Rapid increase in cholera cases causing concern

The number of cholera cases in Mozambique is increasing rapidly, raising concern among health workers that this outbreak may be far worse than last year's. Figures released on Friday by the Ministry of Health show that a further 49 cases have been identified, 43 of them in the central province of Sofala, bringing the total number to 1,134. "As it has reached this number already in the first month of the year, it is worrying," Angelina Xavier, UNICEF project officer for water and sanitation, told IRIN. "Last year we had 2,000 cases throughout the whole year." There have been two cholera-related deaths so far, both in the central Sofala province. The Ministry of Health, supported by UN agencies and NGOs, has conducted ongoing campaigns encouraging communities to adopt safe hygiene practices for a number of years, and has provided clean water, and materials for constructing latrines and safe garbage disposal. Cholera is endemic to Mozambique and outbreaks occur every year between January and May, when seasonal rains are at their heaviest. In 2003/04 as many as 20,000 cases were recorded. Traditionally, the congested capital, Maputo, and the port city of Beira suffer the most during cholera outbreaks. So far there have been no cholera cases in Maputo, although Xavier said sanitary conditions in some of Maputo's overcrowded suburbs were dismal and a cause for great concern. "I've seen people selling bread, salads, samoosas on the streets, right next to an open drain or a rubbish heap, where there are plenty of flies. The problem is the foods like the bread and samoosas that will not be cooked are easy to contaminate - people just buy them and eat them in the streets," Xavier noted. In the market in the heart of Maputo city, "The Mercado do Povo", it is not easy to practice good hygiene. Twenty-year-old Ana Manuel serves hot food at a stall which she has made an effort to keep clean. However, the biggest problem in the market was the lack of water. "We take water from the tap [standpipe] but it closes at 12.30 and often it doesn't open at all. We have to search for water elsewhere, so we don't have enough," Manuel said. The ablution facilities at the market were also poor, she added. "The toilets in the market are very small, they tend to fill up so then I lose interest in using them. And when it is hot there are lots of flies," Manuel explained. There was also no soap in the toilets. In the central city of Beira, in Sofala province, where already 381 cases have been recorded and the cholera ward is reportedly overcrowded, the sanitation system is particularly poor. The city is below sea level and is one the most humid, hot and congested places in Mozambique. Providing adequate clean water and sanitation services in one of the world's poorest countries remains a sizable challenge. According to official figures, 74 percent of people in rural areas lack access to potable water and 71 percent do not have access to an improved latrine; in urban areas, 60 percent lack access to clean water and 64 percent do not have access to improved latrines. Cholera vaccination was tried successfully in Mozambique in 2003-04, and analysts believe that running this alongside campaigns to improve hygiene may yet bring the annual outbreaks under control.