By Dr Linda Omar
What is Cholera?
Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Cholera remains a global threat to public health, the disease still affects at least 47 countries across the globe, resulting in an estimated 2.9 million cases and 95,000 deaths per year worldwide (source; WHO).
Cholera is an extremely virulent disease that can cause severe acute watery diarrhoea. It takes between 12 hours and 5 days for a person to show symptoms after ingesting contaminated food or water. Cholera affects both children and adults and can kill within hours if untreated.
Most of the infected people do not develop any symptoms, although the bacteria are present in their faeces for 1 – 10 days after infection and are shed back into the environment, potentially infecting other people. Among people who develop symptoms (20%) develop acute watery diarrhoea and vomiting with severe dehydration, which can lead to death if left untreated.
The burden and impact of cholera epidemics are greatest in Africa, particularly in sub-Saharan Africa, where case fatality rates (CFRs) have exceeded the upper threshold of 1% since 2014. Cholera disease can be an indicator of inequity and lack of social development in poor sanitation and hygiene areas (source; WHO).
There are several risk factors that play a major role in the spread of the disease, these could include, poor water and sanitation infrastructure and services, high-risk hygiene and social practices, living in high-density areas such as IDPs camp or slums, change of the climate and seasonality (dray season, floods and drought), besides other natural phenomena e.g. El Niño, poverty and famine that currently affecting many AFRO countries, cross-Borders and high population movement.
According to the WHO records found that worldwide, 844 million people still lack access to even a basic drinking water source, more than 2 billion drink water from sources that are faecally contaminated, and 2.4 billion are without basic sanitation facilities, exposing them to a range of water-related diseases including cholera.
Cholera in Zimbabwe
Zimbabwe is among those impacted countries by the scourge of cholera with outbreaks following a somewhat cyclical pattern. The country experienced two major outbreaks, one in 2008/09 which resulted in over 100,000 cases including over 4,000 deaths, and another in 2018/19, where there were 10,000 cases with 69 deaths across the 21 cholera hotspot districts in the country.
In February 2023 the country declared again a cholera outbreak in many of its provinces that are known cholera hotspots. Like any other cholera-risk country, cholera outbreaks in Zimbabwe have been linked to a range of risk factors, including inadequate access to safe drinking water, poor sanitation, and inadequate healthcare facilities.
Cholera Prevention and Control
In line with Sustainable Development Goal #3, WHO and African Member States are committed to ‘Ensure healthy lives and promote wellbeing for all at all ages’, and together they strive to mitigate the recurring cholera outbreaks, which have been a major public health challenge for many African countries in recent years. On that note, in 2021 Zimbabwe endorsed a high-level Framework for the National Multisectoral Cholera Elimination 10-Year Roadmap for Zimbabwe.
The developed roadmap was composed of six operational pillars which are namely: Leadership and Coordination, Public Health Preparedness and Response, WASH, WASH Infrastructure, Advocacy and Community Empowerment and Innovative Financing and Resource Mobilization.
Another way in which SDG3 can help Zimbabwe to mitigate the recurring cholera outbreaks is by improving access to safe drinking water and sanitation, which is the key element in cholera control. Nevertheless, improving access to safe drinking water and sanitation can help to reduce the spread of not only cholera but also other waterborne diseases such as Typhoid Fever.
Cholera can be treated effectively with simple interventions such as oral rehydration therapy and antibiotics. Therefore, improving healthcare facilities and access to healthcare and availability of Cholera Treatment Centres (CTCs) plays an important role to reduce the morbidity and mortality associated with cholera outbreaks. As well as Oral Cholera Vaccines (OCV) should be used in conjunction with improvements in water and sanitation to control cholera outbreaks and for prevention in areas known to be high risk for cholera.
An additional key element in cholera prevention and control is Community Engagement should be considered throughout outbreak response with increased communication regarding potential risks, symptoms of cholera, precautions to take to avoid cholera, when and where to report cases and where to seek immediate treatment when symptoms appear.
In conclusion, cholera prevention and control require a coordinated and multisectoral approach. Cholera cannot be prevented, controlled, or eliminated by one entity.
To attain that it requires each one to take part in the fight against cholera and to have resource mobilization and collaboration in place. Besides harmonization of multi-sectoral partnerships at different levels of government and across private and non-private sectors is very crucial for achieving cholera control or elimination at national and global levels. Medlico Research and Training Centre joins the other sectors and civil society in controlling cholera outbreaks, partnerships with Government Ministries and Departments, Civil Society, and Private Medical Practices in the spread of key information and messages about cholera.
As well as we support capacity building, data processing, research, and consultations for evidence-based decision-making.
Together we can achieve SDG3 (Good Health & Well-Being) for All. Cholera in Zimbabwe follows a somewhat cyclical pattern