Opinion: Let’s be more serious about cholera

Cholera, a water-borne disease, had its first global outbreak in 1817 with an epicentre in Jessore near Calcutta.

CHOLERA is rearing its ugly head in Zambia today at a time when many people thought that Zimbabwe was the only country that was facing the diarrhoeal scourge.By yesterday, Zambia had recorded at least 9 500 cases of the disease with about 374 deaths. 

Zambia has turned its giant national stadium into a cholera treatment centre as multitudes of people flock to seek treatment. The disease has potential to spread to many other countries if action is not taken to contain it.Our country is facing the same predicament with cases going up by the day. 

The main difference with Zambia is that the case fatality rate is higher in Zambia (3,9%) than in Zimbabwe (2,2%).If cholera is not contained, the death rate can surpass the 2008 one where at least 4 200 people succumbed to the disease. Everyone needs to be serious about the disease and blaming one person or organisation is unfair.

Cholera, a water-borne disease, had its first global outbreak in 1817 with an epicentre in Jessore near Calcutta. To date, seven distinct cholera pandemics have been recorded in the past two centuries. The 7th pandemic started in South Asia in 1961, reached Africa in 1971 and the Americas in 1991.

The disease should not kill many people as case fatality rate is usually less than 2%. The continuous spread of the disease is a serious test on primary healthcare system which should orient its structures and functions towards the values of equity and social solidarity.

The principles required to sustain primary healthcare are its capacity to respond equitably and efficiently to the health needs of citizens, including the ability to monitor progress for continuous improvement and renewal, the responsibility and accountability of government, sustainability, participation and an orientation towards the highest standards of quality and safety and inter-sectoral approach. 

Primary healthcare should thus dwell on health education and promotion, good nutrition, clean water supply, good sanitisation, immunisation, affordable first line drugs, easy patient transfer to mention but a few.

Cholera prevention and control has four key stakeholders which are the patients themselves, councils, government and non-government organisations. It is thus prudent for each of these to act wisely for the disease to be contained.You and I have special roles to play especially now when almost all the districts are affected in the country.

Personal hygiene is very critical with hand-washing being paramount.Those who want to sanitise their hands can do so and it should be a taboo to eat any food without first washing one’s hands with soap and water.We are just after the festive season when behavioural determinants of health played significant roles in the spread of cholera.Many people were partying, braaing, dancing on open spaces where there was no proper sanitation and even water to wash hands.Cholera is a water-borne disease which can easily be transmitted through contaminated water and food. Vibrio cholerae has an incubation period of between three hours and six days and many people may be harbouring the bacteria without symptoms.

Councils need to be serious about issues of water and sanitation.For long, sewage and water pipes have not been attended to and this is an embarrassment for the country.The coming of the rains can worsen cholera as there is further contamination of water bodies. There is great potential for faecal contamination of water with raw sewage from burst pipes. Those that make use of unprotected wells have a higher risk of contracting the disease.Uncollected garbage is a serious matter that requires redress, alas, no serious measures are being taken by city fathers. Garbage is everywhere including at shopping centres where food is served. Residents are continuously at risk of contracting diarrhoeal diseases like cholera, dysentery or typhoid. If council is responsible for garbage collection, why is it that we have a perennial problem of uncollected garbage yet we have many office-bearers? That alone is an indicator of first-degree incompetence.

Government should chip in quickly with funds to sustain management of cases and of importance is the availability of necessary drugs and workforce to fight the scourge. Case management of cholera has not been as robust as expected. Council clinics and hospitals seem overwhelmed with cases hence complicated cases may not get the required management. There is serious understaffing at council clinics and hospitals with fewer nurses being seconded to cholera units. All this is fuelled by rampant brain drain in the health sector which has seen more than 5 000 nurses leaving the country for greener pastures in the last 2 years.Inter-sectoral approach remains fundamental in the mitigation and containment of cholera with councils expected to take the leading role. People should be reminded to practise good hygiene which include hand-washing with soapy water as well as sanitisation. All hands have to be on the deck if we are to win the cholera battle.

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