Epidemiological features of epidemic cholera (El Tor) in Zimbabwe

Abstract

Epidemics of cholera have been frequent in southern Africa since the reintroduction of the disease to the continent in 1970. In late 1992, following a severe drought and an influx of refugees from Mozambique, cholera reappeared in Zimbabwe for the first time since 1985 and rapidly spread through the rural areas of the country. Data relating to symptomatic cholera infection collected during 2 large outbreaks on the eastern border of the country showed that host age and sex were important factors relating to symptomatic infection, as were population density and access to water. Epidemic profiles for the 2 study areas differed in that one of the profiles exhibited a distinct second phase epidemic. This unusual pattern was compared qualitatively with the output of a series of simple mathematical models to examine the contribution of different epidemiological processes to the pattern of disease observed. Model output suggested a complex disease process, in which the dynamics may have been influenced by spatial components. Statistical analysis of these unusual data showed that the observed pattern was independent of the effects of host age or sex, and provided compelling evidence of a marked spatial component of the second phase epidemic.

Community Mortality from Cholera: Urban and Rural Districts in Zimbabwe

“…6 This outbreak was the largest recorded in Zimbabwe and one of the largest in Africa. [1][2][3][4]7,8 During August 2008-July 28, 2009, the Zimbabwean Ministry of Health and Child Welfare reported 98,592 cases and 4,288 cholera deaths. 6 The crude case-fatality rate (CFR) was 4.3%, and 61.4% of the cholera deaths occurred in communities outside areas with health facilities.…”

Elevation and cholera: an epidemiological spatial analysis of the cholera epidemic in Harare, Zimbabwe, 2008-2009

“…This is one of the largest and most extensive outbreaks of cholera yet recorded in Zimbabwe affecting rural and urban areas [1-4]. …”

Descriptive spatial analysis of the cholera epidemic 2008–2009 in Harare, Zimbabwe: a secondary data analysis

“…This was the largest and most extensive outbreak of cholera recorded in Zimbabwe and indeed in Africa, affecting rural and urban areas with more than 100 000 cases and 4000 deaths, about half of which occurred in the urban centres of Harare and Chitungwiza. [2][3][4][5][6][7] During the 2008-2009 Zimbabwe cholera epidemic the country was in economic crisis and the health care system had become dysfunctional, with most government hospitals unable to provide services or closed due to a lack of essential medical supplies. Many staff in health structures had not been paid, and many were unable to report for duty.…”