The Sunday Mail
Harare and Chitungwiza recently recorded cases of cholera after an outbreak claimed five lives in Chegutu earlier in the year. Our Reporter Norman Muchemwa interviewed Ministry of Health and Child Care Director of Epidemiology and Disease Control Dr Portia Manangazira (pictured above) on the disease. The following are excerpts from the interview.
Cholera is caused by what we know: we know how to prevent it and what drives it.
Broadly, water sanitation and hygiene are the most basic components in the fight against cholera. As long as people do not have safe water and sanitation, they are prone to cholera and other water-borne diseases.
When we see someone with the disease, that alone says a lot about where they are coming from.
It says a lot about the conditions that they live in; that is, level of poverty, population density and access to clean water.
Once all those issues have been addressed, we will not see cholera at all.
Cholera is an indicator disease because, it indicates that there is faecal oral contamination, so it means even human wastes finds its way into food or water.
The other issue may also be the immunity of the population to the bug and/or individual immunity to the bug.
I am saying that because when we experienced a cholera outbreak in 2008, we were actually cholera naïve, we had never been in contact with cholera before, so nobody was immune to it.
In areas where there are drivers of cholera, you can find that some of the people there might carry the bug but not suffer from the disease. They will be just transmitting it through faecal excretion when it increases to certain levels.
In an area where there is cholera, 10 percent of the people with the bug suffer with the disease.
But if you look at us before 2008, we can’t say for sure if some of us were carrying the bug because we had not been exposed to a combination of factors discussed earlier.
So those are the causes of cholera. Quantity of water matters, but also quality of water matters. Water has to be clean, it must not have any odour.
Also, the way food is handled and consumed matters when it comes to cholera.
The reasons why cholera keeps on resurfacing in those areas which were affected in 2008 is because conditions are still the same in terms of hygiene, water and sanitation.
In an urban area, clean water must be available from taps and we call that potable water.
Borehole water is not recommended in urban set-ups unless it is pumped into a tank and treated first so that it is suitable for human consumption.
This is because at one moment the water might be tested and results show that it is clean, but a lot happens underground in terms of pollution.
We are now using borehole water as a stop-gap measure in urban areas because some of the settlements are not properly planned.
We put a lot of people in a small area and we don’t provide them with safe water and sanitation. That will be asking for troubles such as cholera.
The 2008 cholera outbreak started in Unit O suburb, Chitungwiza.
We actually know the area where the whole community was taking water from a shallow well. The well happened to be contaminated by sewage and we have seen that again and again even in places such as Stoneridge where people dig shallow wells and pit latrines.
The water table is high because it is in the Manyame catchment area and once one starts seeing water oozing from a shallow well, they assume it is clean underground water.
In such cases, human waste would have mixed with drinking water and there is no treatment of the water which is infested with bacteria. We have what we call primary prevention and secondary prevention where we react and address an acute problem in places where an outbreak has already happened.
We have tried to raise awareness and urge whoever is in charge of water sanitation and hygiene to do their work according to the prescribed various pieces of legislation, according to our Public Health Act.
It is clear who is supposed to provide such services and what parameters are supposed to be in urban, rural and resettled areas.
It is unfortunate that these things are not looked into properly.
Solid waste management, refuse collection which attracts flies and other bugs that cause diseases, are not managed well.
We have to break that interface between the bug and humans and we have been vocal to local authorities on that matter.
We want an end to a situation where we mix human waste, garbage and water.
As a ministry, we are very active in surveillance of such diseases as dysentery, cholera and typhoid throughout the country.
Information is collected regularly to see how many cases of water-borne diseases have been reported, confirmed and treated.
The surveillance is important since we now have the cholera bacteria in our systems and we can’t prevent it. It is important to pick up the first cases as early as possible so that they do not spread.
Surveillance, in this case, is the best tool because we cannot avoid bacteria.
But we can ensure that we safeguard human health and make sure that we detect early, respond early, swiftly and effectively to effectively treat the first few cases so that they don’t spread.
We have learnt the hard way from the cholera outbreak of 2008. We also continuously train our staff so that they can have high index of suspicion and not wrongly treat these diseases.
To us cholera is a cause for concern and one case is treated like an outbreak that is why we are quick to deploy personnel and raise the red flag.
Finally, we are looking at long-term measures to fight the disease. We are not in isolation as a ministry. As I have said, the determinants of cholera are outside our purview as a ministry.
The rest is in the Ministry of Local Government in terms of housing, planning and service delivery. We have to make sure that they carry their mandate by telling them where things are not right.
We have also been working with the Ministry of Environment, Water and Climate because they have a national working committee on water sanitation and hygiene and they take care of WASH programmes.
They also go to urban and rural local authorities to make sure the environment is kept safe.
The fight against water-borne diseases and in this case cholera is not just for the Ministry of Health and Child Care alone, we all have a role to play.
