Cluster of Sudden Deaths due to Carbon Monoxide Poisoning in Malaba Township, Tororo District, Uganda, August 2018

Summary

On 8 August 2018, there were media reports of sudden death of two young women who had locked themselves up in a metallic makeshift container in Malaba Township, To roro District which served as a restaurant in which both worked. We visited Malaba Police Station, where the Police Office in Charge of Criminal Investigations, explained the event scenario. We visited the scene with the help of a police officer and interviewed a number of persons including the co-workers of the deceased case-persons, local area chairman, landlord and neighbours. Two female teenagers died of unintentional carbon monoxide poisoning caused by suffocation overnight  while sleeping in a metallic makeshift structure. Acute poisoning resulted in 100% case fatality rate among female teenagers due to suffocation caused by Carbon Monoxide poisoning.

Background

Acute poisoning has been reported to occur in residential homes with no proper ventilation, people staying in overcrowded places, mining grounds, septic tanks and saloon cars due to poor air circulation (2) (3). Over 325,000 Ugandans are short of proper housing unit (2). Temporal housing structures in form of metallic make shift containers are used as homes and restaurants and are commonly seen in small trading centres, taxi parks and along busy high ways. On 8 August 2018, there were media reports of sudden death of two young women who had locked themselves up in a metallic makeshift container in Malaba Township, Tororo District which served as a restaurant in which both worked. We set out to establish the cause of their death and recommend evidence based control measures.

Methods

We visited Malaba Police Station, where the Police Office in Charge of Criminal Investigations, explained the event scenario. We visited the scene with the help of a police officer and interviewed a number of persons including the co-workers of the deceased case-persons, local area chairman, landlord and neighbours.

Results

On 7th August 2018, at 6:00 am, two females aged 13 and 14 years old, known to operate a mini restaurant in Malaba taxi park, reported to work and lit charcoal stoves with ―kabani‖ a local stick used to light stoves fast. They cooked and got ready to serve however due to the scarcity of customers during day, they worked through the evening to sell more food. At 6:00 pm, they carried their food and stoves to the street . They rested on wooden benches as they waited for their customers.

They sold food till midnight and due to exhaustion from the days work, they carried the charcoal stoves and left over food to the metallic makeshift container where they slept. They left food cooking on the charcoal stove while sleeping. The following day, 8 August 2018, they were found dead in the container at 6:00am. Their metallic container rests on a concrete basement and is roofed with iron sheets.

The container is a solid compartment with a door and no windows, chimney or any other form of ventilation. The door is locked during the night. These females usually slept elsewhere after work and this was the first time they had spent a night in the metallic container

Discussion

We found a cluster of sudden deaths of two females who were operating a mini restaurant in a metallic makeshift in Eastern Uganda. Their death was attributed to carbon monoxide suffocation from a burning charcoal stove in a small unventilated metallic makeshift structure. Their death is likely to have resulted from suffocation from CO. CO is associated with death , mental illnesses and morning fatigue (5). Restaurants in containers are mushrooming and they employ people of all age groups. The targeted customers are usually busy men who get limited or no time to run back home for their daily meals and work in taxi parks, along highways and in busy trading centres.

Because of the nature of the business, food vendors will occasionally extend their working hours to late in the night. This makes them spend some nights in the metallic containers exposing them to suffocation from the Carbon Monoxide produced by burning charcoal stoves. There are limited studies associating Carbon monoxide poisoning to public health implications in Uganda. Malangu (2008), reported that Carbon monoxide poisoning contributed 20% towards the total hospital admissions in two hospitals in Kampala (6).

Conclusion

The cluster of deaths in Malaba township was caused by CO poisoning which suffocated the 2 young girls who had slept in an unventilated metallic makeshift structure with a burning charcoal stove. Public health actions and Recommendations Community education about dangers of sleeping in metallic makeshifts containers and houses with poor ventilation; and avoidance of lighting charcoal stoves inside sleeping rooms was carried out. Local leaders and landlords were advised to ensure construction of structures with proper ventilations and separate kitchen sections from sleeping rooms.

References

1. Zhang, J., & Smith, K. R. (2003). Indoor air pollution: A global health concern. British Medical Bulletin. https://doi.org/10.1093/bmb/ldg029
2. http://www.monitor.co.ug/News/National/25-dead-four-months-suffocation-drugs-food-poisoning/688334-4600940-jes0r9/index.html.
3. https://www.newvision.co.ug/new_vision/news/1414721/workers-suffocate-death-septic-tank