Online Reporter
ZIMBABWE defeated the last major cholera epidemic in the country by the end of June this year but the danger of new infection continually remains, as the moderate level outbreak in the Kariba area now a month old shows.
Around 115 cases of cholera have been recorded in Kariba, generally outside the town, with one death. The Ministry of Health and Child Care is on alert and has swung into its systems for finding and treating patients, therefore it is now unlikely that there are any hidden undiagnosed cases around.
A full set of measures is being taken, including making sure in the small camps where much of the outbreak has occurred that communities have effective latrines, with help given to make sure they are dug. There will be a range of other measures, of course, to make sure that people understand the need to ensure food and drinking water are safe, although good cooking and those simple treatment methods for a bucket of water will work.
The problem with cholera is that it needs just one sick person, in the wrong place at the wrong time, to trigger an outbreak. Because Zimbabwe is generally free of the disease most of the time, that one person in a wrong place for any new outbreak is likely to have been on a visit to a country where there are active cases, or even to be uninfected themselves but be carrying some contaminated food.
Cholera can spread very rapidly within a community, being an extreme diarrheal disease and the waste being a major source of infection, so it can get into water supplies or on food or be carried around. In the rainy season there is the additional danger that contaminated puddles can overflow and the bacteria be sent into streams and ponds.
So there is a need for continual vigilance and for the disease to be diagnosed as soon as possible so that the full range of effective action can be taken. This effective action is definitely not limited to treatment of the sick, although that is obviously important.
But the health authorities would like to find the source or sources of the infection, while these are still few, to make sure those under treatment are not spreading the infection further, and to mobilise the community into the full range of protective measures.
These measures generally mean high levels of personal hygiene, careful washing and preparation of all food, and care taken to make sure drinking and cooking water comes from a safe source or is rendered safe through simple processes, such as boiling, or adding a little bleach or those water purification tablets that are usually distributed during an outbreak.
Once again the village health workers suddenly find themselves on the frontline, making sure that anyone falling ill with diarrhoea is quickly brought in for diagnosis and treatment, and that their community has upgraded all hygiene and other measures to prevent transmission and is keeping everyone safe.
The sort of risk and the sort of prompt response can be seen in the recent single case found in Harare, a sick person in an informal settlement. Fortunately, and all credit to the health authorities, that person was identified promptly and isolated for treatment while the authorities made sure the area where he was staying was checked over and everyone in the vicinity was warned and told what to do.
It is certain that the case was imported into the city, either the person coming from outside the city or eating something brought from outside the city. By all reports, although we assume the authorities are still keeping their eyes wide open, the diagnosis was sufficiently prompt that the sick person was unable to spread the infection before treatment started.
The effectiveness of the response under the present Government could be seen in the measures taken to control and then end the last outbreak. This in the end produced 34 549 suspected cholera cases, 4 217 confirmed cases and 33 831 recoveries. Cumulative deaths reported were 718 with 87 being laboratory confirmed and 631 suspected deaths.
There were additional complications, including a lot of the initial cases being in communities that for religious reasons do not seek medical attention. Once again, the remarkable ground coverage of the Health Ministry managed to make inroads into such communities which helped to bring an end to the outbreak, although not until it had spread to most districts.
The low death rate, considering untreated cholera is often fatal, shows the effectiveness of the control programme, at least in finding and treating the sick. We learned a lot, and the measures most of us took at that time should be part of our daily routines against a lot of other infections.
While the authorities need to be on alert so there is prompt diagnosis and treatment for any suspected case, everyone should, in any case, be taking routine precautions.
A lot of people now use borehole water, which is not always 100 percent pure according to tests in Harare, and so might need some simple treatment, not just to avoid rare cholera but also to avoid a host of other possible illnesses.
People buy fruit and vegetables from a wide range of markets, shops and vendors, and so should have simple automatic routines for washing these before eating them. This will prevent a range of other infections, many less dramatic and dangerous than cholera but still a nuisance, taking hold.
We can all play our part and the advice from health authorities is fairly easy to follow. Simple hygiene and simple routines for water safety and washing food will keep us free from a wide range of unpleasant infections and so should be part of our normal lives.
daglous masveta
