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Cholera: UFS experts provide prevention and treatment tips

28 June 2023 Photo Supplied

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.

News Archive

Conference: Expanded ARV treatment

2005-03-02

VENUE: University of the Free State, Bloemfontein, South Africa
DATE: 30 March 2005 - 1 April 2005

ARV Programme as on 24Feb Download Word document
Programme Special events Download Word document

Official web site www.fshealth.gov.za/subsites/arvc

Rationale for the Conference
At the time of the planned Conference, much ground would have been covered, both in the Free State and in South Africa, in respect of the expanded public sector ARV treatment programme in respect of research, experiences in practice, training of staff, treatment of patients, lessons learned, successes and failures, etc. The time would then be quite opportune to share these in a systematic manner with other provinces and countries, as well as with the large variety of stakeholders and role players in the ARV and related domains, be they academics and researchers, policy makers and service/facility managers, the variety of caregivers, and the community organisations and affected patients.

The Conference and current research
The proposed Conference is, firstly, directly linked to the current research on the public sector roll-out of ARV treatment in the Free State conducted by several research institutions (e.g. CIET, CHSR&D, UCT Lung Institute). Secondly, the Conference could and would serve as a forum for other research groups in the country and further a field to report and share knowledge and experiences on ARV treatment and related initiatives. Lastly, the Conference will stage a golden opportunity for researchers and scientists, on the one hand, and policy makers, managers, and caregivers (as knowledge users), on the other hand, to engage in cross-disciplinary discourse on this mutual and topical theme.

Theme of Conference
Expanded ARV treatment in the Free State: sharing experiences

Focus
The focus is primarily on public sector ARV treatment in the Free State, but also initiatives/activities/perspectives of relevance to the Free State elsewhere in the country at large and further a field, as well as relevant ARV initiatives in the public, private, NGO and FBO sectors. Bear in mind, however, that ARV treatment is but part of a much more comprehensive approach to HIV and AIDS. The Conference will, therefore, not narrowly focus on the ARV treatment programme only. The broader context, other relevant dimensions, and a comprehensive approach to the challenges of HIV, AIDS and TB are of equal importance.

The purpose of the Conference
Enhance meaningful exchange, mutual understanding and collaboration among researchers, scientists, policy makers, managers and practitioners in the field of ARV treatment and related fields.

Share experiences in the various spheres of ARV treatment and related spheres (policy, management, practice, research, training, public-private-civil society sectors).

Record, reflect and report on the establishment of the ARV treatment programme in the Free State, and in within the context of the comprehensive HIV/AIDS programme.

Disseminate important research results on ARV treatment and related themes to health policy makers, managers, practitioners, communities and to the research community.

Stimulate discourse among various disciplines and various stakeholders/role players involved in ARV treatment and related programmes.

Sensitise and acquaint researchers to the requirements of policy makers, managers and practitioners in respect of ARV treatment and related fields.

Facilitate the implementation of research results in ARV treatment policy, programmes and practice.

Dissemination of Conference-related information
Information generated during the Conference could feed into policy, management and practice of ARV treatment, the training accompanying such programme, and the existing body of knowledge. After the Conference the information will be disseminated via the Internet and by scientific and popular publications.

Date and duration
Set for 30 & 31 March & 1 April 2005; to commence at 09:00 on the first day (30 March) and to end at 16:30 (1 April) the third day.

Format and scope of Conference
Alternating plenary, parallel sessions and debates focused on topical issues and interest groups. The Conference will strive to be maximally interactive and participative.

Themes and topics to cover:

Policy, management and health services/practice (various levels and contexts – clinical treatment, information, IT systems, pharmacy, laboratories, nutrition)
Research covering all relevant disciplines and diverse dimensions of ARV treatment and related themes
Training and evaluation of training
Patients, communities and civil society organisations
Public, private, NGO, FBO initiatives and partnerships

Emphasis will be on the Free State, however, with of significant involvement from other provinces, SADC countries, and countries further a field. The thrust will be to export lessons and experiences from the Free State, but also to import lessons and experiences from other provinces, countries and sectors.

Presenters
Key presenters from the Free State, other provinces, South Africa, from the private, FBO and NGO sectors, and from several other countries

Delegates
About half of the delegates will be Free State stakeholders and role players (all levels and all contexts). The other half will be role players and stakeholders in the ARV and related fields from other provinces, the national level, and other countries, as well as from the private, public and non-governmental sectors.

Focused workshops
Provision will be made for half-a-day or one-day workshop initiatives on the third day (1 April 2005).

Enquiries
For more information please contact:

Prof Dingie van Rensburg
Centre for Health Systems Research & Development
University of the Free State
PO Box 339
Bloenfontein
SOUTH AFRICA
9300

Contact:
Carin van Vuuren
Conference Organiser
Centre for Health Systems Research & Development
University of the Free State
P.O.Box 339
Bloemfontein
South Africa
9300
Tel +27 (0) 51 401 2181
Fax +27 (0) 51 4480370
Cell 0832932890
e-mail: arvconference.hum@mail.uovs.ac.za

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