ZIMBABWE: Cholera outbreak threatens to become endemic

Tuesday, October 21, 2008

A cholera outbreak that has bridged Zimbabwe's dry season is proving difficult to contain and has spread from the cities to rural areas.

There are fears that the onset of the rainy season could make the waterborne disease endemic if the authorities fail to address the water and sanitation crisis plaguing the county.

Cholera is an intestinal infection causing acute diarrhoea and vomiting and, if left untreated, can cause death from dehydration within 24 hours. It is easily treatable with rehydration salts.

An anthrax outbreak has also been reported in Hurungwe, a rural area in Mashonaland West Province, about 300km north of the capital, Harare, "where 10 cases have been reported, but no deaths as yet. WHO [World Health Organisation] is still investigating", the UN said in a recent situation report on cholera and anthrax.

Anthrax is caused by the bacterium, Bacillus anthracis, and mostly affects wild animals and domesticated cattle, although it can be transferred to humans through inhalation of the bacteria's spores from a live or infected dead animal, blood contact if the skin is broken, or by eating the undercooked meat of a diseased animal. Anthrax is curable if diagnosed early.

120 deaths

The UN noted that "a cholera outbreak has been a cause of concern in Zimbabwe since February 2008 ... so far 120 deaths have been recorded cumulatively, with the highest percentage found in Mashonaland Central" Province in the country's north.

The collapse of health and municipal services is seen as the cause for the spread of the disease, with local authorities failing to provide potable water, rubbish collection and adequate sanitation, forcing people to dig shallow wells to obtain household and drinking water in areas where sewerage spills into streets because of poor, or non-existent, maintenance regimes.

The state-owned Zimbabwe National Water Authority (ZINWA) has pumped raw sewerage into Lake Chivero, one of the reservoirs providing Harare with water; residents with access to piped water often have to contend with a smelly greenish discharge from their taps.

The UN noted in its report that Zimbabwe was battling three cholera outbreaks in different locations. Chitungwiza, a dormitory town 35km southeast of Harare, had recorded 144 cholera cases and 15 deaths up to 13 October. UNICEF has been trucking in 30,000 litres of water daily and providing hygiene education.

In Mola, in the western district of Kariba, there were 22 cases with one fatality as of 7 October, and "probably more cases within the community, unrecognised", the UN report said.

Chinhoyi, in Mashonaland West Province, had recorded 6 deaths by 13 October, and WHO reported another 15 cases the following day, but "many more are assumed to be in the community, and paediatric cases are being admitted to the hospital."

Recurring disease

A cholera outbreak on 31 August in Harare affected the townships of Mbare, Kuwadzana, Highfields, Chikurubi and Mbvuku, in which 19 cases and one death were recorded. The last case was reported on 24 September.
Nevertheless, even where the cholera outbreaks have been brought under control, the UN report warns: "These locations remain potentially risk areas, considering cholera [is a] recurring trend."

The Combined Harare Residents Association (CHRA) said in a statement that Zimbabwe's political deadlock between President Robert Mugabe's ZANU-PF and Morgan Tsvangirai's Movement for Democratic Change was having a direct impact on the provision of services.

"The water woes that have seen many Harare residents losing their lives to cholera outbreaks are a result of the ruthless decision to hand over the administration of water and sewer services to ZINWA," the statement said.

"CHRA urges the powers that be to stop burying their heads in the sand and attend to the governance stalemate as a matter of urgency."