CHOLERA, DIARRHEA AND DYSENTERY UPDATE 2009 (05): AFRICA
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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 - Kenya (Nairobi)
[2] Cholera - Nigeria (Adamawa)
[3] Cholera - Zimbabwe (Mashonaland West, Midlands)

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[1] Cholera - Kenya (Nairobi)
Date: Fri 23 Oct 2009
Source: Daily Nation (Kenya) [edited]
<http://www.nation.co.ke/News/-/1056/676238/-/uo30gl/-/>

At least 9 people have died of cholera in a Nairobi slum. 60 others 
were being treated on Friday [23 Oct 2009]. The staff of a mission 
hospital near Mukuru kwa Njenga said the 1st cases were reported on 
Monday [19 Oct 2009], but there was a dramatic increase on Friday [23 
Oct 2009].

When the Saturday Nation visited Medical Missionaries of Mary 
Hospital on Friday [23 Oct 2009], more than 60 people complained of 
stomach pains, vomiting and diarrhoea. Ms Peninah Nzuki, a community 
health worker, was 1st alerted to the killer disease by a neighbour 
on Monday [19 Oct 2009]. She then took to hospital the 1st patient, a 
one-year-old child, but he died while being treated.

"The water is dirty, and the levels of hygiene are poor, thus the 
disease is spreading fast," she told the Saturday Nation. According 
to the hospital's project coordinator, Ms Elizabeth Bundala, the 1st 
case was reported on Monday [19 Oct 2009], but the number increased 
on Thursday [22 Oct 2009] evening. "The outbreak is serious, almost 
as bad as one 10 years ago," she said.

On Friday [23 Oct 2009], a woman died after complaining of dizziness 
and vomiting the previous night. Ms Mary Bahati, a vegetable vendor, 
responded to the cries of her neighbour, after a friend alerted her 
that he had heard someone vomiting next door. "She was all alone in 
the house, but she died before we arrived at the hospital," said Ms Bahati.

According to the hospital administrator, 2 children below 2 years 
died on Monday [19 Oct 2009] and Tuesday [20 Oct 2009], and more 
remained at risk due to the open sewers in the slum.

Cholera is an acute diarrhoea infection caused by the ingestion of 
the bacterium, _Vibrio cholerae_. Transmission occurs through 
contaminated food or drinking water. The disease is characterized in 
its most severe form by a sudden onset of acute watery diarrhoea that 
can lead to death through dehydration and kidney failure.

The extremely short incubation period -- 2 hours to 5 days -- 
enhances the potentially explosive pattern of outbreaks. It is an 
extremely virulent disease and can kill an adult within hours. 
Doctors at the hospital were administering oral rehydration salts and 
antibiotics to enable the patients to regain lost fluids and energy.

The residents pointed an accusing finger at tankers that purport to 
sell clean drinking water yet, they said, it is contaminated. "I ate 
maandazi (a dough-fried cookie), and now I can hardly walk due to 
stomach pains," said a shopkeeper.

Roadside eating places are erected on sewers, and children freely 
play near raw sewage, oblivious of the risk. "Last night, we treated 
20 people complaining of diarrhoea and stomach pains," Ms Bundala 
said. She cited lack of drugs to treat the huge number of patients, 
though they made a referral to the nearby Alice Hospital and another 
to Kenyatta National Hospital on Friday evening.

Medical staff at the mission hospital were overwhelmed and were 
forced to postpone ante-natal and tuberculosis clinics. A 
surveillance team from the district public health office later 
arrived and mobilized a team to spray the drainage.

[Byline: Joy Wanja]

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

[Nairobi is found in Central Nairobi and can be located on the 
ProMED/Health map of Kenya at <http://healthmap.org/r/008m>. - Mod.JFW]

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[2] Cholera - Nigeria (Adamawa)
Date: 24 Oct 2009
Source: All Africa.com [edited]
<http://allafrica.com/stories/printable/200910261004.html>

A fresh outbreak of the deadly water-borne disease cholera has been 
reported in Michika Local Government Council Area of Adamawa State, 
leaving over 20 people dead in the current outbreak. The disease, 
which has been ravaging the entire state in the last 2 months, is 
believed to have affected 12 (57 percent) out of the 21 local 
government council areas of the state, leaving in its wake over 300 
people dead and over 1000 persons critically ill in hospitals.

The current outbreak, in Tillizo, a mountainous settlement 2 hours 
trekking distance from Bazza, a major settlement in Michika, is said 
to have left 20 people, mostly elderly and children, dead and over 
100 others still critically ill.

Tillizo Community Leader Sebastian Dauda told THISDAY that the 
current outbreak was noticed about a week ago, and all efforts to get 
the State Ministry of Health officials to come to the area have 
proven futile, as they complained of being overstretched.

The rapid spread of the disease is compounded by the recent strike 
action embarked upon by the Health and Allied Workers Union about 2 
weeks ago in protest against the stoppage of the payment of their 
HATT'S allowances by the State Government. The strike action by the 
Health Workers has reduced state government capacity for intervention 
to a minimal level, as the Chairman of the Local Government council 
is said to have been flown abroad for medical check-up.

A medical practitioner serving in the area, Dr Francis Zira, called 
on the federal and state governments to intervene urgently to check 
further loss of lives. Hon. Binta Garba, member of the House of 
Representatives, whose constituency Tilliozo is included, told 
THISDAY when contacted that she is already making contact with the 
officials of the Federal Ministry of Health to seek their 
intervention, promising that assistance would soon be on the way. The 
state commissioner of health, Dr Zainab Kwonche, confirmed the new 
outbreak of the disease, stating that assistance is being mobilized 
to the area, adding that already a mobile medical squad had been 
established to check such occurrences.

[Byline: Matthew Onah]

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

[Adamawa region is located in northeastern Nigeria and can be seen on 
the HealthMap/ProMED-mail interactive map of Nigeria that is 
available at <http://healthmap.org/r/00Xx>. - Mod.JFW]

******
[3] Cholera - Zimbabwe (Mashonaland West, Midlands)
Date: 23 Oct 2009
Source: The Zimbabwean (Zimbabwe) [edited]
<http://www.thezimbabwean.co.uk/2009102325880/health/cholera-returns-and-kills-five-so-far.html>

Five people have died from cholera at 2 different locations in 
Zimbabwe, and 30 other people are undergoing treatment for the 
waterborne disease, raising the specter of another epidemic.

The permanent secretary for health, Gerald Gwinji, told the media 
last week [week ending 17 Oct 2009] that 3 people had died from 
cholera in Mashonaland West Province, in the northeast of the 
country, while 2 other deaths were recorded in Midlands Province, in 
central Zimbabwe. Gwinji attributed the deaths in Gokwe North, 
Midlands, to "religious objectors who for a long time have been 
reluctant to seek medical attention. We are still trying to come up 
with ways of addressing this special group."

A cholera outbreak that began in August 2008 and lasted for a year 
before it was officially declared at an end in July 2009 caused the 
deaths of more than 4000 people and infected nearly 100 000 others. 
The cause of this epidemic was dilapidated and broken sanitation and 
water infrastructure, much of which is still in the same state as a 
year ago, so the coming rainy season is likely to facilitate the 
spread of the disease.

"We have received confirmation of the cholera cases from the 
government, and this poses a new challenge, in the sense that there 
is need to educate and sensitise some communities which are resisting 
prevention and medication for cholera," said Tsitsi Singizi, a 
spokesperson for the UN Children's Fund (UNICEF). "Our education 
teams are already out in full force, and we hope that this time the 
effect of cholera will not be as it was last time," she commented.

Samuel Sipepa Nkomo, the minister for water resources development and 
management, told IRIN that repairing the water and sanitation 
infrastructure in the capital, Harare, was the main priority as this 
had been the epicentre of the previous cholera outbreak. "I am 
currently touring water sources throughout the country to establish 
the state of collapse and dilapidation, and what I have seen so far 
is very depressing," he said.

"In some parts of the country, some settlements have stopped using 
some dams because too much raw sewage was discharged into them. We 
want to ensure that if Harare is rehabilitated, we will not have 
other potential sources of cholera outbreaks." Dams are the usual 
source of water for drinking and household use in towns as well as 
rural areas, but when many of these became too polluted, people 
resorted to digging shallow wells to obtain water. Pit latrines were 
often dug too near the wells, which became contaminated and not only 
helped spread cholera but also made the disease difficult to combat.

The chairperson of the Combined Harare Residents Association, 
Simbarashe Moyo, told IRIN there was concern over the slow pace of 
infrastructure repairs but acknowledged that "after many years of 
neglecting our water and sewer infrastructure by many administrators, 
it is only fair to acknowledge the good work that the current 
administration at the municipality is doing." However, Mluleki Dube, 
who lives in Ashdown Park, a middle-class suburb in Harare, told IRIN 
that the area had been without water for the past 10 days. "The 
sanitation situation ... is a ticking health time bomb because some 
residents now resort to using secluded areas to relieve themselves, 
while others have sunk shallow and unprotected wells to provide water."

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

[The ProMED/Health map of Zimbabwe showing Mashonaland West in 
northeastern Zimbabwe and Midlands province in Central Zimbabwe can 
be seen at <http://healthmap.org/r/00Xy> and 
<http://healthmap.org/r/00Xz>, respectively.

In this update, the cholera outbreak in Adamawa state is reported to 
have spread to close to 60 percent of the local governments in the 
state affected. The latest affected area being largely inaccessible 
and very far away from good medical services, there have been many 
deaths both in the community and health facilities. The health care 
system is already overstretched by the ongoing outbreaks in other 
local governments and the strike by the health care workers. There 
is, therefore, need for the authorities to make treatment accessible 
in the affected communities by setting up well publicized community 
Oral Rehydration Centres and designating health facilities with 
cholera treatment centres to treat the severely dehydrated patients. 
Active community case surveillance networks need to be set up to 
identify and refer cases to the community oral rehydration centres 
and cholera treatment sites. This should go along way in reducing new 
cases and deaths.

In Zimbabwe, the risk factors for the August 2008 to July 2009 
cholera outbreak still prevail, but authorities are determined to 
ensure that the effect of the next outbreak is lower than that of the 
last outbreak. This is being done through improving repairing the 
water and sanitation infrastructure and educating the communities on 
the disease with priority being given to the capital city, Harare, 
which was the epicenter of the previous outbreak.

In Kenya, the new outbreak is blamed on the low standards of living 
in the affected areas of Nairobi. The causes cited include poor 
standards of living, poor food hygiene (roadside food vending) and 
supply of contaminated water to the residents. The authorities, 
therefore, need to address these to control the new outbreak. - Mod.JFW]

[see also:
Cholera, diarrhea & dysentery update 2009 (04): Africa 20091024.203279
Cholera - Cameroon: (North) 20091024.203261
Cholera - Zimbabwe (03) 20091023.203230
Cholera, diarrhea & dysentery update 2009 (03): Africa 20091018.203150
Cholera, diarrhea & dysentery update 2009 (02): Africa 20091011.203025
Cholera, diarrhea & dysentery update 2009 (01): Africa 20091009.202994
Cholera - Nigeria (02): (Borno) 20091003.202860
Cholera - Uganda (02): (Kasese) 20091002.202854

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

Cholera, diarrhea & dysentery update 2009 (26) 20091023.3653
Cholera, diarrhea & dysentery update 2009 (25) 20091009.3500
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 (19) 20090720.2575
Cholera, diarrhea & dysentery update 2009 (18) 20090709.2469
Cholera, diarrhea & dysentery update (2009) (17) 20090429.1620
Cholera, diarrhea & dysentery update 2009 (16) 20090310.0991]
....................................................jfw/msp/be

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