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Archive Number 20091009.202994
Published Date 09-OCT-2009
Subject PRO/EAFR> Cholera, diarrhea & dysentery update 2009 (01): Africa
CHOLERA, DIARRHEA & DYSENTERY UPDATE 2009 (01): AFRICA
******************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
[1] Cholera - Tanzania (Tanga)
[2] Cholera - Kenya (Eastern)
[3] Cholera - Kenya (Eastern)
[4] Cholera - Uganda (Kampala)
[5] Cholera - Cameroon (Northern Cameroon) ex Nigeria
[6] Cholera - Mozambique (Cabo Delgado)
[7] Cholera - Nigeria (Adamawa)

******
[1] Cholera - Tanzania (Tanga)
Date: Mon 5 Oct 2009
Source: IOL (Independent Online, South Africa) [edited]
<http://www.iol.co.za/index.php?set_id=1&click_id=87&art_id=nw20091005211419443C842153> 



A total of 12 people have died in a cholera epidemic in Tanzania over 
the past week, with most cases recorded in the north of the country, 
a health ministry spokesman said on Monday [5 Oct 2009].

Around 600 cases were reported in the east African country during the 
last 7 days, but Handeni district in the northeastern region of Tanga 
was hardest hit with 511 patients, spokesman Nsachris Mwamaja told 
journalists. "The government is doing all it can to check further 
spread of the water-borne disease and treat patients by ensuring 
adequate supply of medicines," Mwamaja said.

Handeni District Commissioner Seif Mpembenwe said that schools in the 
area would remain closed until [1 Nov 2009]. "We are glad that the 
situation is improving and the government's efforts have been 
welcomed by the people. We hope by the end of the month [October 
2009], our efforts will bear some positive results and students will 
resume their classes," said Mpembenwe.

Cholera can also be transmitted by food that has been in contact with 
sewage. It causes serious diarrhoea and vomiting leading to 
dehydration. With a short incubation period, it can be fatal if not 
treated in time.

--
Communicated by:
ProMED-EAFR
<promed-eafr@promedmail.org>

[Handeni District is located in north east Tanzania in the Tanga 
region, which can be seen on the map at 
<http://www.un.org/Depts/Cartographic/map/profile/tanzania.pdf>.The 
HealthMap/ProMED-mail interactive map of Tanzania is available at 
<http://healthmap.org/r/00UE>. - Mod.JFW]

******
[2] Cholera - Kenya (Eastern)
Date: Fri 2 Oct 2009
Source: AllAfrica, Daily Nation (Kenya) report [edited]
<http://allafrica.com/stories/200910020738.html>


A team from Medicines Sans Frontiers [MSF] has camped in Marsabit 
South district [Eastern Province] to avert the spread of cholera, 
which has left 15 people dead.

MSF, also known as Doctors Without Borders, had disbanded its 1st 
camp on [24 Sep 2009] at Moite village in Loiyangalani division 
[Marsabit District] where 11 people died from the disease. And the 
same disease, started to spread in El-Molo Bay location on Tuesday 
[29 Sep 2009]. By Friday [2 Oct 2009], 3 people had succumbed to 
cholera. At the same time, a pregnant woman succumbed to the disease 
in Moite village on Wednesday [30 Sep 2009].

On Thursday [1 Oct 2009], a driver with an NGO had to be airlifted 
from Loiyangalani Town to Nairobi after contracting the disease. He 
had driven a staff member from the NGO to monitor projects they have 
initiated in Loiyangalani Town. The driver is recovering at Karen 
Hospital in Nairobi.

"Those who have died in El-Molo Bay are children under 15 years. We 
also have others who are admitted and the disease is spreading fast 
to other areas," local public health officer Lemaiyon Lenamira told 
the Nation by telephone.

He said a doctor from MSF and a medical staff from the office of the 
local Medical Officer of Health (MOH) have been sent to Moite to 
assess the situation following the death of the pregnant woman. He 
added that their report will determine whether they will return to the place.

Cholera had been reported in Marsabit South district early this year 
[2009] where 18 people died after contracting it.

--
Communicated by:
ProMED-EAFR
<promed-eafr@promedmail.org>

[Marsabit can be located on the HealthMap/ProMED-mail interactive map 
of Kenya at <http://healthmap.org/r/00UG>. - Mod.JFW]

******
[3] Cholera - Kenya (Eastern)
Date: Sat 3 Oct 2009
Source: Daily Nation (Kenya) [edited]
<http://www.nation.co.ke/News/regional/-/1070/667426/-/7n02ul/-/>


To date, 3 people have died of cholera in Mutomo [formerly Kitui] 
District [Eastern Province]. By yesterday [2 Oct 2009], 30 cholera 
patients were being treated at the Mutomo Mission Hospital. More than 
100 others are under observation at Mathima village in Mutha Division.

Mutomo District Medical Officer of Health Dr Patrick Mutuku said 2 of 
the dead were a man and a woman aged over 70. They died on Wednesday 
[30 Sep 2009]. The latest victim is a Standard Four pupil who died on 
Friday [02 Oct 2009].

Dr Mutuku attributed the outbreak to the consumption of contaminated 
water. The number of those affected is growing, he warned.

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[The provinces of Kenya can be seen on the map 
at  <http://www.un.org/Depts/Cartographic/map/profile/kenya.pdf>. 
Mutomo can be located via the HealthMap/ProMED-mail interactive map 
at <http://healthmap.org/r/00UM>. - Mod.JFW]

******
[4] Cholera - Uganda (Kampala)
Date: Wed 7 Oct 2009
Source: Daily Monitor (Uganda) [edited]
<http://www.monitor.co.ug/artman/publish/regional-special/Cholera_kills_three_13_admitted_at_Mulago_92521.shtml> 



Following an outbreak in Kampala last week [week of 28 Sep 2009], 3 
people have been confirmed dead and 13 others are hospitalized at 
Mulago cholera treatment centre.

Kampala City Council Health officer, Dr Messach Mubiru, told Daily 
Monitor yesterday [6 Oct 2009] that one person died from Mulago 
Hospital and the other 2 from Namuwongo. He cautioned people 
especially from the slum areas to desist from eating cold food and 
drinks vended on the streets.

Cholera is caused by a [bacterium] called _Vibrio cholerae_. Its 
symptoms include diarrhoea and vomiting. Dr Mubiru, urged people to 
maintain personal and communal hygiene.

[Byline: Stephen Otage]

--
Communicated by:
ProMED-EAFR
<promed-eafr@promedmail.org>

[Kampala is located in Central Uganda and can be seen on the 
HealthMap/ProMED-mail interactive map of Uganda at 
<http://healthmap.org/r/00UL>. - Mod.JFW]

******
[5] Cholera - Cameroon (northern) ex Nigeria
Date: Tue 6 Oct 2009
Source: Thomson Reuters Foundation AlertNet [edited]
<http://www.alertnet.org/thenews/newsdesk/L6284747.htm>


A cholera outbreak in northern Cameroon has killed 15 people, state 
media reported on Tuesday [6 Oct 2009]. Cameroonian authorities are 
taking measures to contain the epidemic, which was brought in from 
neighboring Nigeria, state radio and the official Cameroon Tribune said.

"The disease was imported from neighbouring Nigeria by a lady who 
visited the country recently," the Tribune said. "She died after 
suffering from diarrhea and vomiting and her dresses were washed in a 
stream used by local inhabitants, thereby contaminating everybody."

Cholera is a perennial disease in the region, where access to potable 
water is limited.

[Byline: Tansa Musa; editing: Richard Valdmanis, Angus MacSwan]

--
Communicated by:
ProMED-EAFR
<promed-eafr@promedmail.org>

[The regions of Cameroon can be seen on the map at 
<http://www.lib.utexas.edu/maps/africa/cameroon_pol98.jpg>.
The HealthMap/ProMED-mail interactive map of Cameroon is available at 
<http://healthmap.org/r/00UD>. - Mod.JFW]

******
[6] Cholera - Mozambique (Cabo Delgado)
Date: Thu 8 Oct 2009
Source: AllAfrica, Mozambique Information Agency report [edited]
<http://allafrica.com/stories/200910080922.html>


Cholera is spreading again in the northern Mozambican province [of 
Cabo Delgado], after a hiatus of 2 months in which no cases were 
notified, according to a report in Thursday's [8 Oct 2009] issue of 
the Maputo daily "Noticias". When the epidemic appeared to have run 
its course, the health authorities decided to close the cholera 
treatment centres in the province, but following a renewed outbreak 
as of [26 Sep 2009], some of them have been re-opened.

The Health Ministry in Maputo has not yet confirmed the spread of the 
disease to Ancuabe district -- but earlier this week the Cabo Delgado 
chief doctor, Cesario Sauegi, was cited as saying he was certain that 
the diarrhea cases reported from Ancuabe were in fact cholera.

The Deputy National Director of Health, Leonardo Chavane, told 
reporters in Maputo on Wednesday [7 Oct 2009] that, with this new 
outbreak, the total number of known cholera cases in Cabo Delgado 
since the start of the year [2009] stands at 19,069 with 15 deaths. 
Chavane blamed the new outbreak on poor hygienic and sanitation and a 
shortage of clean drinking water.

Besides treating the patients in the cholera treatment centres and 
monitoring the cases of diarrhoea, the health authorities are working 
to publicise good hygiene practices among the communities, and using 
chlorine to purify water.

Commenting on the situation in other parts of the country, Chavane 
said that his institution has been monitoring cases of diarrhoea in 
all provinces and districts, even where there has not yet been any 
need to reopen treatment centres.

--
Communicated by:
ProMED-EAFR
<promed-eafr@promedmail.org>

[Cabo Delgado Province is located in northern Mozambique and can be 
seen on the map at 
<http://www.un.org/Depts/Cartographic/map/profile/mozambiq.pdf>.
The HealthMap/ProMED-mail interactive map of Mozambique is available 
at <http://healthmap.org/r/00V3>. - Mod.JFW]

******
[7] Cholera - Nigeria (Adamawa)
Date: Fri 9 Oct 2009
Source: This Day [edited]
<http://www.thisdayonline.com/nview.php?id=156605>


The federal government, yesterday [8 Oct 2009] described the disease 
ravaging parts of Adamawa State as cholera and attributed it to poor 
hygiene, while strike by health workers was blamed for the high death 
rate. This is in reaction to reports of outbreak of a strange disease 
that claimed hundreds of lives in Adamawa and Borno states.

A statement issued yesterday [8 Oct 2009] in Abuja, by the Federal 
Ministry of Health, noted that a survey carried out by the ministry 
revealed that less than 40 per cent of the entire population of the 
state had no access to toilet facilities, which prompted defecation 
in open places that were swept into open water sources such as wells, 
which were major sources of drinking water during heavy rains.

"With the coming of the rains and the attendant flooding, the faeces 
were washed into the wells and contamination occurs. Contamination of 
the drinking water available to the people in the local governments 
involved is the main reason behind the outbreak. With the reported 
outbreak of the disease in the area, the Federal Ministry of Health 
quickly went into action to investigate the causes, which brought to 
fore the above observations. Preliminary investigations initially 
took place in 3 out of the 7 local governments, namely Hong, Mubi 
South, and Mubi North, which were the 1st set of affected local 
governments. Investigations have, however, been concluded in all the 
affected local governments," it noted.

The statement noted that the ministry had sent medicaments and 
supplies to assist the state government in combating the outbreak. 
"The problem on ground is compounded by the fact that medical and 
health workers in the entire area involved are on strike, therefore, 
primary health care centres and other government health 
establishments that would have been handy in taking care of the 
situation were closed, thus severely limiting access to care.

"The Federal Ministry of Health has rushed badly needed medicaments 
and supplies to the state to assist in combating the outbreak. Asides 
drugs, the supplies include, oral rehydration therapy [salts] (ORS), 
IV fluids, and chlorine powder. The objective is to provide curative 
treatment to all that have been affected and ensure that further 
spread is impeded.

"Field investigation and laboratory confirmation is also being 
undertaken simultaneously, as part of measures towards control of the 
cholera outbreak," the statement noted.

[Byline: Kingsley Nwezeh]

--
Communicated by:
ProMED-EAFR
<promed-eafr@promedmail.org>

[Adamawa Province is located in north eastern Nigeria and can be seen 
on the map at <http://www.un.org/Depts/Cartographic/map/profile/nigeria.pdf>.
The HealthMap/ProMED-mail interactive map of Nigeria is available at 
<http://healthmap.org/r/00IF>.

[In this update on cholera in some (7) countries affected by cholera 
epidemics in sub-Saharan Africa, its clear that the disease is still 
a huge public health challenge in the countries affected and on the 
continent as a whole.

The epidemics have been triggered by the onset of rains and hence 
flooding in most of the countries. Low coverage for safe water in 
most of the affected areas means that most of the water used by 
communities is from open unprotected water sources, which easily get 
contaminated with fecal matter from open defecation due to low toilet 
(latrine) coverage in these areas.

Poor food hygiene has been cited as the other cause and this is 
mainly due to street food vending especially in the slum areas in big 
towns and cities. Poor personal hygiene is also a factor and has been 
identified during the current outbreaks.

The resources of national and federal authorities in the affected 
areas appear to be inadequate to deal with the heavy disease burden 
in most of sub-Saharan Africa, hence the lack of stockpiles of 
medicines and supplies to treat cases at the beginning of the 
outbreaks. This explains the high case fatality rates at the onset of 
the outbreaks. Patient referral networks are lacking in the largely 
rural areas or slums where these outbreaks occur, hence a number of 
cases die in the communities before accessing care.

Human resource challenges have been cited during the current 
outbreaks. The shortage of health care workers has reached crisis 
levels in most of the affected countries. The few health care workers 
available aren't remunerated adequately, hence the reports of strikes 
that have aggravated the death rates reported in some countries cited 
in this update.

The current challenges therefore call for a commitment by national 
and federal authorities to commit resources to improving access to 
safe water; improving access to sanitation facilities; improving 
preparedness planning for outbreak response; improving health systems 
for better referral of patients; providing adequate and well 
remunerated health care workers and ample medicines and supplies to 
manage the cases. - Mod.JFW]

[see also:
Cholera - Nigeria (02): (Borno) 20091003.202860
Cholera - Uganda (02): (Kasese) 20091002.202854
Cholera - Nigeria: (Jigawa) 20091002.202850
Cholera - Rwanda: (Western Province) 20091002.202849
Cholera - Tanzania: (Zanzibar West) 20090927.202711
Cholera - Ethiopia (03): Addis Ababa, susp 20090918.202407
Cholera, diarrhea & dysentery: Worldwide 20090914.202068
Cholera - Kenya: Turkana 20090914.202053
Cholera - Ethiopia (02): Addis Ababa, susp., RFI 20090909.201978
Cholera, fatal - Kenya: (Nairobi) susp, RFI 20090907.201933
Cholera - Ethiopia: Addis Ababa, susp., RFI 20090906.201904
Cholera - Zimbabwe (02): (Manicaland) 20090827.201489
Cholera update: WHO global surveillance summary 2008 20090805.201108]

[Additional background information on cholera is available from the 
general ProMED-mail list. The postings below can be found at 
<http://www.promedmail.org>. - Mod.JFW]

[Cholera, diarrhea & dysentery update 2009 (24) 20090930.3411
Cholera, diarrhea & dysentery update 2009 (23) 20090921.3319
Cholera, diarrhea & dysentery update 2009 (22) 20090913.3223
Cholera, diarrhea & dysentery update 2009 (21) 20090819.2939
Cholera, diarrhea & dysentery update 2009 (20) 20090724.2616
Cholera, diarrhea & dysentery update 2009 (10) 20090126.0355
Cholera, diarrhea & dysentery update 2009 (01) 20090102.0015
2008
----
Cholera, diarrhea & dysentery update 2008 (57) 20081231.4125
Cholera, diarrhea & dysentery update 2008 (50) 20081208.3854
Cholera, diarrhea & dysentery update 2008 (30) 20080702.2019
Cholera, diarrhea & dysentery update 2008 (10) 20080212.0563
Cholera, diarrhea & dysentery update 2008 (01) 20080104.0047]
...................................jfw/mpp/mj/jfw/mj/mpp

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