Cholera outbreak: Zimbabwe paying price of lack of water infrastructure

Water pipe burst

The shortage of water and dysfunctional sewer systems in Chitungwiza has driven many people to using bush toilets, a practice long forgotten in urban life.

Although the “bushes” are now a rare find in Chitungwiza owing to the scramble for residential spaces, the current cropping season comes in handy as the many maize fields in the residential areas have become convenience places.

“We have resorted to the maize fields to ease the burden of having to carry water every time to flush the toilet,” said a resident in St Mary’s.

“The bush toilet system has helped most families here to keep toilets clean since our taps have run dry since time immemorial.

Over 200km away from the capital in Buhera, villagers also face severe water challenges amid fears of a cholera outbreak.

“As Buhera Residents Network Trust (BRNT) we fear that cholera might migrate from Bikita and Gutu because of the markets that are due to open on 3 April in Buhera. The traders come from different spheres of Zimbabwe,” BRNT Coordinator Leonard Mabasa told The Standard.

“The water sources and ablution facilities at Mutiusinazita, Gwama, Sanga and Bhidhiri are insufficient to cater for the huge population that come to the market.

“Great caution and good hygene is needed especially for traders who cook sadza and other food items, to avert a cholera disaster.”

Southern Africa is battling a cholera outbreak.

South Africa, Zambia, Mozambique, Malawi as well as Zimbabwe have already recorded confirmed cases of cholera.

Malawi has the highest number of cholera cases — 40 000 with the death toll standing at 1 700.

Zimbabwe recorded its first case on February 12 in Chegutu where 58 cases were diagnosed followed by one case each in Mutare and Mudzi.

Since then the bacterial disease has spread to almost all provinces with only Matabeleland North, Bulawayo and Midlands still out in the clear.

Latest statistics from the ministry of Health and Child Care as of Tuesday showed that the country’s cumulative suspected cholera cases stood at 231, with 209 recoveries and two deaths.

According to the World Health Organisation (WHO) cholera is an acute diarrhoeal infection caused by the ingestion of food or water contaminated with the bacterium Vibrio cholerae.

Cholera is an extremely virulent disease that can cause severe acute watery diarrhoea.

It takes between 12 hours and 5 days for a person to show symptoms after ingesting contaminated food or water, says WHO.

The bacterial disease affects both children and adults and can kill within hours if untreated.

Among people who develop symptoms, the majority have mild or moderate symptoms, while a minority develop acute watery diarrhoea with severe dehydration.

This can lead to death if left untreated.

Government on Tuesday announced that it has set aside a budget of US$ 24 168 353 for the cholera epidemic preparedness and response plan.

The budget will be supported by WHO, the Centre for Disease Control, United Nations Children’s Emergency Fund (Unicef), Medicines sans Frontiers (MSF) and Higher Life Foundation.

Speaking during Tuesday’s post-cabinet briefing, Information minister Monica Mutsvangwa said that the cholera situation was under control.

Mutsvangwa said active screening at ports of entry and exit had been initiated, and surveillance activities were ongoing.

“Cabinet wishes to inform the nation that cholera outbreaks on the African continent are occurring in the context of cyclones, floods, conflicts, poor sanitation and unreliable water supplies. cross-border mobility also plays a part in the spread of cholera and other diseases,” Mutsvangwa said.

Cholera outbreaks are not a new phenomenon in the country.

From 2008 to 2009, there was a severity which saw 98 585 cases reported and 4 287 deaths recorded in nine months.

It only stopped after international organisations such as USAid, Doctors Without Borders, Red Cross and UN agencies, including Unicef and WHO provided medicine and water treatment chemicals.

Another outbreak took place in 2018, killing at least 69 people, while at least 10 421 cases were recorded.

Harare has over the years emerged as a cholera hotspot with outbreaks now common.

Zimbabwe declared a state of emergency in Harare in 2018 after cholera swept through the capital.

Harare’s water system is old and falling apart, causing water loss and contamination from growing dumping sites and sewage.

Densely populated areas are particularly prone to waterborne diseases, as inadequate supplies of safe water force people to use unsafe alternatives like hand-dug wells and boreholes.

Harare mayor Jacob Mafume however told The Standard yesterday that the municipality was ready to deal with the cholera outbreak and other diarrheal diseases.

“We have upgraded Beatrice Infectious Hospital,” Mafume said.

“We have two wards that we have furnished with the assistance of the private sector, Simbisa Brands in particular.

“Wilkins Hospital is ready. We are also engaged in monitoring travellers that are coming from countries that have reported high incidences of cholera, countries such as Malawi and Mozambique.

“Recently we just dealt with Covid-19; the mix of the protocols is almost similar.

“We encourage the public to wash their hands before consuming food and also to drink water from clean sources.”

But health experts are not convinced with the interventions saying as long as there is no lasting solution to the water crisis, cholera will continue to be a health threat.

Health expert Johannes Marisa said it was prudent to have preventive strategies.

“The current cholera cases should be an eye-opener if we are to remain on top of the situation,” Marisa said.

“Safe and clean water supplies should be there without fail if cholera is to be contained easily.”

Marisa said more funds should be availed towards the cholera fight.

“We should not forget that cholera was in Zambia and Malawi first before cases were detected in Zimbabwe,” he said.

“Garbage removal should be robust to avoid water pollution. Enhanced sanitation should be in municipal or council DNA.

“Stocks of essential drugs should be maintained which include antibiotics like cotrimoxazole, intravenous drugs and fluids in high volumes for hydration in case of serious illnesses.

“The country should never run short of the required drugs which are life-saving in the event of a cholera attack.”

Community Working Group on Health (CWGH) executive director Itai Rusike said there is need to establish sustainable solutions to prevent recurrent cholera outbreaks.

“Access to safe water should be given higher priority and water treatment facilities should be excluded from load shedding,” Rusike said.

“The cholera hot-spot areas and those struggling to deal with the cholera scourge should seriously consider introducing the cholera vaccine but the vaccine should remain a complimentary measure and not a replacement to the Water Sanitation and Hygienic interventions and this needs to be implemented even as the population receives vaccination.”

Rusike said Zimbabwe needed to strengthen the primary health care principles and laws regarding public health.

“In order to address the public health issues surrounding cholera outbreaks, there is need to organise massive clean-up of public markets and stopping illegal vending of food in undesignated areas,” he said.

“Waste management should be enhanced by responding to all sewer system blockages and spillage as a matter of urgency and clearing illegal dumpsites.”

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