services

Uganda is one of the countries with one of the highest fertility rates of about 7 live births per woman
and this is because of a low contraceptive use. The 2011 Uganda Demographic Health Survey (DHS)
showed that the contraceptive prevalence rate was only 30% meaning that only 30% of married women
aged 15 to 49 years were using modern contraceptives. The same report also showed that the unmet
Page11

need for family planning was 34.3% meaning 34.3% of women want to limit their family size or to space
their children but have no access to family planning services. The problem of teenage pregnancy was
 highlighted during the needs assessment survey for Toth Health Center in its catchment area. For this
reason, the project is providing family planning services. Figure 9 shows that the number of women
served with family planning services varied widely with some months having zero. The highest number
was 30 in November and, other than the months with zero, the lowest number served was 2 in
September. The average was 12 per month.

Conclusion and Word of Thanks

Nakaloke Development Initiative for Communities (NADECO) is very grateful to Dr Miklos Toth and his
dear wife Elena for the assistance they have continued to provide to this project. Indeed, it is befitting
that NADECO decided to name the project Toth Health Center. Miklos and Elena visited the project on
February 4th 2012 and they were received with great pleasure by the community. They were given the
important names from the Bagisu culture of Uganda where the project is located. Miklos was named the
greatest name in the tribe. He was named Masaba which is the name of the father of all Bagisu people
and the same name given to the great mountain (Mount Elgon in Eastern Uganda) on whose foothills the
Bagisu live. Elena was given the name Nakhumisa which is a special name given to girls born during the
season of sowing seeds when the rains are about to come. It means they put a lot of hope in her like
farmers put hope in the seeds they plant.

Elena and Miklos have continued to support the project and they have also funded the provision of
water to the clinic. The water is trapped from rain water and directed in pipes to water taps and sinks
which the health workers use in the clinic. This has greatly improved the quality of care.
Page11

Water Tank installed at the back of the clinic to trap rain water:
 Now the clinic has running water in taps and has sinks.

Laboratory sink:
Page11
 Hand wash basin for clinical staff:

We thank God for all this kindness. Elena and Miklos are special people with a compassion which has
enabled them to take such bold action to improve the well being of others in need.

Thank you very much!!

Page11