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Dr Walter Chigwaru Correspondent
Cholera is a diarrhoeal disease that is caused by the bacterium Vibrio cholerae. Cases of cholera are on the increase in Zimbabwe. Cholera is spread by ingestion of contaminated food or water.

The bacteria are transmitted between humans through the faecal-oral route; a bite of contaminated food or a sip of contaminated water can cause infection. Transmission of the disease can easily be prevented if we consume clean (safe) food and water. Cholera often results in no or mild symptoms, but sometimes it can be severe and life threatening.

While cholera is a life-threatening disease, it can easily be prevented and treated. Approximately one in 10 of infected persons present severe cholera, which in the early stages includes the following symptoms:

profuse watery diarrhoea, sometimes described as “rice-water stools”

vomiting

rapid heart rate

loss of skin elasticity

dry mucous membranes

low blood pressure

thirst

muscle cramps

restlessness or irritability

Whenever you or your loved ones present some of the symptoms above, please seek medical attention.

Treatment or management of cholera includes the use of medications and treatments such as rehydration therapy, antibiotics and zinc.

All people residing in (or visiting) areas where cholera is occurring should adhere to the following five basic prevention steps in order to protect themselves and their families. Generally, the risk of contracting cholera is very low for visitors to areas going through a cholera epidemic. The tips below have been shown to reduce the risk of transmission of cholera. The hints below can be applied in the prevention of all other forms of diarrhoea where bacteria are a causative agent including typhoid and campylobacteriosis.

Follow the following dos and don’ts in order to keep yourself and your loved ones safe from cholera.

1. Drink and use safe water

Drink safe water that has been sufficiently boiled or that is supplied by reputable suppliers – as long as they have intact seals. Canned/bottled carbonated beverages are normally safe to drink and                                                                     use.

Use safe water to brush your teeth, wash and prepare food, and to make ice. Where safe water is not available, avoid rinsing your mouth afterwards. Simply spit the spent paste and wipe your mouth with a clean towel.

Clean food preparation areas and kitchenware with soap and safe water and let dry completely before reuse.

Use clean and ironed cloths or dish towels each time you manually dry all utensils – including cutlery, dishes, crockery, silverware and so forth that come into contact with your food or drink.

* Piped water sources for example piped communal/municipal water, drinks sold in unsealed containers, cups or bags (for example ice pops, popularly known as freezits) or ice may not be safe to consume. Ice cream from unreliable sources is frequently contaminated and can cause illness. If in doubt, avoid it. Be sure that the water used to make those products was safe to drink. You must treat all water of uncertified quality all the time before consuming it.

What is safe water?

Microbiologically safe water (referred to here simply as “safe water”) is that which has been treated using effective means. Boiling can make water safe to drink provided it is boiled for one minute of longer. Other forms of safe water available to consumers in Zimbabwe include bottled water (sealed) supplied by reputable processors.

Reputable processors are those whose drinking water bears a verifiable quality certification seals such as that from the Standards Association of Zimbabwe (CAZ), South African Bureau of Standards (SABS) or other regional quality bodies. Avoid drinking water without certified quality unless you have treated it yourself (boiled or chlorinated it). If a chlorine treatment product is not available, you can treat your water with household bleach, for example sodium hypochlorite.

As a general guideline, chemical treatment of water is achieved by adding 10 drops of household bleach to every 5 litres of water (or two drops of household bleach to every 1 litre of water) and waiting 30 minutes before drinking. Read manufacturers’ instructions before use. If in doubt, consult experts.

To ensure that your treated water remains safe to drink, always store it in a clean and covered container. Further, to ensure that your water containers are clean, rinse them with boiling/chlorinated water. Take care not to shake hot water in a closed container as this may lead to bursts and serious burns.

2. Wash your hands often with soap and safe water

Before you eat or prepare food

Before feeding your children

After using the latrine or toilet

After changing sanitation napkins or diapers or cleaning your child’s bottom

After taking care of someone ill with diarrhoea

* If no soap or hand sanitiser is available, you can scrub your hands often with ash or sand and rinse with safe water. As a general rule, always wash your hands with safe water.

3. Use latrines or bury your faeces; do not defecate in any body of water

Use latrines or other sanitation systems, such as chemical toilets, to dispose of faeces.

Wash hands with soap and safe water after defecating.

Clean latrines and surfaces contaminated with faeces using a solution of one part household bleach to nine parts water.

What if I don’t have a latrine or chemical toilet?

Defecate at least 30 meters away from any body of water and then bury your faeces.

Dispose of plastic bags containing faeces or night soil in latrines, at collection points if available, or bury it in the ground.

Do not put plastic bags in chemical toilets.

Dig new latrines or temporary pit toilets at least a half-metre deep and at least 30 meters away from any body of water.

4. Cook food well (especially fish), keep it covered, eat it hot, and peel fruits and vegetables

To ensure that your food is safe to eat, either boil or cook it sufficiently or peel it using clean cutlery. Otherwise do not consume it.

Be sure to cook all foods until they are very hot all the way through. Should you use a microwave to heat or cook your food, be sure it is sufficiently and evenly heated through. Avoid stir-fried meals for example “gango”, or half cooked meals.

Boil unpasteurised milk before drinking it.

Be sure that meals bought from street vendors (lunch packs, boiled/roasted corn and so forth) are thoroughly cooked in your presence and do not contain any uncooked ingredients.

• Avoid all raw foods other than fruits and vegetables that you have peeled yourself. Remember to always use clean cutlery to cut / peel ready-to-eat fruits and vegetables. Make sure your hands are clean for safe handling of the fruits and vegetables. As much as possible, avoid all fruits that are consumed without peeling such as apples and grapes! Be aware that the shiny and attractive apple that is being sold by the road side may have been sprayed with dirty water or wiped with a dirty cloth! Avoid it.
• Consume all cooked foods immediately after cooking it – while it is still hot. Make sure to use safe water to clean all utensils that come into contact with your cooked food.
• Prepare and consume all foods as far away from sewage flows as possible! Avoid contact of food with flies.

5. Clean up safely – in the kitchen and in places where the family bathes and washes clothes

• Wash yourself, your children, diapers, and clothes, 30 meters away from drinking water sources.
• Wash and rinse all containers and cutlery that will be used to serve food (cups, plates, table knives, spoons, flasks and so on) with safe water.
• Avoid swallowing bath water when you wash yourself.

As a rule of thumb, make sure that anything that passes through your lips (food, water, your pen or even your fingers) is clean before you shove it in.

Are there other routes of transmission of cholera?

Since diarrhoea causing bacteria are transmitted via the faecal-oral route – meaning from the anus of an infected person to the mouth of another, any acts that increase chances of faecal-oral transmission such oral sex may increase the risk of transmission of cholera if the receiver does it on an infected partner without a condom. Be aware that this occurrence is rare or has not been demonstrated. Ingestion of contaminated food or water is the principal route.

Can herbal medicines be used to treat cholera?

While herbal medicines are known to treat a number of diseases, studies are still ongoing to validate such effects. There is no plant based traditional medicine with known/ validated efficacy against cholera. As soon as symptoms appear, seek medical attention from your personal doctor, local clinic or hospital.

The health tips above were compiled by Dr. Walter Chingwaru – a Biomedical Scientist/Senior Lecturer based at Bindura University of Science Education. The guidelines were adapted from similar guidelines provided by US Centres for Disease Control and Prevention (CDC). For more information, Dr Chingwaru can be contacted via email: [email protected], [email protected] , or phone: 0713669091. You can follow him on Twitter: https://twitter.com/walterchingwaru.

Disclaimer: Please be advised that the ideas posted above are meant to serve as general public health information only, with intention to increase awareness for healthy living. It is neither intended nor implied to substitute professional medical advice. The author cannot guarantee the accuracy, currency or completeness of this information provided. Should you find some of the ideas interesting or relevant to your health status, please seek the advice of your physician or other qualified health provider prior to changing course of your treatment or adopting new habits. The author accepts no responsibility or liability for any injury, loss or damage incurred by use of or reliance on the content.