Cholera outbreak in bustling Dakar highlights Africa’s urban ills

As its poorer West African neighbours, Guinea and Sierra Leone, grapple with endemic cholera, Senegal is facing a rare but telling explosion of the disease in low-income neighbourhoods of its busy capital, Dakar.

The first cholera epidemic to surface in Senegal in eight years broke out on 11 October in a crowded, low-income suburb of the capital, highlighting the link between disease and the poverty across the continent that is associated with urban decay and rural exodus.

In just under a month, a total 801 cases had been registered, mainly in Dakar, including six deaths, Dr Bassirou Johnson of the Health Ministry’s epidemiology department told IRIN on Wednesday.

“I’m very optimistic that we’re over the worst,” Johnson said. “We registered 38 new cases on Tuesday compared to 75 daily last week.”

The spectre of a return of the disease after so many years has raised widespread fear. Dakar university officials have become embroiled in allegations that several students were infected by sub-standard canteen food and have had to deny the charge. And on a dusty back street heaped with piles of uncollected refuse not far from the city centre, residents threw signs up across the road saying “Cholera is threatening us. Where is the mayor!”

Cholera, an acute intestinal infection spread by contaminated water and food, reached West Africa in 1970 after an absence of more than a century. It is now endemic in much of the region, notably in Sierra Leone, Burkina Faso and Cote d’Ivoire.

In such countries it is an ongoing hazard of the rainy season as latrines overflow and wells become polluted in rural and under-developed areas. This is not the case for Senegal.

“Cholera is the disease of poverty,” Claire-Lise Chaignat, the Geneva-based coordinator of the World Health Organisation’s (WHO) global cholera task force, told IRIN by telephone.

“The outbreak in Senegal could be due to several factors -- the season, poor food safety, lack of proper hygiene by the population and, I suppose, the fact that the general environment probably hasn’t improved, as is the case across cholera-latent parts of Africa.”

“High density population areas are explosive for a cholera outbreak,” she added, referring to the kind of conditions in which the bacterium thrives – overcrowded slums with poor sanitation and sewage, inadequate waste management or contaminated water supplies.

In Dakar, Johnson said authorities had not been able to identify the reason behind the rare outbreak.

“But what we did from the outset was to tackle the problem head-on, keeping the public informed on how to avoid catching cholera and what to do if they had it,” he added.

Hammering home the message contained in a stream of radio and newspaper alerts urging strict personal hygiene, President Abdoulaye Wade went on state television washing his hands with soap. This week, health officials were on the offensive, raiding street markets for stale bread and other suspect foods, and enforcing a ban on roadside sales of bags of potentially unsafe water or blocks of ice.

As health authorities disinfected markets, rail and bus stations and public transport vehicles, tourist-popular Gambia, which is sandwiched between northern and southern Senegal, anxiously moved to seal its borders against infection by monitoring hawkers from its neighbour.

Senegal’s relatively low fatality rate to date – less than one percent – indicated the country’s capacity to handle medical emergencies, Chaignat said at WHO headquarters.

“They know how to handle the cases, they’re sending out the right control messages, and are keeping people informed,” she said. “They’re also able to cope because the epidemic has broken out in town where they have high density care facilities. That wouldn’t necessarily be the case if an epidemic broke out in the countryside.”

In Sierra Leone, health officials reported 633 cases and 56 deaths over September and October. Togo on Wednesday reported the first signs of an outbreak.

In Guinea, hit by a severe outbreak that erupted in July in its capital, Conakry, there had been 1,192 cases including 100 deaths by late October, a fatality rate of 8.39 percent.

“That is extremely high,” Chaignat said. “When the fatality rate is over one percent it means people are not informed or do not have proper access to care. It can also mean a country lacks the means to deal with the disease, and needs help.”