Better hygiene needed to break cycle of cholera deaths

When the last cholera outbreak erupted early in May in the Tla hamlet in the Niger Delta, 21 people died of the disease. Health officials are urging villagers to improve hygiene standards before annual rains come and threaten to bring with them a spat of new cases. Tla is an isolated hamlet 370 km northeast of the capital Bamako. Like many other villages near the Niger, cholera outbreaks, which used to come only with the rains in August through to December, now erupt almost all year round and spread quickly, health officials told IRIN. “Within two weeks [in May], there were 94 reported cholera cases out of which 21 people, two thirds of whom were women, have died,” said Dr Kandioura Toure, head of the epidemiological monitoring section at the National Health Direction in Bamako. Tla’s latest outbreak was the last in a series following unusually heavy rains last August, which caused widespread flooding in the Niger Delta. Since then, about 4,000 cases of cholera were registered in the Koulikouro, Segou, Mopti, Timbuktu and Sikasso regions of central Mali. Some 310 people died. Malian authorities are once again concerned as the West African rainy season is approaching. Unless action is taken quickly, another series of fatal cholera outbreaks could follow, they warn. According to Paul Ngwakum, a medical coordinator and doctor who works for Medecins Sans Frontieres-Luxembourg in Bamako, the cholera cycle usually is concurrent with the rains, but that is changing. “There have been cholera outbreaks in Mali for much of the last year now and with the rainy season, a new cycle could erupt,” he said. “Cholera would then no longer be seasonal but endemic in Mali,” Ngwakum told IRIN by phone. Yusuf Conate, National Director of Health at the Malian Ministry of Health, supported this view. “Cholera cases have continued unabated for nine months now. If we are not careful, we will have cholera cases all through the year,” Conate said. Cholera, an acute form of diarrhea, spreads through contaminated water and poor sanitation. It is commonly found in impoverished countries with limited access to clean water and poor education regarding hygiene and sanitary practices. Mali is one of the poorest countries in the world with around 70 percent of the country living on less than one US dollar a day, according to the World Bank. The Malian government has intensified the information campaigns in the Niger Delta Region through radio stations, broadcasting cholera awareness messages, officials at the Ministry of Health said. Children have been particularly targeted. “The importance of strict hygiene is being impressed on the pupils in public and private Koranic schools,” said Conate. However, changing habits is proving difficult. Some communities have rites that are conducive to the spread of the disease. “They eat from, cook by, wash and defecate in the river. One can only try to sensitise them that cholera is transmitted through ingestion,” Luc Derlet MSF Luxembourg coordinator said. Derlet explained that funeral rites sometimes involve cleaning dead bodies, a major source of contamination, in the river. “Some of them think they have to jump into the extremely polluted river waters at least once a day to be healthy,” Conate said. “This definitely does not help curb the disease,” he added. “Very often, it is because the people do not follow the very basic hygienic conditions that are taught to them that the disease spreads,” Conate said. Madou Coulibaly, a resident of Tla, had one relative who died of cholera. He complained about a crucial lack of medical facilities in the area. “In the village, there is no health centre,” he said. “All deaths occurred either in the village or on the way to the nearest health centre, 7 km away from Tla.”