Cholera is a serious health condition that is caused by ingestion of water or food contaminated with faeces. Cholera causes severe dehydration and kills adults within hours. It is caused by the bacterium-vibrio cholera-and spreads rapidly depending on several factors.
This year, cholera outbreaks and deaths have been reported in some countries in Asia and Africa. Cholera outbreaks in Yemen, South Sudan, Kenya, Tanzania, and Nigeria made headlines recently. As at July, 2017, over 1,500 suspected cases and 17 cholera related deaths have been reported in Kwara state, Nigeria.
A look at the table below shows that Cholera outbreaks are still of public health concern:
|Country||Suspected Cases of Cholera and deaths|
|Yemen||October, 2016. As at July, 2017, 362,545 persons had become infected and 1817 persons have died.|
|South Sudan||As at may, 2017, 7,735 cholera cases, including 246 deaths have been reported|
|Tanzania||24,108 cases including 378 deaths have been reported.|
|Kenya||17,597 cases since December, 2014. In 2017, 1216 cases (including 14 deaths have been reported.|
|Nigeria||1558 suspected cases between April and June 30, 2017. Cases reported in Lagos and Kwara state|
Source: World Health Organization
Why does cholera affect several individuals during outbreaks? What factors make people more vulnerable? Why is cholera more likely to occur in some countries than others? Let’s look at certain factors that make Cholera spread rapidly.
Poor water supply
Generally, safe water supply prevents cholera by adding chlorine. This is then delivered via pipes or taps to individual houses and public facilities. However, in many African countries, pipe borne water is not readily accessible. Many rely on boreholes, wells, rivers and streams for drinking or cooking water. People also buy water sold in bottles and sachets. Without adequate water quality monitoring, sachet or bottled water may be sources of cholera infection. Worldwide up to 663 million persons do not have access to safe drinking water. This puts millions at risk of cholera yearly. For instance, lack of safe drinking water was found to be the main source of the recent cholera outbreak that claimed 246 lives in South Sudan.
Myths and misconceptions about Cholera
Many epidemics are partially driven by misleading information and poor knowledge of the means of transmission. Like other infectious diseases such as Ebola, several myths and misconceptions contribute to the spread of cholera. For instance, people believe you have to be around a sick person to have cholera. This is untrue because 3 out of 4 persons infected with cholera may not show any symptoms but transmit the infections through faecal contamination of food or water. Cultural beliefs also slow down adoption of preventive practices. For example, in some rural communities residents still preferred obtaining water from streams despite the provision of semi-automatic boreholes by government agencies.
Lack of sanitation in public places, restaurants, and households
According to United Nations, 2.5 billion people do not have access to toilets worldwide. In view of these, open defecation is very common. In India, up to 640 million people defecate openly. These include persons who have toilets at home but prefer going to defecate outside the home. In developing countries like Nigeria, several primary, secondary and tertiary schools do not have adequate toilet facilities.
Poor waste disposal
Inappropriate ways of disposing waste may fuel the spread of cholera. Some cities lack functioning waste management processes. Dumpsites are located within markets (where food items may become contaminated) or residential areas. People drop waste in convenient places such as nearby streams which may contaminate some water sources.
High Population density
Overcrowded areas and high density populations are at risk of cholera because these affect water, food and waste management. If the residents get water from a common source that is contaminated, the risk of rapid spread is high. Refugee camps are usually overcrowded. Kakuma, Dadaab are two refugee camps that have been struck by cholera epidemics.
Events and Mass gatherings
Weddings, conferences and other events that bring people together can also make cholera spread wildly. The standards of hygiene adopted by the catering team determine how susceptible attendees are to cholera. For instance, June, 22, 2017, 146 delegates of an international medical conference received treatment for cholera. Furthermore, between 10 and 12 of July, 136 cases occurred in connection with a China trade fair. The government subsequently shut down two hotels linked to the outbreaks because both had unsuitable sanitary conditions. In Nigeria, some gatherings occur in open places that do not have provisions for waste disposal or defecation. This puts all attendees at risk of diarrhoeal diseases such as cholera.
Generally, countries that embark on educational campaigns, improve access to safe drinking water and facilitate use of toilets are likely to have fewer cases of cholera. Until significant improvements occur in the provision of some of these basic amenities, cholera outbreaks may continue to re-emerge.