Clean water key to containing cholera
Rumbidzayi Zinyuke Senior Health Reporter
THE cholera outbreak that has to date claimed 12 lives in Manicaland has brought to the fore the urgent need for safe water and better sanitation in communities.
The first case of cholera in the province was reported in Mutare City in February. The outbreak gradually increased and has now spread to other districts within the province. There are fears that there could be more cases than have been reported.
According to the Ministry of Health and Child Care Daily Situation report, Manicaland reported the second highest number of cholera cases, after Harare, since the outbreak was detected this year.
As at July 24, 1 476 suspected cholera cases had been reported in the province, representing about 40 percent of the total number of cases recorded in the country to date.
About 62,3 percent of the 842 laboratory-confirmed cases emanated from the province.
Although the outbreak has slowed down, cases are still being reported.
“When I got infected with cholera, I was lucky that I was quickly rushed to the hospital and I got there on time. But many people might not be so lucky. They are not quick to think of cholera when they get diarrhoea and they only go when they realise that their condition is not getting better,” said Mrs Tendai Runodamoto.
Cholera is spread by the ingestion of contaminated food or water and can cause severe diarrhoea. While most of those affected will have mild or no symptoms, cholera can kill within hours if untreated.
Zimbabwe recorded the worst cholera outbreak in 2008, which affected 98 596 people and claimed more than 4 000 lives, making it the largest and deadliest outbreak in history of the country.
A subsequent outbreak was reported in 2018 and this one affected 10 421 people while killing about 69 people.
Studies done after the 2018 outbreak, which affected mostly Harare suburbs, showed that water and sanitation challenges were the major contributing factor.
According to a policy research working paper commissioned by The World Bank, sanitation risk, poverty, sewer burst density and incidence of imported cases are all risk factors for cholera.
“In particular, outbreaks in developing country contexts are usually attributed to where households have low access to WHO Joint Monitoring programme classified ‘improved’ water and sanitation infrastructure such as networked water and sewer systems. However, poorly maintained or operated network infrastructure can also fail to bring about the protection from cholera that it may seem to promise,” the paper noted.
Cabinet last month noted that water and sanitation challenges were responsible for the surge in cholera cases that had been reported in the country.
“Government will implement a multi-sectoral approach led by the Minister responsible for Water, Sanitation and Hygiene, in order to address the water, sanitation challenges which are fuelling the cholera outbreak,” said Information, Publicity and Broadcasting Services Minister Monica Mutsvangwa in her post Cabinet brief.
The World Health Organisation on World Water Day in March expressed concern over the upsurge of cholera even in countries that had not had the disease in decades.
“While the situation is unprecedented, the lesson to draw is not a new one: safe drinking water, sanitation and hygiene are the only long-term and sustainable solutions to ending this cholera emergency and preventing future ones,” the agency said.
Although Government has instituted many interventions to stop the outbreak in its tracks, without proper water, sanitation, and hygiene, Zimbabwe remains at risk of cholera cases and deaths.
Public Health experts have also stressed the importance of ensuring access to clean water and good sanitation for communities.
Harare Institute of Public Health principal Dr Amos Marume stressed the need to strengthen health systems and to ensure water and sanitation services were enhanced.
“Cholera outbreaks and other diarrhoeal diseases are diseases of poor sanitation and hygiene and are associated with contaminated water sources and unhygienic practices around homes.
“The message is still the same, the public needs to be educated about these diseases and they need to take each public health threat seriously,” he said.
The World Economic Forum website states that indeed, cholera is one of the diseases likely to become more common under climate change, largely as a result of its effects on water and sanitation through more frequent floods and droughts.
“Cholera so often follows wars and natural disasters largely because of the damage to water and sanitation infrastructure leading to contamination of drinking water,” the website notes.
Manicaland has borne the brunt of two major cyclones and several severe storms since 2018, the worst of which was cyclone Idai.
This year, cyclone Freddy passed through the province and destroyed infrastructure, including houses, boreholes and toilets.
But communities still need to be educated as they remain oblivious to some of the challenges that fuel the outbreaks.
Mutare District health promotion officer Mrs Sophia Nezandonyi although water and sanitation challenges had been behind the initial outbreak, community behaviours had fuelled its spread.
“The first suspected case we had in Odzi was put down to food poisoning by the community when he died. Then one person who had attended to the first case also started having diarrhoea but he was denying that his sickness was due to cholera so he refused to go to the hospital. The community and villagers who came to the funeral got infected that is when we were alerted of these cases,” she said.
She said the district had reported the highest number of cases and deaths between April and May but the situation was now under control following targeted interventions involving all stakeholders.
“When the outbreak was at peak we were recording at least seven cases a day but now we can go for days without reporting a single case. This is because we had multi-sectoral interventions where environmental health technicians were deployed and they worked with village health workers and other community workers to assist the health workers. We had community mobilisation and sensitisation and as a team, we made sure that every rumour about a suspected case was followed up and investigated. This could be the reason why we have managed to slow down the outbreak,” she said.
Hence community participation remains key.
Community Working Group on Health (CWGH) executive director Mr Itai Rusike said overcrowded areas and public gatherings where access to clean and safe water were a major challenge in containing such an outbreak.
“The use of alternative unsafe water sources such as unprotected shallow wells due to the erratic water supplies is a major challenge in many parts of the country. Underground water maybe contaminated by leakages from the dilapidated sewerage system, unfortunately there is general low practice of treatment of drinking water from the boreholes or the protected and unprotected dug wells,” he said.
“We need to ensure effective multi-sectoral coordination to eliminate cholera in Zimbabwe by increasing access to clean, safe and sustainable water supply at household level including access to basic sanitation facilities.”
Community involvement and ownership is essential for effective response to such outbreaks hence village health workers have been at the forefront of educating communities, even where there is no outbreak.
Mr Lamson Mulolo, a VHW in Muchena area said raising awareness in the communities had helped to change some of the risky behaviours that fuelled cholera outbreaks.
“As village health workers we have been working with other health workers to go into the communities and speak to the people about proper sanitation and hygienic practices. We encourage them to have hand washing points near the toilet and we tell them why it is important to wash their hands,” he said.
Another village health worker Mrs Shupikai Saidi said they had been monitoring public gatherings such as funerals to ensure that people followed proper sanitation practices.