HomeColumnsCurbing cholera in Zimbabwe: Part One …a national concern

Curbing cholera in Zimbabwe: Part One …a national concern

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THE right to clean water and universal health is a human right enshrined in the UN Human Rights Charter for everyone to enjoy; Zimbabwe being a signatory to the UN Charter on Human Rights is no exception.  

Further, the provision of safe clean water and sanitation is critical to control and prevent the transmission of waterborne diseases, such as cholera, typhoid and others, which, in recent years, have become endemic. 

In April 2023, Zimbabwe recorded 436 suspected cholera cases, two laboratory confirmed deaths, seven suspected deaths and 88 confirmed cases in eight out of the 10 provinces. Matabeleland South had the highest cumulative suspected cases, followed by Manicaland and Bindura in Mashonaland Central. 

In its Cholera Situation Report of May 2023, Zimbabwe’s Ministry of Health and Child Care states: “… earlier reports of cholera outbreaks in the country and the recent rain showers experienced countrywide this October 2023 is cause for alarm and may exacerbate the rise in cholera cases in Zimbabwe”.  

Cholera has become endemic in Zimbabwe since 2008, when Zimbabwe suffered its worst cholera outbreak which affected over 100 000 people and claimed over 4 000 lives.  Most of the deaths were in Harare where water and sanitary systems in most of the major high density areas are severely rundown due to the opposition-run municipal incompetence and neglect.  The nationwide cholera epidemic was one of the largest outbreaks in recorded history.

Moreover, the potential for cross-contamination of water and sanitation systems make recurrent outbreaks of cholera during the rainy season a major risk factor.  A lack of access to clean water in Zimbabwe is also a key underlying cause of the high prevalence of malnutrition.  

The annual resurgence of cholera in Zimbabwe is of great national concern. More so as it is preventable and easy to treat; yet, despite being easy to treat, cholera is estimated to affect between three and five million people each year, and causes over 100 000 deaths worldwide.

As a medical epidemiologist, I am aware that public health concerns every one.  

This makes it important for us to understand the nature of a disease and study the culture and sociological behaviour of the people as well as other extraneous issues that negatively impact a community where diseases are most prevalent.  

Those diseases that currently affect large numbers of people need to be thoroughly investigated in order to understand and isolate the medical, socio-environmental, technical and administrative factors contributing to such disease outbreaks.  

Local culture practices and beliefs are central to promoting actions such as the adoption of protective hygiene measures; for example, hand washing with soap, safe preparation and storage of food, the safe disposal of faeces and funeral practices.

Besides the recent COVID-19 pandemic, Zimbabwe has experienced not only a resurgence, but a notable increase in disease outbreaks in the past 20 years, namely: malaria, tuberculosis, measles, polio, leprosy, typhoid and cholera, all of which were under control (or eradicated), but not without their share of casualties.

Which brings us to the question: What is cholera? 

Cholera is an acute, diarrheal illness caused by infection of the intestine with the toxigenic bacterium vibrio cholera.  Cholera bacteria enter the body through the mouth, often in food or water that has been contaminated with human waste, due to poor hygiene and sanitation and where street food and vegetable vendors prepare and sell food in unsanitary conditions and spaces.  

V. cholera bacteria live in shallow, salty water on microscopic crustaceans. They can also exist as colonies of biofilms that coat the surface of the water, plants, stones, shells and similar items (litter and rubbish dumps) and can live among the eggs of midges, which serve as a reservoir for cholera bacteria. They also thrive in moist earth, damp dirty clothing and in the stools of patients with the disease. 

Cholera is more prevalent where there is overcrowding and poor sanitation. Typical at-risk areas in Zimbabwe include peri-urban high density areas and squatter camps where minimum requirements of clean water and sanitation are not met. 

Poorly washed vegetables irrigated by contaminated water sources are another common source of infection. In situations where sanitation is severely challenged, such as squatter camps or areas with limited clean water resources, a single infected victim can contaminate all the water for an entire population.

The consequences of a humanitarian crisis, due to disruption, or lack, of clean water and adequate sanitation systems, or the movement of populations to unsatisfactory and overcrowded areas increases the risk of cholera transmission, should the bacteria be present or introduced. An extremely virulent disease, cholera 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.

Symptoms of suspected cholera include: severe watery diarrhoea, vomiting and rapid dehydration. Confirmation is by identifying v. cholerae in stool samples from affected patients. Detection can be facilitated using rapid diagnostic tests (RDTs), where one or more positive samples trigger a cholera alert.  

Some simple measures can reduce the risk of contracting cholera. Regular hand washing is important to prevent the spread of disease. When travelling in areas where the disease is endemic, it is important to:  

λ Eat only fruit you have peeled;

λ Avoid salads, raw fish and uncooked vegetables;

λ Ensure that food is thoroughly cooked;

λ Make sure water is bottled or boiled and safe to consume;

λ Avoid street food, as this can carry cholera and other diseases.

Capacitating local medical and scientific bodies to detect (diagnose) and monitor (collect, compile and analyse data) cholera occurrence in this country is central to an effective surveillance system and to planning future control measures. With early and proper treatment, the fatality rate would no doubt decrease.

Additionally, the provision of safe water and sanitation is critical to prevent and control the transmission of cholera and other waterborne diseases in Zimbabwe.  

Dr Tony M. Monda is currently conducting medical epidemiology research on urban disease control and public health issues in Zimbabwe.

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