Cholera Crisis of 2018Cholera is a disease that is both preventable and treatable, though it can be fatal under the worst of circumstances. It typically affects the most destitute areas of the globe where sanitation practices are weakest. Random outbreaks can and do occur across all continents, however. The greatest challenge to diminishing the effects of a cholera crisis is that it can spread quickly among populations with a lack of adequate hygiene measures, proper vaccination or isolated and contained care centers.

Disease Basics

According to the Center for Disease Control (CDC), cholera is caused by toxigenic Vibrio Cholerae, which leads to the acute bacterial intestinal infection. Symptoms include vomiting, diarrhea and, in severe cases, collapse and shock. Fatalities occur in approximately 25 to 50 percent of all cases. While cholera is uncommon in the U.S. and other developed nations, cases have been increasing around the world since 2005. The CDC classifies the magnitude of cholera outbreaks as a pandemic that has persisted for over four decades in Asia, Africa and Latin America.

Saltwater is the natural source where Vibrio Cholerae originates and may be passed on to humans by ingesting anything from infected water, like shellfish, crab and shrimp. The risk is heightened when any of these foods are undercooked or consumed raw. Cholera can be passed through the drinking water supply as well, which is a common form of transmission.

The Cholera Crisis

A cholera crisis occurred in February 2018 in Uganda, resulting in 700 reported cases and 27 deaths. In Malawi, an outbreak in April affected 893 individuals and caused 30 deaths. A recent outbreak has occurred in Yemen as well. The total number of cholera cases in Yemen over the past year is estimated to be 1,090,280 with 2,275 deaths. This means one out of every five people infected with cholera died last year in Yemen. In addition, Haiti has reported 432 cases of cholera this past year, with four deaths resulting from the disease.

Progressive Efforts

While contemplating the statistics shared in regard to the cholera crisis, it is important to think about what solutions are available to prevent this destructive disease from spreading and to know what actions are being taken to assist those who are suffering. The most obvious solution to a cholera crisis is to offer aid in the form of clean water solutions so potable water can be readily available to all.

The U.N. has made remarkable progress in its efforts to make clean water available to everyone around the world. More specifically, its efforts are known as the Water for Life International Decade for Action and took place during 2005-2015. As a result of this initiative, 1.3 billion people were provided with clean drinking water. It is estimated that there are still 2.5 billion people who drink contaminated water.

Improved sanitation practices and adequate facilities is also a dire need. The U.N. reports that there are currently 2.3 billion people worldwide who are without access to basic sanitation facilities, such as toilets. The two concurrent issues of lack of sanitation facilities and a lack of clean water interplay to cause illness amongst many in the form of communicable diseases passed through to the residents of poverty-stricken areas.  As a result, approximately 1.5 million children die from related illnesses.

Efforts to help can generate a return on investment for those in developed nations. Research has shown that every U.S. dollar spent on improved sanitation generates a return of $9. World Water Day on March 22 and World Toilet Day on Nov. 19 are international observance days set aside to raise awareness of these issues.

– Bridget Rice

Photo: Flickr


Cholera, an acute infectious disease, is not new to the east African country of Uganda. For 47 years, epidemics of cholera have occurred frequently in the country, and cases of the disease in Ugandan communities are still reported annually. Uganda’s recent cholera outbreak was reported Feb. 22, 2018.

Refugee Overcrowding

The announcement came after 668 cholera cases had been identified in the refugee settlements in Hoima District. Hoima District is a Western Ugandan district home to thousands of Congolese refugees escaping ongoing violence in the Democratic Republic of Congo’s northeastern Ituri province.

More than 4.4 million people have been forced out of their homes in Democratic Republic of Congo amid a surge in severe violence. The aggression stemmed from President Joseph Kabila’s refusal to step down at the end of his mandate in 2016. As a result of the humanitarian disaster, it is estimated that about 43,000 Congolese refugees have settled into Ugandan areas this year. This brings the total of Congolese refugees in Uganda to more than a quarter of a million.

Increased Violence

Although Uganda welcomes all those fleeing violence and seeking refuge into the country, government-funded health facilities have been overwhelmed by the sharp rise in the refugee population. Since the initial outbreak announcement in February, at least 1,747 people have become sick and at least 36 have died from the worsening situation. Most of the deaths were recent evacuees from the Democratic Republic of Congo.

In addition to plaguing the refugee resettlements in Hoima District, Uganda’s recent cholera outbreak has also now spread to two additional sub-counties. It is estimated that drinking unsafe water from Lake Albert, poor sanitation and a lack of handwashing facilities in the area have contributed to the dehydration, diarrhea, vomiting and fatality rates.

Response Efforts

Uganda’s recent cholera outbreak has proven an urgent demand for additional resources and funds to prevent the spread and deaths from the bacterial disease. However, some response efforts and services are currently in place. Thanks to a fast-acting response plan by the U.N. Refugee Agency and The Ministry of Health, health actors and community leaders are working to provide medical supplies, health personnel and other essential support. This includes demonstrations on proper food and hand hygiene and water safety to reduce transmission of the illness. Many technical teams are working to conduct medical screenings, provide treatments and produce water purification tablets near Western Uganda’s Lake Albert and Kyangwali refugee settlement.

Additionally, international agencies like the World Health Organization and UNICEF have provided two different cholera kits with vital supplies for cholera case management. Uganda Red Cross Society has actively supported social mobilization to prevent and regulate the outbreak.

Because of these life-saving efforts enforced by health workers and technical teams, there has been a significant decrease in the number of new cholera cases within the western Lake Albert region. As of Feb. 28, health care workers were detecting approximately 100 new cases of cholera a day. By March 12, the daily case number had decreased to 20. The medical assistance provided helped decrease the mortality rate by two percent. However, Uganda’s recent cholera outbreak is not over and the work in cholera-suffering hotspots is far from resolved.

– Natalie Shaw

Photo: Google

cholera in Uganda
There has been a stream of refugees to Uganda due to the violence in the Democratic Republic of the Congo and Republic of the Congo. The majority of the individuals who escape the brutality in those countries oftentimes find their way into the neighboring state of Uganda.

Killings and burnings of people’s homes are just a few reasons the Congolese are deciding to flee. Determination to evade the violence comes also with a sense of urgency for the Ugandan government and the people, even though there may be downfalls in the process.

Cholera in Uganda

The people of Uganda have recognized both their intake of refugees, and also the refugees’ individual issues. Ever since these people entered the country, there has been an outbreak of cholera in Uganda. This is a bacterial disease that can be contracted by drinking contaminated water and, if not treated properly, can be fatal. Since this disease is highly contagious, it is spreading rapidly throughout the country.

Most of the people coming from the Congo are screened but, unfortuantely, they are oftentimes already contaminated with the bacteria that leads to cholera at the time of their screening. “We are not doing enough to respond first,” said David Alula of Medical Teams International. “More attention needs to be paid to address the situation.”

Medical professionals understand that the situation occurs more widely and at a larger scale in the Congo, but 36 refugees have died thus far from the highly infectious disease.

Governmental Measures

The Ugandan government is doing everything it can to assist its people as well as the refugees experiencing the cholera outbreak. The nation’s head is working on emphasizing water treatment, staff recruitment to allow more people to be treated appropriately and the factors of what may have caused the severe outbreak of this disease.

“We had not planned for this kind of sickness all along. Everything is being doubled on the ground, and more efforts are [being] put in place to make sure it’s contained,” stated the Ugandan official in charge of Kyangwali, Jolly Kebirungi. It is quite remarkable to see the efforts that the Ugandan government is putting forth to help out; it treats the refugees as they would their own citizens. It shows a sign of unitedness and care that can lead to an ultimately more stable community.

A More Stable Community

“In Uganda, refugees are accommodated not in tented camps but in settlements, where they are allocated plots of land that they can farm and build their homes on.” Once Uganda accumulates enough power to ensure health and safety regulations through its medical professionals, the nation will have what it takes to contain and eradicate the disease in this region.

The main priority for Uganda is to maintain the well-being and safekeeping of the refugees they let enter the country. This strategy will lead to a nation of respect and will allow the country to prosper.

– Matthew McGee

Photo: Flickr

Cholera Epidemic in South Sudan is Officially OverThe cholera outbreak that has been affecting multiple countries in southern Africa ended in South Sudan on February 7. The country reported no new cases of the illness in more than seven weeks. Cholera had been affecting South Sudan since June 2016 and was widespread, with over 20,000 cholera cases and more than 400 deaths related to the disease. The country declared an end to the epidemic and continues to make efforts to keep the disease from making a comeback.

Cholera is a disease characterized by diarrhea, vomiting, leg cramps and loss of body fluid due to an infection of the intestine with the bacteria Vibrio cholerae. Oftentimes the dehydration of the body can cause shock. Death can occur within a few hours if not treated. Cholera is easily spread through contaminated food and water, poor sanitation and lack of hygiene.

The efforts to wipe out the cholera epidemic included rapid response teams responding to and observing cases, providing clean water for residents and promoting proper hygiene routines, as well as treating the infected patients with vaccinations and medicines.

Many organizations joined with the South Sudan government to fight the cholera epidemic, including the European Union Humanitarian Aid, GAVI the Vaccine Alliance, the United States Agency for International Development and the World Health Organization (WHO). These groups together were able to deliver 2.2 million vaccinations throughout the country through GAVI’s global stockpile.

Although the country is officially cholera free, the WHO representative for South Sudan, Evans Liyosi, stated that cholera is still a common illness, and therefore it is still considered a risk and the country needs to maintain its observation and respond to new cases of the illness to prevent another outbreak. The country also needs to further strengthen its health and sanitation systems and promote healthy living behaviors.

The cholera outbreak that South Sudan faced was the longest and largest cholera epidemic that the country had ever seen. Cholera had spread throughout the entire country and swept through the capital, Juba. With the immense efforts of every organization involved, the government and the people of South Sudan, they were able to officially end the cholera epidemic.

– Chloe Turner

Photo: Flickr

cholera crisisThe Eastern and Southern countries in Africa face a serious cholera epidemic. This epidemic displays the lack of public sanitation as well as neglect from the government that many African countries face.

Cholera

Cholera is a diarrheal illness caused from an infection of the intestine with bacteria called vibriocholerae. The symptoms of the illness include: diarrhea, vomiting and leg cramps, and such loss of body fluid can lead to dehydration and sometimes shock. Oftentimes, death can occur within only hours without treatment.

Since the start of the New Year, there have been over 2,009 cases and 22 deaths in the countries in Africa facing the cholera crisis. Zambia, one of the countries in southern Africa, faced the worst of the epidemic, with more than 74 deaths since October of 2017. The main area where Zambia’s impacted with cholera is in their capital, Lusaka. The government banned street food from vendors in the capital to reduce the number of cases, but in return, caused violent protests from the vendors.

Cholera Causes

The government, along with the World Health Organization, states the cause of the cholera crisis is poor waste management and lack of personal hygiene. These factors cause the contamination of food and water, which in turn, can spark the epidemic.

To help with the cholera crisis, the government has sent in the army to control measures, clean the markets and unblock drains. An oral vaccine program was also launched with the goal of immunizing one million people, and since its implementation, the number of cholera cases have dropped.

Cholera Effects

The effects of the cholera crisis have not just been deadly, but also have forced public places to close. Many schools, churches and workspaces are deferred until they can contain the outbreak. This impediment puts citizen jobs, payment and education on hold.

The World Health Organization (WHO) suggests the prevention of cholera consists of clean water, sanitation and reminding communities of basic hygiene behaviors that includes hand washing with soap after using the bathroom, before eating or touching food.

The WHO also suggests there should be media regarding health education messages for these reminders, and the implementation of routine antibiotic and immunizations if available.

– Chloe Turner

Photo: Flickr

Good News in Global HealthCholera impacts 2.9 million people each year, killing about 95,000 in some of the poorest and most vulnerable communities of many Asian, African, and some Caribbean countries. The good news in global health is that the Global Task Force on Cholera Control (GTFCC) is bringing together more than 50 partners from academic institutions and nonprofits to reduce cholera by 90 percent by 2030.

This alliance includes The Bill and Melinda Gates Foundation, the World Health Organization, Water Aid and Doctors Without Borders. This plan was released to the public in October 2017 in Geneva.

GTFCC is hosted by the World Health Organization and has begun with a strategy called Ending Cholera: A Global Roadmap to 2030. This proposal has three strategic axes to make this goal possible.

First, the GTFCC would work to look for early signs of cholera and by sending a quick response in efforts to halt the spread of the disease. Country-level planning would also go into effect for early detection and response.

Second, these partners would improve the Water Sanitation and Hygiene concept, or WASH. The U.N. recognizes WASH as a basic human right. However, more than two billion people worldwide lack access to WASH.

Improving oral vaccines would also be a part of the second plan to end cholera. Between 2013 and 2016, the GTFCC administered five million doses of the cholera vaccine. Gavi is an international vaccination organization focused on children, and it is funding these vaccines.

Lastly, this strategy will be an effective system of coordination for technical support, resource mobilization and partnership at local and global levels. It will work to strengthen donors and international agencies, while locally, partnerships with be strengthened between affected countries.

While this plan will be carried out by all the NGOs and academic institutions, the Global Task Force on Cholera Control will be providing a strong framework for support to ensure this roadmap to ending cholera deaths by 2030 is executed in a timely manner, which is good news in global health.

Lorial Roballo

Fighting Cholera in Bangladesh and Around the Word

Vibrio cholerae, more commonly known as cholera, is a virulent bacteria that causes the body to flush all available liquids into the intestines. Those infected with cholera suffer from violent bouts of diarrhea and vomiting, and without treatment the sickness will likely be fatal. Symptoms can worsen quickly and organ failure can ensue within hours of the patient beginning to feel sick.

Cholera is treatable, and after years of research, there is now an oral cholera vaccine (OCV), which can be used to provide immediate, short-term protection from the disease. In the case of an outbreak, this vaccine can give aid groups enough time to improve access to clean water and sanitation before the disease has a chance to spread. Cholera is present in 70 countries worldwide, putting over one billion people at risk of contracting the disease.

In the 21st century, there has been a World Health Organization (WHO) initiative to stockpile OCVs in case of an outbreak. Creating the stockpile of vaccines has drastically improved the ability of aid groups to respond to crises quickly and effectively. For example, when Haiti was struck by an earthquake in 2010, there was a devastating impact on the nation’s infrastructure, greatly limiting the availability of clean drinking water. The WHO’s stockpile of vaccines was a blessing for the Haitian people, who were facing the threat of a full-scale cholera outbreak.

Cholera was first discovered in 1817, when the British East India Company sent explorers into the isolated swamps of southern Bangladesh. It was this first emergence of cholera that led to the global spread of the bacteria, which is contracted through contact with feces, usually through contaminated drinking water.

Bangladesh has been the epicenter of the fight against cholera since the emergence of the disease, and in 1960 the United States government founded the Cholera Research Laboratory in Dhaka, Bangladesh. This facility has since been renamed the International Center for Diarrheal Disease Research (ICDDR, B) and has been credited by the WHO as having saved the lives of 50 million Bangladeshi citizens suffering from cholera or diarrhea-related illness.

The ICDDR, B treats 220,000 patients a year, most of whom recover within a few days (young children are at higher risk and tend to require longer treatment). Patients at this facility lie in “cholera cots,” which is a euphemistic way to describe a cot with a hole in the center and a bucket underneath.

The ICDDR, B is leading the fight against cholera in Bangladesh and around the world. The Gavi Vaccine Alliance, in cooperation with the WHO, recently shipped 900,000 doses of OCV to Bangladesh to prevent the spread of cholera in refugee camps and among the general population. The task of stopping cholera in Bangladesh is now in the hands of the international community. The possibility of eradicating cholera in Bangladesh is closer than ever, and soon this disease may cease to exist as a constantly looming threat to the most vulnerable people on the planet.

Tyler Troped

Photo: Flickr

Natural Disasters Hit Poor the HardestThe aftermath of Hurricane Irma, which hit the Caribbean and United States in September 2017, along with the 8.1 magnitude earthquake that shook Mexico also in September illustrate the total destruction entire communities face when hit by natural disasters. Natural disasters have been proven to increase poverty and most adversely affect those who are already poor.

The category five Hurricane Irma made landfall on Antigua, the Dominican Republic, Puerto Rico, Barbuda, Guadeloupe and more, totaling over 10 Caribbean countries affected. In Barbuda alone, 90 percent of vehicles and buildings have been destroyed and many people have been left homeless. Because Barbuda is not as wealthy as other Caribbean countries, it cannot as quickly rebuild for its people, leaving its citizens more impoverished than ever.

Mexico’s 8.1 magnitude earthquake has also left many suddenly in poverty or more impoverished than they previously were. Many buildings were reduced completely to rubble, particularly in the town of Juchitan, which was hit hardest by the earthquake. Residents of the town slept in streets and parks following the earthquake to avoid aftershock and because of damages to numerous homes creating uninhabitable conditions.

Juchitan is located in Oaxaca, a rural region in southwestern Mexico, and one of the poorest areas in the country. Jorge Valenica, a reporter from Mexico City, discussed the damaging effects of the earthquake on Juchitan in an interview with NPR. He stated, “As with many natural disasters, the communities that get hit the worst sometimes are the communities that were already the most in need.”

The World Bank reports that poor people are so adversely affected by natural disasters because they are usually more exposed to natural hazards – i.e. their homes, if they have them, are not built as well, and they have less access to evacuation resources than those who are middle and upper class. Unfortunately, when the poor lose necessities like shelter, they typically do not have savings, family, friends or the government to fall back on. Even those who do not completely lose their homes often cannot avoid repairs and renovations due to new building standards created to make homes safer.

In light of the worsening of poverty in places hit by natural disasters, organizations such as Oxfam continue to work to provide basic needs to individuals, focusing upon hygiene and sanitation for those most affected by the storms. Oxfam’s main goal after Hurricane Irma is to contain and eliminate any cholera and other diseases caused by damage to water infrastructure, helping to keep people healthy. Natural disasters continue to hit the world’s poor the hardest, but even in the wake of a catastrophe, goodness, giving and help can be found.

Mary Kate Luft

Photo: Flickr

Common Diseases in Tanzania
Gender inequality, limited access to safe water, lack of sanitation, poor hygiene and a recent drop in immunization are major issues Tanzanian citizens face in urban and rural areas of the country. These factors have contributed to the rampant spread of three common diseases in Tanzania: HIV and AIDS, cholera and malaria.

The most common disease affecting the Tanzanian populace is HIV and AIDS. HIV is a virus that attacks the immune system, the body’s natural defense against disease. The immune system is destroyed when left untreated and the person cannot recover from infections, big or small. At this stage, the person has AIDS.

According to the World Factbook, in 2015, almost 1.4 million people in Tanzania were living with AIDS. This is the most recent estimate. Also reported by the same source, Tanzania ranks sixth in comparison to the rest of the world with the number of its citizens living with the disease.

HIV is the main source of adult mortality in the country. The World Factbook states that in 2015 an estimated 35,700 Tanzanian adults died from the disease, placing the country in fourth place in comparison to the rest of the world.

According to the charity organization, AVERT, the populations most affected by HIV in Tanzania are people who inject drugs, men who have sex with men, mobile populations and sex workers. Of all HIV infections, 80% of them result from heterosexual sex. Tanzanian women are infected more than men due to having older partners, getting married earlier and neglecting negotiating skills for safer sex due to gender inequality.

The second of the most common diseases in the Tanzanian population is cholera. Cholera is a bacterial disease usually spread through contaminated water. Cholera causes severe diarrhea and dehydration. Cholera kills infected persons within hours when left untreated.

According to the World Health Organization (WHO), by April 20, 2016, there was a total of 24,108 cases of cholera in Tanzania, including 378 deaths. The majority of the cases were reported from 23 regions in mainland Tanzania (20,961 cases, including 329 deaths). Neighboring Zanzibar islands reported 3,057 cases of the disease, including 51 deaths.

The disease spread quickly due to conducive conditions such as limited access to safe water in poor households, sanitary problems and poor hygiene found in both mainland Tanzania and Zanzibar. In addition, the nation’s water supply institutions lacked the capacity to disinfect water and conduct regular water quality monitoring and assessments.

Recently, there has been a decline in the number of newly reported cases of cholera. However, the conditions that helped the disease to persist still have not changed, so the risk for more infections remains high.

The final common disease affecting the Tanzanian population is malaria. Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. Mild symptoms include fever, headache and chills. Severe symptoms include anemia, difficulty breathing due to fluid-filled lungs and cerebral malaria in children. In adults, organ failure is also frequent.

The World Factbook reports malaria is a leading killer of children under five in Tanzania. According to the Malaria Spot website, Tanzania has the third-largest population at risk of malaria in Africa. Over 90% of the population live in areas where there is malaria. Each year, 10 to 12 million people contract malaria and 80,000 die from the disease, most of them children. There is no vaccine for malaria. This fact contributes to why the disease continues to be a threat to Tanzanians.

Common diseases in Tanzania are prevalent because the geographical and economic conditions of the country favor their spread. While HIV and AIDS, cholera and malaria have been a threat to the population there have been positive strides. The Center for Disease Control (CDC) has been working with the government of the United Republic of Tanzania and more than 60 partner organizations since 2001 to address HIV, malaria, and other health threats by helping support service delivery and strengthen health systems and infrastructure. The CDC partnership has seen success, including:

  • 637,875 people are currently receiving HIV treatment
  • 74,430 pregnant women have received medication to reduce transmission to their babies through PEPFAR (The United States President’s Emergency Plan for AIDS Relief) since 2010
  • 1,155,833 men have been circumcised to prevent new HIV infections since 2010
  • New malaria infections have decreased from 18% to 10% in children 6-59 months in 2011-2012

With continued aid and improvement in living conditions for the Tanzanian people, common diseases in Tanzania will no longer remain common.

Jeanine Thomas

Photo: Flickr

Cholera Crisis in Somalia
For the vast majority of developing countries, poor water quality and waterborne disease are the biggest contributors to mortality rates. For the people of Somalia, this reality has only been made more evident in their recent cholera crisis.

Cholera is an acute diarrheal disease.  It has the potential to kill its victims within hours if left untreated. Not only is the disease extremely virulent and easy to contract, but it also kills at unprecedented speed and is often difficult to detect.

The transmission of cholera gets often linked to a lack of access to clean water sources and sanitation facilities. This type of environment is particularly characteristic of the peri-urban slums of Somalia where open defecation is commonplace, and populations get crowded together.

The cholera crisis in Somalia stems from an endemic food deficiency that has plagued the country for years and has placed them on the brink of famine. Drought and extreme food insecurity have forced Somalian farmers into crowded urban areas putting an even greater strain on the limited clean water sources and contributing to the poor hygiene problem. After three consecutive years of failed rains, the current drought has resulted in more than 600 deaths. Most of these were related to acute watery diarrhea or cholera.

A humanitarian coordinator notes of the crisis: “Open defecation not only puts women’s dignity and security at risk, but it also poses a serious health hazard.” In addition to providing vaccines and treatment for existing cases of cholera, it is imperative that Somalians acknowledge the dangers of poor hygiene habits on their health and prioritize finding alternatives.

CARE Somalia is making an impact on the crisis through water, sanitation and hygiene efforts to prevent the onset of the disease. Alongside the Ministry of Health in Somalia, they reached over 250,000 people and potentially save the lives of thousands.

Another integral part of the organization’s humanitarian aid is the distribution of water purification tablets. The tablets can treat large volumes of water with chlorine and disinfect within 30 minutes, killing off bacteria that could transmit typhoid or cholera in a community’s water supply.

Since 2011, CARE invested in water infrastructure and hygiene efforts to curb another famine and improve the cholera crisis in Somalia. Although progress has been made, it is vital to keep the momentum on the project and continue prioritizing infectious disease prevention in poor slums worldwide.

Sarah Coiro

Photo: Flickr