ZIMBABWE: 30 strains of cholera as death toll approaches 4,000

From the start of the outbreak in August 2008 and up until 1 March 2009, cholera has claimed the lives of 3,939 people, infected 85,300, and has been reported in all the country’s 10 provinces and 55 of its 62 districts.

The International Centre for Diarrhoeal Disease Research (ICDDR), based in the Bangladesh capital, Dhaka, found that in one of its 16 Zimbabwean test sites, all water sources – borehole, tap water, drain water, and shallow wells – in Budiriro, a working-class district in the capital, Harare, were contaminated by cholera.

"It was found that all the water sources that have been sampled were heavily contaminated with total coliforms, and some of them were also contaminated with faecal coliforms. The interesting finding is that the borehole was also contaminated with faecal coliforms," the ICDDR said in its preliminary report.

"The count of total coliform in 100ml of water is too numerous to count and the faecal coliform count was 26/100ml, which is many times higher than the WHO recommended level."

Coliforms are a large group of bacteria found in the intestinal tracts of mammals and are often an indicator of the presence of disease; WHO guidelines stipulate that drinking water should not contain a single coliform.

In Budiriro, as of 28 February, 196 cholera deaths and 8,154 cases – nearly one-tenth of all cholera cases in Zimbabwe so far – had been reported.

The highest number of deaths at a specific site so far, according to the WHO, has been at the Beatrice Road Infectious Diseases Hospital, a government clinic near the sprawling Harare township of Mbare, where 265 people have died and 5,135 cases have been reported.

During the investigations in January 2009 by the ICDDR at sites across the country, from Harare to the second city of Bulawayo in the southwest, to Mutare in the east and in other rural locations, "a total of 30 [cholera] strains were isolated," the report said.

Shortage of medical skills

"The whole aquatic environment seems to be heavily contaminated, and environmental intervention is essential," said the ICDDR, which was established in 1978 and is credited with developing oral rehydration therapy for treating diarrhoeal diseases, including cholera.

The whole aquatic environment seems to be heavily contaminated, and environmental intervention is essentialThe report said there were an "inadequate" number of skilled health care personnel, such as physicians, nurses and paramedics, "in most of the health facilities", and in "one CTC [cholera treatment centre], in the absence of ORS [oral rehydration salts], IV [intravenous] fluid was administered orally".

"However, the sense of urgency in handling of patients with severe dehydration was not always evident … In some cases, intravenous lines were not removed even after full correction of dehydration. However, no cases of over-hydration were observed," the report said.

"The use of ORS was not up to the mark, and there was a clear tendency of over-reliance on IV fluids. Inadequate promotion of ORS was a common observation," the ICDDR noted.

"Insufficient attention was paid to health education and delivering key health messages (e.g. importance of using safe water, hand-washing, or correct way of disposal of faeces) to patients or their families during their stay in the health centres."

The visiting physicians commended the "positive attitude" of the health care personnel, "considering the paucity of human resources, limited training in diarrhoea management, and insufficient preparedness".

The effects of Zimbabwe’s food shortages – 7 million people are dependent on food aid – and the country’s economic collapse was seen in food availability for both patients and staff, and the challenges associated with sourcing fuel for motor vehicles.

IRIN