Fighting cholera

With almost 17,000 cases reported in the latest nationwide cholera outbreak, the Democratic Republic of Congo (DRC) must rethink its preparedness strategy to curb future outbreaks, health experts told IRIN.

“The government must take the lead in educating the public on hygiene,” Pilajie Babakazo, an assistant professor at the School of Public Health, University of Kinshasa, told IRIN on 20 October. “Although the government already has made efforts and has structures in place to deal with disease outbreaks, it must do more because the population remains largely poor. For instance, one cannot ask the population to boil drinking water when a large portion of them lack the [energy] with which to boil the water.”

A long-term strategy to prevent future outbreaks must involve the community, Babakazo said, adding: “The problem we face at the moment is high rates of illiteracy in the country; sensitization is not strong enough to educate people on how to avoid contracting cholera. Cholera is a disease of dirty hands and the people must be sensitized on hand-washing practices.”

In a 17 October bulletin, the Ministry of Public Health and the UN World Health Organization (WHO) said 7,306 cases and 404 deaths had been reported in the four provinces affected - Bandundu, Equateur, Kinshasa and Orientale. Some 9,357 cases and 77 deaths have been reported in four provinces where cholera is endemic - Katanga, Maniema, North Kivu and South Kivu, according to the bulletin.

The latest outbreak started in March in Kisangani, Orientale Province, where it has since been brought under control, but has now spread to areas along River Congo to Bandundu, Equateur and Kinshasa provinces.

In the provinces where cholera is endemic, Babakazo said, the government and its development partners should treat the water used by the population to avoid future outbreaks. “Cholera is rampant in an area like [the eastern town of] Goma where people drink water from the lake [Kivu] that is not safe. If the government provided safe drinking water there, cholera outbreaks would not occur.”

She said the transmission vehicle for the latest outbreak had been the River Congo, which passes through all the four affected provinces, with infected travellers carrying the disease to several areas along the river.

According to Kossi Ayigan of the WHO, the health cluster coordinator, the emergency response phase of the current cholera outbreak is drawing to a close and should be followed by firm action on proper sanitation and provision of safe drinking water by the government and its development partners.

“The epidemic is subsiding; the humanitarian actors are now completing the emergency response, now the government and its development partners should take over and include in their development plans a section on how to provide proper sanitation and safe drinking water,” Ayigan said. “They need to undertake quickly some heavy public work; especially the rehabilitation of sewerage systems, to ensure waste water is drained properly and to revamp the provision of tap water in areas without running water, like Equateur.”

Ayigan said humanitarian actors were considering introducing water purifiers - each costing US$35 and able to purify up to 18,000 litres - in the interim, before long-term development projects are in place. But this was subject to availability of funds.

“The DRC is a large country and the main concern would be logistics; it is not easy to do something from one province to another; with the water purifiers, we would be trying to ensure that the epidemic does not spread further,” Ayigan said.

"The move from emergency to development must, for instance, be accompanied by increased latrine construction as well as other sanitation measures, such as the clearing of gutters.”

Long-term strategy

Benoit Ilunga Kebela, head of the disease control department in the Ministry of Public Health, told IRIN that in addition to efforts the government is making to contain the outbreak, it had a long-term strategy - incorporating research, surveillance and case management - to ensure the disease was controlled in the outbreak areas and managed, “with a view to eradicating it”, in the endemic areas.

“The current outbreak is occurring in the west of the country for the first time in almost 10 years; the previous one was in Kinshasa in 2000. The strategy we have in place focuses mainly on management of [cholera] cases, establishment of treatment sites and putting measures in place to avoid further transmission,” Kebela said. “Moreover, we are using messages placed through the media [radio, TV, skits and comedies] to urge the population to maintain hygiene; we are asking them to wash hands using water and soap, those who do not have soap can use ash and water; to chlorinate drinking water, cover cooked food and to ensure they eat hot meals.”

Kebela said only Kinshasa and Mbandaka, capital of Equateur, remained problematic. “We have it under control in Kisangani and Bandundu areas; the situation for Kinshasa has been worsened by the current rains and the large numbers of people, especially those residing in crowded [and low-income] residential areas.

“In Mbandaka we have assessed the disease hot-spots and we are now focusing on improving general cleanliness of the area, while in Kinshasa sensitization of the public on hygiene continues.”

The government’s long-term strategy, Kebela said, was to continue surveillance and monitoring as pre-emptive measures.

“Cholera is one of the diseases that we monitor on a weekly basis; in the east of the country, besides surveillance, we are providing medicine and managing the cases; it is important to note that the management of cholera involves several other government ministries, such as energy, water and environment, in order to achieve hygiene and cleanliness,” he said.

Research is ongoing, Kebela added, to explore ways and means of eradicating the disease, especially in the endemic provinces in the east.

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