Cholera - Is it still a major issue for Africa ?

What is Cholera 

"It is an acute, diarrhoea illness caused by infection of the intestine with the toxigenic bacterium Vibrio Cholera serogroup" Gaffga H N, (2007).  It can cause death if not treated within hours.


Britain and the battle with Cholera 

Cholera first occurred in Britain in 1831, there were 4 major outbreaks in the next 30 years. The second outbreak in 1848 cost the lives of 53 000 people. There was no cure and people died in less then 12 hours. There were over 700 works published in the uk to try and answer what caused this disease. The general theory at the time was that it was spread through the air due to rotting animals and sewage.  John snow did not believe this, when the problem in soho near to where he lived he began to investigate. Snow S (2002)
Instead of reading more text about Snows battle with finding the answer that caused the cholera outbreak in soho london I believe a short video clip will be more interesting.

Is Cholera a major issue in Africa in the 21 century ?

Cholera was eradicated from industrialised countries from water ways by the introduction of sewage treatment plants over 100 years ago after the root of the problem was known. The problem is cholera is still a major cause of death and illness in developing countries, even there is the knowledge now on the best methods to prevent cholera, we are not still in the 1800's.

There has been cholera epidemics around the world, in 1997 it was in Africa where there were over 1 million cases within the first three years. In contrast Cholera hit Latin America in 1991 but within a short period of ten years it had been dealt with and cases were rare Gaffga H N, (2007).
Why therefore hasn't this been the case for Africa where it is still a major problem. In the period between 1970 and 2011 50 % of the cases in Africa came from only seven countries. It included Angolo, Democratic republic of Congo, Mozambique, Nigeria, Somalia, Tanzania and South Africa.
Data provided by the WHO in 2016 still show a similar picture, out of a global 132,121 cases report to the WHO 54 % came from Africa. Figure 1 shows that from the countries where data was provided in Africa in 2016  the highest cases are shown in dark brown. This includes the demographic republic of Congo (28093 cases), Tanzania (11360), Somalia (15619) and Yemen (15751). Mengel A M et al (2014).



Source

What are the major driver of Cholera in these countries in Africa 

In most of these countries in Africa that have the highest numbers of cholera cases the main issue that keeps coming up as the reason is poor sanitation. Which is made worse by recent droughts, poor infrastructure and lack of funds to deal with the problem. In the democratic republic of Congo  people have been made to collect water from sources which shouldn't be used for drinking - they have no other choices because safe sources from wells have dried up and using lakes or rivers are the only options.
In Somalia the Cholera outbreak which started in 2016 is said to be linked to drought, leading to a knock on effect with a shortage of clean drinking water which doesn't help the situation. There is also a lack of infrastructure to deal with the problem. There is also suggestion that a diarrhoea outbreak in Ethiopia in the same period could be linked Green A 2017 .

Here is a great link for those who want to explore more case study's on this issue.

In a paper by Bwire G et al 2016, they suggest that 'cross-border' could be playing a role in spreading cholera. This is because when people are travelling across borders for either trade, looking for work or visiting families migrants become infected after being exposed to a cholera in a contaminated area. There was 603 cases in Malawi and Uganda when a cross border outbreak occurred. The study found that children under five were most affected and cross- border cholera outbreaks are not being investigated by government agencies enough.

Moore s et al 2017 paper suggests that the driver of Cholera in Africa could down to natural causes such as El Nino. In Africa as it causes increased rain to fall in East Africa and a reduction in Southern Africa. As water is linked to the transmission of cholera this could be possible. For those who wish to know more about EL Nino there is a great blog post exploring El Nino in detail, here is the link . The results of the study found that during the recent El Nino 2015 to 2016 cholera epidemics increased, the cases were higher in East Africa who have higher rainfall levels during this period. It is surprising that in Southern Africa where rainfall decreases cases of cholera also increased, so there might be other drivers at play.
The outbreak in Tanzania which killed 300 started in 2015 and so did the outbreak in countries such as Somalia, Kenya and Uganda which all had a sudden increases in outbreaks at the start of EL Nino and increased rainfall.


What are the response of governments in these affected countries in Africa.

• Many cover up the issue don't realise accurate numbers of cases.
• They don't have funds or infrastructure to deal with the issue, the fight needs huge human and financial resources. In Haiti for example which received huge investment due to the devastating outbreak there has been improvement. Mitz & Tauxe 2013
• Many countries in Africa like Somalia Work with Aid agencies and Humanitarian partners.  This year the government of Somalia launched an Oral Cholera Vaccination program which will target 450,000 people in high risk area. WASH have also been providing hygiene kits to over 316,000 people.