Diarrhoea epidemic kills 470 children

Botswana is struggling to control a diarrhoea epidemic that has claimed the lives of 470 children since January. "A few adult cases have been reported but mostly children are affected," Colo Boitshoko, spokesman for the Ministry of Health, told IRIN. "We had a lot of rain for this time of the year - normally we have some diarrhoea cases around this time, but it never turns into an epidemic. The rain is the underlying cause." Kutloano Leshomo, Communications Officer for the United Nations Children's Fund (UNICEF), said laboratory tests of samples from Francistown, conducted by the Centres for Disease Control (CDC) in Atlanta, USA, suggested the outbreak had come from various sources. "Contaminated water, unhygienic practices at the household level, poor sanitation, infant feeding-bottle contamination with human waste and ongoing person-to-person transmission" had all contributed to spreading the disease. The tests indicated the presence of Enteropathogenic E. Coli bacteria and Cryptosporidium, a microscopic parasite that lives in the intestines of infected humans and animals, and is found in soil, food, water, or surfaces that have been contaminated with infected human or animal faeces. Water authorities, "especially in villages, have acknowledged that they do not have capacity and resources for regular monitoring of the quality of water, meaning that sometimes water is not chlorinated," Leshomo said. Boitshoko pointed out that "we have contamination in the water, mainly in rural areas where the majority of the population lives - village reservoirs and natural ponds have been affected, and people are drinking rainwater". The reason it has taken so long to control the outbreak, Leshomo suggested, was "first, because the Ministry of Health lacks sufficient capacity to handle an emergency of this nature, especially diarrhoea coupled with malnutrition, but also because some of the issues are outside the jurisdiction of the Ministry of Health ... the water supply authority in the villages, for example, falls under the Ministry of Local Government." "Even large villages, where infrastructure is relatively good, have not been spared." According to dr Dorothy Ochola, Project Officer at UNICEF, "severe, acute malnutrition, secondary to diarrhoea, is contributing to the high fatality rate". Since the onset of the outbreak, a steady increase in cases of malnutrition-related illnesses, especially marasmus and kwashiorkor, have been registered. "It is estimated that approximately 450 to 500 children are in urgent need of therapeutic feeding," she said. Some patients postpone seeking medical attention, raising the fatality rate. According to one humanitarian official, "children often develop 'phogwana e wetse' [sunken fontanelle] as a result of diarrhoea and malnutrition, but in rural areas that is often attributed to something spiritual and a traditional healer is consulted first, delaying rehydration." The outbreak is widespread and 23,264 cases have been reported across all of Botswana's districts. Ministry of Health statistics recorded 4,564 cases in the southeastern region of Serowe-Palapye, believed to be the origin of the epidemic, and 4,391 cases in Kweneng East, the areas that have been hit hardest. With the number of weekly cases on the decline - 1,201 reported last week - Boitshoko said the "epidemic is still not under control but it is going in the right direction". A concerted effort by the World Health Organisation, UNICEF, the International Red Cross, the CDC, Medecins sans Frontieres and local water authorities, coordinated by the Ministry of Health, has accelerated the response to the outbreak. "The numbers have been going down due to the various interventions that have been put in place, such as concerted social mobilisation to educate parents," Leshomo noted. "We are now very hopeful," Boitshoko said. "We should not have to lose so many children to such a disease. Diarrhoea should not have to kill."