Cholera is undergoing a resurgence in Africa with an estimated 3 to 5 million cases and about 120,000 deaths annually across the continent. The true disease burden is still largely unknown due to the poor surveillance systems in operation in many African countries.
A worsening of Cholera outbreaks in some regions in Africa and Asia due to climatic changes has been predicted by researchers for 2020.
Warmer temperatures they have said will cause more outbreaks, due to rainfall changes, Cholera may move more inland to affect the more densely populated areas.
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Cholera is an acute enteric infection caused by the ingestion of Vibrio cholerae a bacterium that is usually found in water or food contaminated by faeces. It is majorly associated with poor access to safe water and proper sanitation.
It's impact may be felt more in times of war, conflicts, displacement, overcrowding or refugee situations where basic environmental infrastructures are disorganized or destroyed.
Lack of access to safe water and basic sanitation may predispose a group of people to an outbreak.
Signs/symptoms may include:
- Acute painless, copious, watery diarrhoea
- Vomiting
- Severe dehydration.
- Death
The incubation period is from about a few hours to five days. This makes it quite easy for explosive outbreaks to occur which could easily become difficult to control, with so many people affected.
75% of infected people may not show any signs or symptoms even though the bacterium remains in their faeces for 1-2 weeks. In this way it is shed back into the environment, and poses a risk of reinfecting others.
Cholera can be extremely virulent, and may affect anyone: including infants, children, youths and adults. It has the propensity to kill people that were initially well and healthy within hours.
People who suffer from a lower immunity for any reasons are at a higher risk of death from Cholera.
Prevention and preparedness of cholera require a coordinated multidisciplinary approach.
The ability to get accurate surveillance data to monitor the onset of an outbreak and to put in place adequate intervention measures is important in curbing these outbreaks.
A pattern observed from sensitive and accurate data from surveillance systems over time, may help in identifying vulnerable or high risk groups, areas and populations where the use of the preventative cholera vaccine may become imperative.
Accurate epidemiological data is important in the implementation of any prevention and preparedness strategies.
One of the most recent outbreaks is that of South Sudan, in which the South Sudan ministry of Health declared a cholera outbreak in Juba county on the 23rd of June.
As of 27th June 347 cases and 26 deaths from 63 villages in the said county had been recorded.
This outbreak was first noticed mid May and is said to have begun at the Juba protection of Civilians site (PoC).
There have also been reported cases of cholera outbreaks in West, Central and East Africa : Nigeria, Ghana, Democratic Republic of Congo, Mali, Nairobi Kenya to mention a few.
Cholera is more prevalent amongst the poor and occurs more during the rainy season and especially with floods.
The higher the socio-economic status and standard of living the lower its occurrence.
The crux of the problem has been traced to poor access to safe drinking water and the existence of poor sanitary living conditions.
Several communities in Sub-Saharan Africa still lack access to safe drinking water, good latrines for safe and effective disposal of faeces and there is still a widespread poor sense of hygiene.
All the aforementioned challenges have been linked to poverty.
An improvement in socio economic conditions usually leads to a reduction in the frequency of occurrence of epidemics such as cholera.
The International community has worked to put systems in place to aid in the eradication of Cholera in several countries. However, very few of such initiatives have been put in place in Africa.
Agencie de Medecine preventive along side Africhol will be working to improve the Cholera Surveillance systems in 11 countries in Africa. This is aimed at improving the accuracy of the incidence data that is available in the region as this will help improve the effectiveness of the preventative and containment measures being applied on the scene.
Currently work is ongoing to reduce and totally eliminate cholera outbreaks in Africa.
Some of the actions taken by Africhol and ally organizations include:
- Improving the Surveillance networks within Africa
- Water treatment
- Education of the public
- Cholera Vaccination.
According to Africhol (African Cholera Surveillance Network), cholera preventive and control measures vary from location to location within Africa.
Surveillance needs to be carried out per region to ascertain what will work best in eradicating the disease in each area.
According to a recently released report by UNICEF and the WHO on the
Globally, 1 in 3 people, or 2.4 billion, are still without sanitation facilities – including 946 million people who defecate in the open.
In the words of Sanjay Wijesekera [Head of UNICEF’s global water, sanitation and hygiene programmes], “What the data really show is the need to focus on inequalities as the only way to achieve sustainable progress,”
“The global model so far has been that the wealthiest move ahead first, and only when they have access do the poorest start catching up. If we are to reach universal access to sanitation by 2030, we need to ensure the poorest start making progress right away.”
There has been significant improvement in the Access to improved drinking water sources. About 2.6 billion people have gained access since 1990, 91% of people globally now have improved drinking water – and the number is still growing.
In Sub-Saharan Africa,alone, 427 million people have gained access. Which is being reflected in the child survival gains. In 2015, less than a thousand under five children die daily from diarrhoea caused by inadequate water, sanitation and hygiene, when compared to more than 2,000 15 years ago.
The progress on sanitation has been hampered by inadequate investments in behaviour change campaigns, lack of affordable products for the poor, and social norms which accept or even encourage open defecation.
WIth some 2.1 billion people having gained access to improved sanitation since 1990, it is sad to note that the world has still fallen short of the Sanitation related MDG target by nearly 700 million people.
Just about 68 per cent of people globally use an improved sanitation facility. This is 9 % below the stipulated 77% MDG target.
A call to action:
Improving the surveillance networks for Cholera will go a long way in helping us profer effective strategies that will help in the control and prevention of Cholera outbreaks.
In as much as very little can be done to control weather and climatic issues such as flooding, adequate town planning measures may be put in place to minimize the risks involved and the consequences.
Increasing access to safe and portable drinking is key in eliminating Cholera.
We also must endeavour to help the poorest nations of the world meet their sanitation goals, so that in years to come Cholera outbreaks can be said to be a thing of the past.
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