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Rumbidzayi Zinyuke-Health Buzz
Since the beginning of this year, Zimbabwe has been fighting a raging battle against cholera.
While the number of cases being recorded had begun to go down after interventions by the Government, there has been a noted increase in cases over the past weeks.
Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae.
The disease remains a global threat to public health and an indicator of inequity and lack of social development.
According to the Africa Centres for Disease Control and Prevention’s epidemic intelligence report for the week 22-30 September, since the beginning of this year, a total of 191 885 cases (85 541 confirmed, 106 609 suspected) and 2 990 deaths were reported from 17 African Union member states.
For the week in review, 1 402 new cases and 41 new deaths were reported from Burundi, Cameroon, Ethiopia, Malawi, Mozambique, Nigeria, Sudan, Zambia and Zimbabwe.
Zimbabwe has to date reported a cumulative total of 4 508 suspected cholera cases, 900 confirmed cholera cases, 30 laboratory confirmed deaths and 97 suspected cholera deaths.
For centuries, the world has struggled to eradicate cholera, but what has been clear is that the provision of safe water and sanitation is critical to control the transmission of cholera and other water-borne diseases.
This message was also clearly articulated at the just ended second edition of the Africa Health Harm Reduction conference held in Marrakech last week.
Safely managed water, sanitation, and hygiene (WASH) services are an essential part of preventing and protecting human health during any infectious disease outbreaks.
Hence it is prudent for African countries, who are more affected by cholera, to prioritise investing in core public health infrastructure, including water and sanitation systems.
Health and Child Care Minister Douglas Mombeshora during his presentation at the AHHR conference, made a commitment that Zimbabwe would continue to strive towards improving water and sanitation services to reduce the harm brought by diseases such as cholera.
“In Zimbabwe we currently have an outbreak of cholera and this has also been reported in urban areas, which should not be the case,” he said.
“This is because there is poor management of waste by the city fathers. Most boreholes in the high density suburbs have been found to be contaminated.
“In the first place we should be providing safe drinking water to all our citizens in the urban areas, now we are finding the opposite. People in the rural areas are the ones who have safe water, not water that is contaminated by faecal material. We are looking at addressing those issues of providing safe drinking water to our population.”
Through the Presidential borehole scheme, the country has set a target to drill 35 000 boreholes by 2025 to ensure every Zimbabwean has access to clean and safe water.
As a measure to reduce the risk of diarrhoeal disease outbreaks, borehole drilling could serve to close the existing gap in water provision.
But more should be done. Local authorities should continue to strive towards ensuring constant supply of clean, potable water.
A study done in 2016 showed that an estimated 80 percent of Harare’s borehole and well water was contaminated and people using it were more at risk of contracting typhoid and cholera.
Without proper sanitation and clean water, the country could continuously be affected by these outbreaks, hence there is a need to look beyond it and come up with sustainable solutions.
While drilling of boreholes is a good alternative, the same have proved to be a fertile ground for bacteria in the case of Harare.
So what could be done?
The Médecins Sans Frontières (Doctors Without Borders) has developed a method of protecting boreholes from contamination using the sanitary seal technique.
This is where a seal is placed between the outermost casing string and the wall of the borehole to prevent entrance to the aquifer by any potential contaminants from the surface.
Already, such boreholes have been constructed in Mbare, Glen View and Hopley where communities were at higher risk of cholera outbreaks.
While the use of the technique could be expensive, it could be the answer to the problem of access to water and sanitation across the county.
Government and local authorities could look into adopting the initiative and rolling it out across the country.
But water alone will not help eradicate cholera.
It goes hand in hand with proper sanitation services.
Minister Mombeshora says while the Government is working towards this, there is still more that needs to be done.
“In terms of sanitation, we still have a long way to go before we can say we have adequately good sanitation both in urban and rural areas. About 37 percent of our population still practice open defecation, including in urban areas which should be unheard of,” he said.
“These issues are also related to water supply. If you do not have water, for flushing toilets in urban areas, the people end up using the bush system. That is why we have seen typhoid and cholera outbreaks in Harare. Water and sanitation issues need to be addressed both in the urban and rural areas.”
Minister Mombeshora said the country needed an accelerated sanitation programme and this was already on the cards as the Ministry had finalised the drafting of a Sanitation and Hygiene Policy which should guide the WASH sector in the implementation of sanitation programmes.
The creation of enabling policies is the best intervention as it will contribute towards the long-term solution for cholera control.
The WHO reckons that actions targeting environmental conditions should include the development of piped water systems with water treatment facilities (chlorination), interventions at the household level (water filtration, chemical or solar disinfection of water, safe water storage) and the construction of systems for safe sewage disposal, including latrines.
These WASH solutions for cholera are aligned with those of the Sustainable Development Goals (SDG 6) which goes beyond drinking water, sanitation and hygiene to also address the quality and sustainability of water resources, which are critical to public health.
However, many of these interventions require substantial long-term investments and continued maintenance, making them difficult to fund and sustain by less developed countries where the interventions are most needed.
But these could face an even bigger threat as the availability of water itself is also becoming a challenge owing to climatic changes.
Dr Olufunke Cofie, the West Africa Regional Representative of the International Water Management Institute (IWMI) says climate change is affecting water resources in Africa and the rest of the world.
“Climate Change is affecting water resources. This leads to the prevalence of physical and economic water scarcity in Africa,” she said.
She encouraged countries to develop water resources using ecological and built infrastructure that is complementary, equitable, and resilient and added that nature-based solutions improve water availability, quality, and disaster risk reduction.
It, therefore, means that a holistic approach to the reduction in the harm caused by disease outbreaks and other disasters such as climate change, cyclones, earthquakes among many others will be the way to go for Africa.
Because a one sided approach will not work.
An approach that will look into the availability of the water resource and making that water safer for communities coupled with proper sanitation services will definitely be a long term solution to ending cholera.
A small step at a time and Africa will be able to end diseases such as Cholera.
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