MOZAMBIQUE: Cholera spreads in central provinces

Photo: Tomas de Mul/IRIN

Some suspect the outbreak was caused by people drinking untreated water taken directly from rivers like the Zambezi

JOHANNESBURG, 11 November 2008 (IRIN) - Fears that cholera may already be spreading throughout central Mozambique has forced the government to issue the highest state of alert.

"We are dealing with a cholera outbreak and unfortunately it has already started spreading," Fernanda Teixeira, Secretary General of the Red Cross in Mozambique told IRIN. "In the beginning we were not sure if it was cholera because of the high mortality rates."

According to Mozambique's National Disaster Management Agency (INGC), "Samples collected for laboratory examination confirmed a cholera epidemic on the 5th of November." Some 250 cases and 48 fatalities have been registered since then but not all have been confirmed to be cholera-related.

A rapid assessment, conducted by Oxfam, the British-based non-governmental organisation (NGO), pointed to Guro district in the central Manica Province as the epicentre, and indicated that the outbreak started on the 24 October. New cases have also been registered in Tete and Zambezia provinces.

Controlling the outbreak

"What is most important now is prevention and rehydration of patients - the high mortality rate is usually because rehydration starts too late," Teixeira said.

Poor sanitation, inadequate sewage systems and streets filled with garbage could be at the root of an outbreak in urban areas, but in the harder-hit rural areas a more likely cause in could be a lack of potable water. "These areas have been suffering from drought," Teixeira said, and contamination could spread quickly if there were only a few sources of water for people to use.

Cholera is a waterborne intestinal infection causing acute diarrhoea and vomiting; if left untreated, it can cause death from dehydration within 24 hours, yet according to the WHO, cholera is "an easily treatable disease", cured with rehydration salts.

Swift intervention by the Ministry of Health with the help of international health NGO Médecins sans Frontières (MSF) has resulted in a reduced case fatality rate. Cholera Treatment Centres to help patients have been set up and a prevention campaign is already underway.

Raising awareness of hygiene is a key element in stemming the outbreak: "We started advocacy aimed at sensitising and educating people on hygiene and sanitation practices," Teixeira said.

Water, sanitation and hygiene promotion activities have included providing potable water, chlorinating traditional wells, constructing latrines and distributing soap and jerry cans.

Constant cholera

Mozambique started recording cases of cholera in Zambezia province as early as October 2007 and "despite great efforts by the Government of Mozambique, the epidemic persists to date," according to a Situation Report released by the UN's Children Fund, UNICEF, on 11 November based on information received from various partners.

Before the current spike, 7,547 cases with 78 deaths were recorded between October 2007 and October 2008, according to the Mozambican Health Ministry.

Only three provinces - Sofala, Cabo Delgado and Gaza - have not registered any cases of cholera in the past 60 days, the UNICEF report said.

"We have cholera every year, but never with such high mortality rates. The situation now seems under control," Teixeira commented. But with the rainy season quickly approaching, "cases could again go up".

tdm/he