Global,
national efforts must be urgently intensified to control Zimbabwe cholera
outbreak
30 JANUARY 2009 | GENEVA -- Zimbabwe’s cholera
outbreak, one of the world's largest ever recorded, is far from being brought
under control. An enhanced response is needed to urgently reverse an epidemic
that has so far infected more than 60,000 people and killed more than 3,100
since August 2008.
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WHO health action in crisis - Zimbabwe
"The World Health Organization and other
international and local partners are supporting the Ministry of Health and
Child Welfare's (MoHCW) efforts to control the epidemic. But unless drastic
action is taken by all players in this crisis, more Zimbabweans will succumb to
the outbreak, and other countries in the southern African region will face the
continued threat of spill over epidemics," said Dr Eric Laroche, Assistant
Director-General for WHO's Health Action in Crises Cluster.
Urgent measures needed in Zimbabwe include:
• increasing
awareness, particularly at grassroots level, regarding prevention and treatment
measures. Most recorded deaths have occurred at home, which means that more
effective messaging directed at all communities, particularly the remotest
parts of the country, is crucial for the Zimbabwean public to be best prepared
to act against the epidemic.
• making
available more medicines, particularly oral rehydration salts (ORS) and
chlorine tablets, at community level so health care workers, and ordinary
people themselves, have the means to quickly treat cases of cholera that
emerge. One of the greatest challenges is ensuring people can access health
services. As this is not possible for many people, due to limited access to
transport or money to pay for the trip to the health facility, stocks of simple
yet life-saving supplies, such as ORS and chlorine tablets, must be provided to
each community.
• mobilizing
resources to pay thousands of Zimbabwean doctors, nurses and other health staff
who have been unable to obtain salaries and have not had enough money for basic
needs, such as buying a bus ticket to get to work. This vacuum in availability
of national health staff is a prime factor in the increasing number of cholera
sufferers dying.
• opening
access to more nongovernmental organizations (NGOs) to respond to the cholera
outbreak in more areas of the country. Currently, NGOs, such as Médecins
Sans Frontières, are operating large numbers of cholera treatment centers
and units in areas where other support, including government, is not available.
Such activities must be promoted so to increase access to health care,
particularly at district level.
• strengthening
the multisectoral response being provided by all players - United Nations,
NGOs, governments and donors - is vital. More effort is needed in multiple
areas, including improved case management, water and sanitation, social
mobilization, provision of financial resources to health providers operating in
Zimbabwe, and increasing health staff in the field.
"We are dealing with an extraordinary
public health crisis that requires from us all an extraordinary public health
emergency response, and this must happen now before the outbreak causes more
needless suffering and death," Dr Laroche said. "Political
differences need to be put aside, economic barriers overcome, health services
in the country's periphery strengthened and community awareness to respond
enhanced to save many more people from dying due to a disease that can be
readily prevented and treated."
As of 29 January, 2009, that number had
reached 60 401, with 3161 deaths, and showed no signs of abating. All 10
provinces, as well as neighboring countries, have been affected. Although the
Case Fatality Rate has decreased slightly, it is still above 5%, with about
three times more deaths being recorded at community level rather than within
health facilities. The acceptable level should be below 1%. Neighboring South
Africa has also reported 3000 cases, but the strength of its health care and
water and sanitation systems have seen the case fatality rate remain below 1%.
WHO and its partners have worked efficiently
with the MoHCW to date to respond to the outbreak, including by:
• establishing
a Cholera Command and Control Centre in the capital, Harare, to coordinate and
strengthen alert, response, case management, social mobilization and logistics
activities.
• mobilizing
an outbreak response team of more than 40 experts, including national and
international disease control specialists from across WHO. This team has been
working on technical coordination, early warning alerts, social mobilization
activities, case management and training, outbreak logistics, laboratory
support and critical response activities in the most affected provinces.
• deploying
10 experts from public health institutions and technical partners in the Global
Outbreak Alert and Response Network (GOARN) to support technical coordination
at the Cholera Command and Control Centre, and provide technical support to the
MoHCW for outbreak response. These include the Burnet Institute in Australia;
the London School of Hygiene and Tropical Medicine (LSHTM) and Health Protection
Agency in the UK; the International Centre for Diarrhoeal Disease Research,
Bangladesh (ICDDR,B); US Centers for Disease Prevention and Control; and the
National Board of Health and Welfare, Sweden.
• delivering
medicines and other health equipment to health centers treating cholera
patients.
• working
with the donor community to raise badly needed resources for cholera response
activities, as well as the overall strengthening of Zimbabwe's health sector.
Dr David Heymann, WHO's Assistant Director-General
for Health Security and Environment Cluster, said despite these measures, the
scale of the outbreak should serve as a catalyst for increased support from all
parties involved in response efforts.
"The challenge is not just in Harare, but
in remote, hard-to-access parts of the country where the effective
implementation of control measures to contain Zimbabwe's cholera epidemic is
very difficult," said Dr Heymann. "In addition to the issue of staff
shortages, there is a need for increased awareness about how to treat cholera,
filling the gaps in medical supplies, providing reliable logistics support and
capacity to deliver supplies, and increasing access to health services and safe
water supply in remote areas where nongovernmental organizations are not
operating. Combined, these factors present a major challenge to bringing this
outbreak quickly under control."
For more information
please contact:
Paul Garwood
Communications Officer
Health Action in Crises
WHO, Geneva
Telephone: +41 22 791 3462
Mobile: +41 79 475 5546
E-mail: garwoodp@who.int