Opinion article by Ms Akani Baloyi; Dr Olivia Kunguma, Disaster Management Training and Education Centre for Africa (DiMTEC) at the University of the Free State; and Dr Arishka Kalicharan, Department of Basic Medical Sciences, Faculty of Health Sciences, University of the Free State.
Since the 1800s, many countries globally have had a long history of cholera outbreaks, with several countries experiencing periodic outbreaks and the disease remaining a public health concern. In Africa, countries like Senegal, Malawi, Zimbabwe, the Democratic Republic of Congo, Tanzania and many more have suffered greatly from this water-borne plague.
South Africa is among these countries – one of its major outbreaks, in 2008, killed more than 65 people, with more than 12 000 cases reported. The outbreak spread from Musina in Limpopo to the other provinces. The spread of cholera from Musina was attributed to a 2008/2009 outbreak in Zimbabwe, which affected more than 98 000 people; this was a case of disease contagion.
The 2008/2009 Zimbabwe outbreak was rated the country and the world’s largest ever recorded. Due to its political and economic crises, thousands of Zimbabweans migrated to South Africa. The movement of people from Zimbabwe helped spread the disease, as it is highly contagious. Because South Africa also had its own political and economic issues, cholera started spreading like wildfire. Similarly to Zimbabwe, South Africa is struggling with service delivery by local authorities due to poor governance and corruption.
In an effort to improve Zimbabwe’s health system after that outbreak, the United Nations donated almost $5 million. Despite such a big cash injection, the country’s health system is still not of a standard that can help mitigate and prevent cholera. The country still finds itself losing people due to cholera outbreaks.
The challenge in Africa is that decision-makers suffer from ‘reactive syndrome’, i.e. they wait for an outbreak before intiating activities like surveillance, health promotion, encouraging of laboratory testing, assessing and maintaining boreholes/ municipal water plants, and providing temporary emergency water, sanitation and hygiene. Only when an outbreak is already under way do they remember the existence of emergency and response plans, and then start updating them.
A recent cholera outbreak in Hammanskraal, north of Tshwane in Gauteng, South Africa, had claimed 23 lives by 28 May after residents were diagnosed with diarrhoeal disease due to cholera. In the neighbouring Free State, two deaths had been reported by 9 June.
It has become common knowledge that the main source of cholera infection is poor sanitation, lack of clean water, and contaminated food. But it is important to also know that most people exposed to the cholera bacterium do not get sick. They are unaware they have been infected, unless they start displaying symptoms such as diarrhoea, vomiting, and muscle cramps. Excessive diarrhoea can lead to dehydration, making it difficult for the body to perform basic functions. If left untreated, diarrhoea can be fatal.
The root causes are exacerbated by poor investment in public health and an unsettled political environment, in particular governance of municipalities and neglect of water treatment plants. The prevalence of this preventable infectious disease demands immediate attention from policymakers, health organisations, and society in general. Addressing the root causes, boosting preventative measures, and ensuring access to clean water and adequate healthcare services to eradicate cholera in South Africa is crucial.
How can we mitigate and prevent the spread of cholera?
While we lobby for policymakers or people who hold political power to be called to account and advocate for large-scale investment in establishing and maintaining water and sanitation facilities and the strengthening of public health community engagement, we need to consider some methods the public can explore.
Most infected people will have few to mild symptoms, which can be successfully treated with an oral rehydration solution. This solution replenishes the body’s fluid levels and can treat mild dehydration caused by diarrhoea, vomiting, or other medical conditions. Oral rehydration solutions can be made at home with the following ingredients:
- 1 litre of preboiled water (an effective way to disinfect the water)
- 6 level teaspoons of sugar (improves the absorption of electrolytes and water)
- ½ teaspoon of salt (promotes water absorption, since there is significant fluid loss due to diarrhoea)
- 1 tablespoon (or a palatable amount) of white vinegar (contains antimicrobial properties for preventing and treating infections)
This solution should be consumed after every loose stool, or as often as possible. If a child has been infected with the disease, in addition to the oral solution, give the child 20 mg (over 6 months of age) or 10 mg (under 6 months of age) zinc per day (tablet or syrup).
We should also always adhere to cost-effective habits such as routinely washing our hands and consuming preboiled water.
There are also three World Health Organisation (WHO) pre-approved oral cholera vaccines, namely Dukoral, Shanchol, and Euvichol-Plus. They all require two doses for full protection. These vaccines are available at the nearest clinic or hospital, and are relatively cost-effective.
Cholera and several other public health crises should not exist in the modern economy we are living in. Africa has the resources needed, including several medical interventions. Africa must address its issue regarding political leadership, which is its biggest challenge. There is an urgent need for proactiveness among our political leaders and government authorities which should see them take the lead in continuous multi-sectoral collaboration. They should invest in preparedness programmes that include training health workers and surveillance. And lastly, there is an urgent need for an accountability system for all the funds donated and invested towards improving a country’s healthcare system.