Cholera outbreaks a serious threat

Cholera outbreaks have claimed the lives of about 40 people in Zimbabwe and international NGO Save the Children UK (SCUK) has warned that if the disease spreads to urban and former commercial farm areas it could be disastrous. Chris McIvor of SCUK told IRIN that the district of Binga, in Matabeleland North province, first experienced a cholera outbreak about four weeks ago. This was followed by an outbreak at Nyaminyami, in Mashonaland West province. These districts in the western Zambezi Valley are two of the least developed in Zimbabwe. So far, 350 cases and 19 fatalities have been recorded in Binga, while around 400 cases and about 20 deaths have been reported in Nyaminyami, McIvor told IRIN. "The real issue is: is it sufficient to call it an epidemic, and is it serious? In Binga and Nyaminyami, I would say, certainly it is," he said. The fatality ratios in the two districts pointed to a serious lack of preparedness for the coming rainy season. Cholera is a waterborne disease. "Normally [the fatality ratio] should be about one percent - above 2 percent indicates that treatment has been slow, medication has not been supplied, and that health and awareness campaigns have been delivered slightly later than they should have been," McIvor added. While "everybody's worked very hard, and the commitment of the ministry of health team has been very evident - with nurses staying in [quarantine] camps for three to four weeks at a time - the cholera outbreak has caught all of us unawares and unprepared". Anti-cholera prophylaxes and treatment drugs "were not pre-positioned, neither were they available at national, provincial, or district level", he said. "If the cholera continues and spreads to other areas, given that there's a national shortage of drugs, then we could be in trouble," McIvor warned. SCUK was exploring the possibility of importing drugs from South Africa in case of future outbreaks, as well as to make sure the currently affected districts had adequate supplies. IMMEDIATE INTERVENTIONS The NGO had already distributed "primary drugs for the treatment of cholera, as well as prophylaxes" for people in contact with cholera sufferers in Nyaminyami. McIvor explained that prophylaxes were important, as someone "may be a-symptomatic, but still a carrier" of the disease. SCUK had also assisted in setting up cholera quarantine camps, "we've managed to source some tents from ICRC (International Committee of the Red Cross), water bowsers from UNICEF (UN Children's Fund), as well as food and some household items for those facilities". "We've also provided for Binga 1,600 litres of diesel and 400 litres of petrol, so the ministry of health technicians can get around the district to provide the public with information, set up camps, take people to hospital, etc, while in Nyaminyami we provided 1,400 litres of diesel, and 400 litres of petrol for similar purposes," McIvor said. One of the main ways of preventing the spread of cholera was through public education, he added. The disease is "quite easy to control if people have the information - that they should wash their hands after going to toilet, etc. It can be treated if people know what [symptoms] to look out for - lives can be saved through good public education, setting up [quarantine] camps and making sure they're adequately stocked." He said about 5,000 bars of soap had been distributed "to every family in the main site of the Binga outbreak, and we will be supplying soap, along with public education, to families in Nyaminyami in the very near future." He warned that the latest outbreaks needed to be quickly contained. "Are we prepared if cholera expands? At the moment we are not adequately prepared. The disease thrives in overcrowded conditions, and if it reaches urban or former commercial farming areas [which have been densely resettled], there's potential for us to see a significant rise in deaths," McIvor said. Fighting cholera "has got to be everyone's responsibility: national government, local government, international and national NGOs". "This is an emergency - it's not a joke, cholera is appalling when you see it. Young kids sitting with drips on stone floors, or lying in their own vomit and diarrhoea ... if you see it once, you never want to see it again. It's a preventable, treatable, social disease. It's everybody's responsibility," McIvor concluded.