By Edmund Smith-Asante
A report published by the World Health Organisation (WHO), says by the end of 2011 a total number of 589,854 cholera cases had been reported globally, out of which 7,816 deaths were recorded.
This figure represents an increase of 85 per cent in the number of cases reported in 2010 and a 16 per cent increase in the number of countries.
However, a total of 188,678 cases were reported from Africa only, representing an increase of 64 per cent compared with the 2010 figure of 115,106 cases.
The rest of the total figure was taken up by Asia – 38,298, Oceania – 1,514 and Europe 71. The Americas however took the largest chunk of 361,266, owing to the epidemic that hit Haiti as a result of the earthquake that struck on January 12, 2010.
Haiti alone reported 340,311 cases, which resulted in 2,869 deaths during the period.
According to the “weekly epidemiological record” dated August 3, 2012, reported cases were from 58 countries of the world, consisting of 27 African countries (four more countries than in 2010), 15 Asian countries (an increase by one from the previous year), nine countries from the Americas (five more than 2010), five from Europe and two from the Oceania region.
For Africa, countries that had reported cases during the period were; Somalia, Nigeria, Democratic Republic of Congo, Cameroon, Niger, Angola, Benin, Burkina Faso, Ghana and Central African Republic.
The rest were; Chad, Congo, Cote d’Ivoire, Djibouti, Guinea, Kenya, Liberia, Mali, Mauritania, Malawi, Mozambique, Senegal, Somalia, Togo, Tanzania, Zambia and Zimbabwe.
Leaders in Africa
The chunk of cases recorded on the African continent was taken by five countries, with Somalia’s 77,636 reported cases, 1,130 deaths and 1.46 per cent case fatality rate (CFR) topping the African chart.
Nigeria followed at a great distance with 23,377 reported cases, 742 deaths and a rather high CFR of 3.17 per cent. On its heels was Cameroon with 22,433 reported cases, but with a larger number of deaths – 783 and not surprising, the highest CFR of 3.49 per cent for the period.
The Democratic Republic of Congo placed fourth with 21,700 cases, 584 deaths and a CFR of 2.69 percent, while Ghana came fifth, having reported a total of 10,628 cases by the close of 2011 and a total of 105 deaths with a CFR of 0.99 per cent.
Cases in Africa
Four countries from Central Africa, the Great Lakes region, and the Horn of Africa, accounted for 145,164 cases (Cameroon, Democratic Republic of Congo, Nigeria and Somalia), or 77 per cent of cases reported from the continent.
There was a sharp increase in cases reported from the Horn of Africa with 127 cases (and 1 death) reported from Djibouti. No cases were reported from Ethiopia, Sudan or Uganda.
A total of 2,295 cases were however reported from Kenya (74), Mozambique (1,279) and Tanzania (942). In southern Africa the number of reported cases declined to levels never previously reported during the current millennium, with 2,949 cases reported from Malawi (120), Mozambique (1,279), Zambia (330) and Zimbabwe (1,220).
An outbreak occurring along the Congo river and affecting four provinces in the Democratic Republic of the Congo – Ituri, North and South Kivu, Katanga and Maniema provinces, had 8,088 reported cases including 436 deaths, while five departments in the Congo reported 762 cases and 35 deaths, in an area which had been cholera-free for about a decade.
Cases were also reported from Burundi (1,072).
But despite Nigeria’s status as the second highest in Africa, the WHO says it experienced a 47 per cent decline compared with 2010 where it had 44, 456 cases.
Conversely, both Cameroon and Chad reported a doubling in number of cases compared with 2010, with 22,433 and 17,267 reported cases respectively. Cases were also reported from the Central African Republic (117, including 15 deaths). The CFRs however, remained high: Cameroon 3.5 per cent, Central African Republic 12.8 per cent, Chad 2.7 percent, Niger 2.6 percent and Nigeria 3.2 per cent.
In West Africa reported cases increased to the levels of 2006 to 2008 with a total of 16,088 cases compared with 3,074 in 2010. Ghana’s 10,628 cases accounted for 66 per cent of cases reported from West Africa.
Increasing numbers of cases were reported from Côte d’Ivoire (1261), Mali (2220) and Niger (2324). Cases were also reported from Benin (755), Burkina Faso (20), Guinea (3), Liberia (1,146), Mauritania (46), Senegal (5) and Togo (4). The CFRs were high for Burkina Faso (10%), Mali (4.3%) and Mauritania (6.5%).
But whereas the proportion of cases reported from Africa was less than 50 per cent of the global total for the second consecutive year, it must be stressed that increase in the number of global cases compared with 2010 was the result of the major outbreak in Haiti, which started in October 2010 and was still ongoing when the report was put together.
That notwithstanding, the number of deaths increased by 3.5 per cent from 7,543 in 2010 to 7,816 deaths with an overall case fatality rate (CFR) of 1.3 per cent in 2011, the WHO says.
Africa leads in cholera deaths
Africa scored another first, with 23 of the 33 countries that reported deaths from cholera coming from the continent and accounting for 4,183 deaths or 53 per cent of the global total, while in the Americas, the Dominican Republic and Haiti reported 3,205 deaths or 41 per cent of the global total.
As in previous years though, trends and annual figures provided in the WHO report excluded the estimated 500,000 to 700,000 annual cases labeled “acute watery diarrhoea” in south-eastern and central Asia.
Nevertheless, imported cases were reported by the Americas, Asia, Europe and Oceania. The WHO report says in 2011, 61 per cent of reported cases at the global level originated from a large outbreak affecting Haiti and the Dominican Republic that started at the end of October 2010.
In spite of this increase in case-load in 2011, cases from Africa represented one third of the global total compared with the high 93 per cent to 98 per cent of total cases worldwide reported during 2001 to 2009.
Increasing trends were also reported from Asia with a total of 38,298 cases, a nearly threefold increase compared with 2010, or 6.5 per cent of the global total. Oceania reported a decreased number of cases from Papua New Guinea (1,541) compared with 2010 (8,997).
Africa tops in WHO verification – Ghana included
During 2011, WHO participated in the verification of 37 outbreaks in 30 countries, out of which 25 occurred in Africa, three in the Americas, eight in Asia and one in Europe. All of these outbreaks were confirmed.
Six outbreaks that affected Central Africa, the Democratic Republic of the Congo (East and West DRC), Ghana, the Horn of Africa and Yemen accounted for 207, 472 cases or 35 per cent of the global total. The outbreak in Hispaniola reported 361,162 cases, 61 per cent of the global total.
The WHO emphasises though, that the actual numbers of cholera cases are known to be much higher than those reported. “Discrepancies are associated with underreporting and limitations in surveillance systems, including inconsistencies in case definitions and the lack of standard terminology,” it says in the report.
Fear of travel-related and trade-related sanctions may also contribute to underreporting and may jeopardise efficiency of control measures. Many countries are making important efforts to contain the spread of cholera, but concerns have been raised about the growing number of people living in unsanitary conditions who are at risk from outbreaks of cholera and other epidemic-prone diarrhoeal diseases, according to WHO.
The World Health Organisation says prevention, preparedness and response all depend upon an effective surveillance system and are linked and inter-dependent. There is a need to shift the emphasis from response to prevention in order to avert outbreaks by expanding access to improved sources of drinking- water and improved sanitation, and by working with communities to encourage behavioural change to diminish the risks of infection.
Additionally, oral cholera vaccines which have proven to be safe and effective are now considered to be part of a comprehensive and multidisciplinary approach to cholera prevention and control.
In 2011, the 64th World Health Assembly adopted resolution WHA 64.15 recognising the re-emergence of cholera as a significant public health burden and calling for the implementation of an integrated and comprehensive approach to cholera control.
Cholera has claimed many lives throughout history and it continues to be a global threat, especially in countries in Africa. Between 1999 and 2005, there were over one million reported cholera cases and over 28,000 reported deaths worldwide. Africa alone accounted for about 90% of the cases and 96% of the deaths worldwide.
The disease is also listed as one of three internationally quarantinable diseases by the World Health Organisation (WHO), along with plague and yellow fever.
In addition to human suffering and lives loss, cholera outbreak causes panic, disrupts the social and economic structure and can impede development in the affected communities.
- Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae. An estimated 3-5 million cases and over 100,000 deaths occur each year around the world. The infection is often mild or without symptoms, but can sometimes be severe.
- Approximately one in 20 (5%) infected persons will have severe disease characterised by profuse watery diarrhoea, vomiting, and leg cramps. In these people, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.
- GHS challenges WHO ranking of Ghana as 5th most cholera endemic country (modernghana.com)
- New cholera outbreak in Nigeria kills 74, sickens hundreds (wireupdate.com)
- Three years of cholera in Haiti (crofsblogs.typepad.com)