With resources stretched thin, aid agencies struggling to contain a cholera outbreak across all but one of Mozambique’s 10 provinces hope the approaching end of the rainy season will bring some relief.
"This year is worse than previous years, even worse than years in which we had floods. There are more cases and the fatality rate is slightly higher," secretary-general of the Mozambican Red Cross, Fernanda Teixeira, told IRIN. Over 12,000 cases and 157 deaths have been recorded since 1 January 2009.
The latest Southern Africa Regional Cholera Update, compiled by the UN Office for the Coordination of Humanitarian Affairs (OCHA), said the highest number of cases had been recorded in the northeastern provinces of Nampula (3,033) and Cabo Delgado (2,427).
"More and more districts are affected and there is an urgent need to strengthen surveillance, preparedness and response to the cholera outbreak in Mozambique, particularly in districts with high transmission risk and border districts to countries affected by cholera," the OCHA update said.
Not a new problem
Cholera is also ravaging neighbouring Zimbabwe – 92,811 cases and 4,077 deaths have been reported since August 2008, according to OCHA – but Teixeira said the Mozambican outbreak was not necessarily related: "Cholera has always been in Mozambique, it’s endemic."
The cholera country profile of Mozambique by the World Health Organization notes that the disease has been present in the country since 1973. In 1992, ‘93, ‘98, ‘99 and 2004, notified cholera cases in Mozambique represented between one-third and one-fifth of all cases reported in Africa.
Cholera is a waterborne intestinal infection that causes severe diarrhoea and vomiting, leading to rapid dehydration. Left untreated it can bring death within 24 hours, but the World Health Organisation (WHO) describes it as "an easily treatable disease" cured with rehydration salts.
Hard to eradicate
The surge in new cases was attributed to recent heavy rainfall in a number of provinces, but the underlying factors of cholera in Mozambique have always been related to pervasive water and sanitation problems, and a chronic lack of access to health facilities.
"There are many causes, like poor sanitation in cities and in the countryside," Texeira said. Less than 50 percent of Mozambique's 21 million people have access to safe drinking water.
The ministry of health has been leading the response to the outbreak, with the help of partners like WHO, the Red Cross and the UN Children’s Fund (UNICEF). According to the OCHA update, health and water and sanitation were key areas in the ongoing intervention.
"Social mobilization campaigns via radio, and distribution of information, education and communication materials were being intensified in order to reduce misconceptions and mobilize community around key cholera prevention messages," the update noted.
The need for adequate information was recently evidenced in a tragic case of ignorance when two Mozambican Red Cross volunteers were killed by the local community, who were convinced that the volunteers were deliberately spreading cholera. The incident in early March resulted in the charity organization halting its health work in the province of Nampula.
|We are doing what we can with the resources we have … the rainy season will come to an end in April; usually the situation then becomes better|
Providing assistance in remote areas is often very difficult. "People in rural areas don't seek assistance, or lack access to health facilities; when they finally get there it’s often too late," Teixiera said.
Money and weather may bring relief
The OCHA update said a US$ 875,000 donation by the United Kingdom's Department for International Development (DFID) had recently been released to help the humanitarian community in Mozambique cover the immediate needs of the response.
In the meantime, Teixiera said, "We are doing what we can with the resources we have … the rainy season will come to an end in April; usually the situation then becomes better."