Ghana: Cholera ‘swallows’ Accra, doctors fear coming rains will fuel the disease

Current statistical data on the cholera outbreak in the Greater Accra Region indicates that 4,190 cases had been recorded, with 36 deaths.

This became known when The Chronicle visited some selected hospitals in Accra to find out the state of the epidemic. According to Dr. Irene Agyepong Amarteyfio of the Greater Accra Regional Health Directorate, her outfit had requested the various facilities in the districts to check their summaries, in order to produce the final report.

Source: Nathaniel Y. Yankson, The Chronicle, 31 March 2011

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Health officials are worried the rainy season, due to start in April, will fuel the spread of cholera. While Ghana has not pinpointed the source of the cholera bacterium, top health officials say poor sanitation systems and hygiene habits – including open defecation – are largely to blame for the epidemic, which they say is the worst in a decade. Authorities say it is time to crack down on open defecation, irregular rubbish collection and unhygienic food stands.

Source: IRIN, 31 March 2011-04-01

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In a statement issued in Accra, the National Health Students Association of Ghana (NAHSAG) said it had been concerned about the cholera outbreak and was embarking on an awareness campaign in some parts of the Greater Accra and Eastern regions to educate Ghanaians on the need to adhere to strict personal and environmental hygiene to curtail the spread.

However, it said, if the graduates from the three schools of Hygiene – Ho, Korle-Bu and Tamale – since 2008 had been at post, this current situation, would have been brought under control earlier than anticipated, if not prevented.

Source: GNA / Business Ghana, 31 March 2011

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Côte d’Ivoire, Abidjan: cholera claims eight lives

Poor hygiene exacerbated by growing piles of rubbish and the current political crisis are all factors that haelth experts and residents say contributed to a dry-season cholera outbreak in Abidjan, the capital of Côte d’Ivoire. So far eight people out of 61 infected have died.

The first case – in Abidjan’s Adjamé District (a poor neighbourhood that has seen severe post-election violence in recent weeks) – was registered in mid-January [2011]; the major rains ended in November [2010]. Cholera has also affected the district of Williamsville.

“Across this region [West Africa] there are pockets of poverty where hygiene is poor and we see occasional outbreaks,” Mamadou D. Ball, WHO representative in Côte d’Ivoire, told IRIN. “The cholera bacterium is always present.”

Sandrine Touré, a health assistant in Williamsville, said she often sees children eating just after playing in rubbish. She added that many people, even in Abidjan, have no access to safe drinking water.

Since the political deadlock, household garbage is no longer being collected.

Even if families know that poor sanitation is linked to infectious disease, cholera was not much on people’s minds this time of year, said Soumaïla Traoré. “There is negligence in some communities. With the piles of rubbish people knew the threat of illness was real. But no one talked of cholera in this period.”

UNICEF and WHO are working with local health authorities to treat patients and promote better hygiene. advise communities on prevention. They are providing soap, cholera treatment kits and posters with prevention messages.

Source: IRIN, 31 Jan 2011

Tanzania: New cholera outbreak: 4 die

Four people died and 58 were hospitalised following a fresh outbreak of cholera in the eastern Tanzanian region of Morogoro, an official said Wednesday.

“Three of the deceased persons are members of the same family,” Morogoro regional health officer, Cares Lyimo, told AFP. He said the first cases in the area were reported two weeks ago and added that 58 people had since been admitted to hospital with cholera symptoms.

Lyimo said water shortages in the region, forcing residents to buy unsafe water from vendors, were to blame for the outbreak.

The disease is caused by the bacterium Vibrio cholerae and is spread by consuming contaminated food or water.

Around 60 people died of cholera in Tanzania’s northeast Tanga region in September and October.

Source: AFP / News24, 8 December 2010

Guinea-Bissau: zero tolerance of cholera this rainy season

Staff from NGOs and the health authorities are going house-to-house to distribute thousands of bottles of bleach to residents in the Bafata area of central Guinea-Bissau, to prevent another cholera outbreak. An epidemic in 2008 claimed at least 225 lives and infected more than 13,000 people.

“We’re doing everything possible to prevent a cholera outbreak this year. The joint effort of communities and local authorities has prevented many cases of cholera in the past and efforts have once again been stepped up,” said Ingrid Kuhfeldt, Country Director of Plan International, which works to alleviate child poverty.

Cholera is a waterborne disease that usually occurs during the rainy season and spreads quickly in rural areas like the Bafata region, where most people fetch their water from wells that are easily contaminated, and it is not always stored in hygienic conditions.

This year the first rains fell in early June, but so far no cholera cases have been recorded anywhere in Guinea-Bissau. Kuhfeldt told IRIN this was partly the result of careful planning by the government and aid agencies – a repetition of the strategy implemented in 2009, when Bafata had no confirmed cases.

Plan International’s cholera prevention methods include distributing medical and cleaning supplies, like bleach and oral rehydration sachets, sinking wells and building toilets.

The UN Children’s Fund (UNICEF), backed by the European Commission’s humanitarian aid department (ECHO), has been running a hand-washing campaign and distributing water purification kits in case there is an outbreak.

Kuhfeldt told IRIN that a cholera prevention project in which children and young adults were taught to diagnose hygiene problems and apply the solutions in their communities was so successful that it is being rolled out in Bafata and Gabu, 200km northeast of the capital, Bissau.

Children put up posters encouraging people to wash their hands more often, and run house-cleaning competitions every two weeks, with the national flag hoisted in front of the winner’s home. Residents in the targeted communities said fewer people had been sick since the project began.

“Before we started the project in my community it used to be very dirty,” said Malam Dola Cassama, 17, who was elected president of the project in Gantauda, a village 15km from Bafata town.

“There used to be lots of sickness during the rainy season; these days the community is much cleaner. If we see rotting food, we dig a hole and bury it, and we know not to drink from the same cup as someone who is vomiting or has diarrhoea,” he told IRIN.

To be effective, anti-cholera actions must take place long before an epidemic breaks out, so that practicing new behaviour becomes established habit, said Jeroen Ensink of the London School of Hygiene and Tropical Medicine (LSHTM).

In the nearby village of Buntunsum, health worker Amadou Djao said he has seen a dramatic drop in the incidence of infectious disease. “Since the young people started encouraging everyone to place such emphasis on cleanliness, not only has cholera decreased, but also other illnesses spread by contaminated food and water.”

As rainfall across the country becomes heavier, Guinea-Bissau’s Ministry of Health is implementing a series of recommendations made by Plan International, other NGOs, UNICEF, the World Health Organization, and ECHO. These include stockpiling bleach, and running campaigns to dispel myths, such as that the sun can kill the bacteria that cause cholera.

An epidemic in 2005 infected 25,000 people, followed by an epidemic in 2008, which prompted the Ministry of Health to swiftly order laboratory tests for suspected cases of cholera this month, but they proved negative.

“There’s an alertness [to cholera] that has been maintained by the Ministry of Health,” said Geoff Wiffin, UNICEF’s Representative in Guinea-Bissau. “This analysis of suspected cases is an example of action leading to results.”

Source: IRIN, 8 July 2010

Zambia, Kitwe: Kapoto residents refuse to drink treated water because ‘it can make them impotent’

Residents of Kapoto shanty compound where cholera has broken out in Kitwe have shocked the district administration after they refused to be drinking treated water allegedly for fear of becoming impotent.

ZANIS Kitwe reports that Kitwe District Commissioner Macdonald Mtine confirmed that the community in Kapoto compound was not taking free treated water which the Nkana Water and Sewerage Company was providing.

This is despite the outbreak of cholera in the area.

Mr. Mtine, who is also Kitwe District Epidemic Preparedness Committee chairman, said seven people from Kapoto have already been treated for cholera but surprisingly, the rest of the people in the area have continued to drink water from shallow wells located near pit latrines.

He said the people of the damp Kapoto compound should start using treated water from the Nkana Water Kiosks to enable health authorities to contain the cholera situation.

Mr. Mtine expressed worry at the traditional myth circulating in Kapota compound that treated water had certain particles that would make them impotent once they took it.

He said the continuous use of water from shallow wells located near pit latrines was dangerous and exposing the community to more water borne diseases.

He has since appealed to the community not to compromise their health and instead drink treated water.

Source: Lusaka Times, 20 Jan 2010

Zimbabwe: did the United Nations ignore the 2008 cholera outbreak to please Harare?

A U.N. official claims his warnings of a catastrophic cholera outbreak were stifled by a U.N. bureaucracy intent on keeping good relations with Zimbabwe’s dictator, Robert Mugabe.

Georges Tadonki, the former head of the Zimbabwe branch of the U.N. Office for the Coordination of Humanitarian Affairs (OCHA), was fired at the height of the cholera crisis in early January 2009 — in part, he says, because of the warnings he raised. He has appealed his termination, and his case opened before a U.N. dispute tribunal in Nairobi, Kenya, on 23 February 2010. International lawyer Robert Amsterdam, famous for defending the Russian political prisoner Mikhail Khodorkovsky, is Mr. Tadonki’s pro-bono legal counsel.

Between August 2008 and July 2009, about 98,600 people contracted cholera and more than 4,000 died. In April 2008, months before the initial outbreak exploded into a full-blown epidemic, Tadonki says he warned his superiors of the severe risk. But U.N. country director Agostinho Zacarias stifled that warning, Tadonki claims.

Tadonki claims that Zacarias forced him to significantly lower the initial prediction of cholera cases from 30,000 to 2,000 in the UN funding appeal launched in November 2008. “Because the government did not accept that there was cholera, the United Nations was forced to align with that position.” Both a high-level official from the opposition Movement for Democratic Change (MDC) who worked on the humanitarian response and Ed Schenkenberg van Mierop of the International Council of Voluntary Agencies (ICVA), confirmed that Tadonki had warned of a catastrophic outbreak.

Although some facts are in dispute, Tadonki’s story highlights the perils of U.N. engagement in authoritarian states such as Zimbabwe.

In response to the claim that the figures in the November 2008 UN appeal document had been manipulated, OCHA’s Deputy Spokesman told Inner City Press that “the prediction of 2,000 was realistic when it was made”, comparing it to the previous cholera outbreak in 2002, when 3,125 people were infected and 192 died.

Some U.N. officials contested Tadonki’s allegations, including a former U.N. agency head who told Foreign Policy that “the actual size of the cholera outbreak was larger than anyone (including Tadonki) had forecasted.” And some claimed Tadonki’s clash with Zacarias was due to poor performance, which is cited in U.N. internal reports as the reason for his firing, not his efforts to sound the alarm.

There are also conflicting reports about the response of the World Health Organization (WHO), which lead the health response. WHO representative in Harare, Custodia Mandlhate, told Foreign Policy that she, Zacarias, and the country head of UNICEF had finally “decided to go and see the minister of health … and convinced him to declare cholera an emergency.”

Schenkenberg, however, said that WHO “didn’t have its first meeting [to begin coordinating operations] until the first week of December” — after the government had already declared the cholera emergency. Nor had Zacarias pushed the WHO to do so, according to Schenkenberg.

Commenting on the Tadonki case, Wall Street Journal columnist Marian L. Tupy reminds us that “the crisis started when the Mugabe government nationalized Zimbabwe’s water supply in 2005 but soon ran out of money to maintain the infrastructure and treat the water [...]. In 2008 the government shut down the water supply altogether, reducing the people in the urban areas to scavenge for water in ponds and sewers. Since the Zimbabwean health-care system collapsed along with the rest of the economy, the U.N. effectively became responsible for providing the necessary aid to tackle the emerging health crisis”.

Source: Elizabeth Dickinson, Foreign Policy, 22 Feb 2010 ; Matthew Russell Lee, Inner City Press, 25 Feb 2010 ; Marian L. Tupy, Wall Street Journal, 22 Feb 2010

Benin: cholera kills at least five, with scores infected

In Benin cholera has killed five people in the past two weeks in a rare dry-season outbreak.

Health officials detected the first cases of the diarrhoeal disease on 13 January 2010 in the town of Bonou – 90km east of the economic capital Cotonou – where 66 cases and four deaths were recorded up to 29 January 2010, according to the Health Ministry’s director of sanitation Laurent Assogba.

Three cases, one resulting in death, have also been recorded in Cotonou, he said.

Cholera generally spreads during the rainy season when flooding can contaminate water sources. The World Health Organization (WHO) says cholera in the dry season is uncommon but it does occur.

“Cholera is not transmitted only via water during heavy rains,” Aristide Roch Sossou of WHO-Benin told IRIN. “Foods [kept in unhygienic conditions] and dirty hands are also factors favouring cholera bacteria.”

He said studies are underway to identify the source and transmission mode of the bacteria in the latest outbreak.

“We have no evidence for the causes of cholera during dry season,” Geneva-based WHO cholera expert Claire-Lise Chaignat told IRIN. “It may well be that the vibrio germ is being introduced by contaminated people, or it could be present in boreholes.”

Benin’s Health Ministry is telling citizens to be extra vigilant. Anyone in and around Bonou with vomiting or diarrhoea “must go directly to a health centre”, Assogba said.

Health officials are also advising people to observe proper hygiene – including thoroughly washing hands and food.

In 2009 during the rainy season at least 70 people died of cholera in Benin, according to the Health Ministry.

Source: IRIN, 02 Feb 2010

Zambia: Lusaka declares war against malaria, cholera

Lusaka District Commissioner Christah Kalulu is confident [that the city] will have fewer cases of cholera and malaria, and suffer less disaster than it has during rainy seasons over the past decade.

This follows the successful implementation of the District Disaster Reduction (DDR) programme which was launched on August 18, 2009.

By June 2009, 162 deaths occurred countrywide out of 7,587-reported cases of cholera. Lusaka alone had a mortality rate of 30.

The new intervention measures were adopted from the United Nations (UN) lead Programme on Risk Reduction – a global platform on risk reduction currently shared worldwide.

The whole exercise is expected to cost K12.5 billion and so far Lusaka District has raised K5.2 billion from DDR’s own resources since the intervention came as a post budget strategy.

The funds are meant to cover health, water and sanitation, bridges and crossings, garbage collection and drainage clearance.

The Disaster Management and Monitoring Unit (DMMU) which falls under the office of the vice-president, made available temporary water tanks and mobile lavatories in high-risk areas to try and reduce the impact of the disease.

The Lusaka District Commissioner together with the area Members of Parliament and members of the community developed a plan of action [which] will perhaps help answer questions on why [there are] priority [high-risk] areas, like Mandevu and Kanyama.

In 2008, areas like Mandevu experienced floods that left a trail of destruction largely due to the blocked drains and unplanned construction.

The Lusaka District office with the help of prisoners has unblocked drains containing stagnant water, which are not only a potential source of a cholera outbreak but also a breeding ground for mosquitoes that cause malaria.

Mindful of the hazards associated with unblocking drainages, the Lusaka DDR has bought protective clothing, which included overalls, gumboots, and facemasks. The DDR also provides meals for the prisoners.

In areas where there has been erratic water supply or no water at all, the DDR is installing permanent water reticulation stands and sinking bore holes. The Lusaka Water and Sewerage Company (LWSC) has put up 11 permanent water pipes, and is replacing temporary water stands put up in 2008.

Such programmes however cannot succeed without the participation and interest of the community and it is for this reason that Ms Kalulu has embarked on a hygiene promotion crusade. Some of the programmes will include drama with the Muvi Television soap, Banja crew and musicians like Joe Chibangu.

Source: Sam Phirim, Times of Zambia / allAfrica.com, 27 Oct 2009

Cameroon: cholera kills at least 51 in north

Cholera has killed at least 51 people in the past few weeks in northern Cameroon, where health experts say safe water and proper sanitation are sorely lacking.

“[The fight against cholera] here will be difficult because the hygiene conditions are awful,” said a health official who was not authorized to be quoted. He noted that most people defecate in open areas.

The regions affected are Cameroon’s North and Extreme North, with the first infections reported in September, according to the Health Ministry.

As of 14 October [2009] 23 people had died in Extreme North, of 144 infected, according to a Health Ministry document that is updated regularly, while in neighbouring North region 28 people had died of 152 infected.

This area of Cameroon is on the southern fringe of the Sahel and water is scarce; existing boreholes and wells are insufficient to meet the needs of the population, according to UNICEF in Cameroon.

In rural Cameroon only 30 percent of inhabitants have access to safe water and 15 percent to sanitation systems, according to UNICEF.

In the cholera-hit areas local authorities have begun disinfecting wells and other water points, according to Albert Friki, prefect in one affected department of Extreme North region. Authorities are also urging communities to practice proper hygiene.

“We are urging people to be careful with the food and water they consume, and with how they handle the remains of people who died of cholera,” he said.

Cholera epidemics are frequent in northern Cameroon but the current outbreak is particularly severe, the health ministry official told IRIN. The highest number of cholera deaths in recent years was in the commercial capital Douala in 2004 when cholera killed 100 people.

Source: IRIN, 15 Oct 2009

Kenya: cholera outbreaks in the north, Coast and Nairobi slums

In early October 2009, at least 29 people died of cholera and hundreds more were being treated for cholera-related symptoms such as acute watery diarrhoea (AWD) in the larger Turkana District in the northwest and in the eastern regions of Garbatulla and Laisamis, say health officials. The regions are not only facing an acute water shortage, due to a prolonged drought, but also have poor latrine coverage.

Cholera has also surfaced in several parts of the Coast in the aftermath of flooding. Coast Provincial Medical Officer Dr Anisa Omar confirmed on 3 November 2009, that 12 people have been admitted at Lamu district hospital after contracting cholera. There were also outbreaks of water-borne diseases in Magarini and Tana Delta district.

Cholera has also killed 11 people in Nairobi. The first case was reported in the sprawling Mukuru kwa Njenga slum. Some 949 people — most of them pregnant women and children under five years — had been treated for cholera and other water-borne diseases like diarrhoea, vomiting and dysentery.

See below two NTVKenya video reports on cholera in Mukuru.

Source: IRIN, 09 Oct 2009 ; Mathias Ringa, Daily Nation / allAfrica.com, 03 Nov 2009 ; Mike Mwaniki, Daily Nation, allAfrica.com, 29 October 2009