Responding to Cholera Outbreaks in Zimbabwe: Building Resilience over Time

Abstract

Cholera is still a major cause of disease epidemics in sub-Saharan Africa (SSA). During the period January 2017-March 2018, 15 countries in the WHO African Region (AFR) reported cholera outbreaks of varying magnitudes. Zimbabwe has experienced cholera outbreaks dating as far back as 1971 with an unprecedented outbreak occurring in 2008/2009 when 60 of the 62 districts in the country were affected. The outbreak was declared over in May 2009 and by then, 98,592 cases and 4288 deaths had been reported. In Zimbabwe, outbreaks have occurred against a backdrop of a struggling economy and a weak health system. The role of a resilient health system in emergencies response is accentuated premised on experiences from the Ebola outbreak that largely affected three countries in West Africa. Amidst economic and persistent system wide challenges faced by Zimbabwe, preparedness and response capacity has been built over the years. This is evidenced by the rapid response and containment of the recent cholera outbreak. Skilled and equipped rapid response teams, strengthened surveillance and maintaining high alert, effective multisectoral collaboration and high level political engagement are among the critical elements that have built resilience.

Use of Sat Scan for Identification of Cholera Hotpots in a High-Density Suburb of Harare, Zimbabwe.

“…Authors' details 1 Chinhoyi University of Technology, Graduate Business School P Bag 7724 Chinhoyi. 2 University of KwaZulu Natal, College of Health Sciences, School of Nursing and Public Health, Durban, SA.…”

“…Cholera is a major public health problem in Sub-Saharan Africa were sanitation and safe water provision is reported as a challenge [1]. Zimbabwe particularly has had challenges of being unable to control cholera outbreaks due to lack of adequate provision of Water, Sanitation and Hygiene (WASH) programmes [2].The country has been reported to be reactive to the outbreaks of cholera and other diarrhoeal diseases [2]. WASH programmes are actived during the outbreaks and thereafter, complacency has been reported [2].…”

“…Zimbabwe particularly has had challenges of being unable to control cholera outbreaks due to lack of adequate provision of Water, Sanitation and Hygiene (WASH) programmes [2].The country has been reported to be reactive to the outbreaks of cholera and other diarrhoeal diseases [2]. WASH programmes are actived during the outbreaks and thereafter, complacency has been reported [2]. Zimbabwe reported 98592 cases of cholera, including 4288 deaths during the 2008-2009 cholera outbreak [3].…”

“…Zimbabwe has had a repeat of cholera outbreak in September 2018 [2,7]. The Ministry of Health and Child Care declared this outbreak in Harare with 11 cases having been con rmed through a rapid diagnostic test (RDT) and the clinical presentation for cholera [8].…”

Notes from the Field: Cholera Outbreak — Zimbabwe, September 2018–March 2019

“…The first reported cholera case in Zimbabwe occurred in 1972, and in recent years, outbreaks have been reported almost annually. The largest outbreak recorded in Zimbabwe (and one of the largest ever in Africa) occurred during 2008-2009; 98,592 cases were reported, with 4,288 (4.3%) deaths (1). WHO advises that, with proper treatment, cholera case fatality should remain <1% (2); during the 2018-2019 outbreak, the case fatality rate was 0.64%, including deaths occurring within communities and at health facilities.…”