Why cholera remains a menace in Africa

MANY African countries are periodically affected by outbreaks of cholera. For instance, the current outbreak in Malawi, the worst in two decades, has claimed hundreds of lives and forced the closure of schools and many businesses. Cholera deaths have now been reported in Zimbabwe and South Africa too.

Cholera is a disease caused and spread by bacteria — specifically vibrio cholerae — which you can get by eating or drinking contaminated food or water.

It’s a medieval disease which has mostly affected developing countries, many of which are in Africa. Between 2014 and 2021, Africa accounted for 21% of cholera cases and 80% of deaths reported globally.

In several African countries, cholera is the leading cause of severe diarrhoea. In 2021, the World Health Organisation reported that Africa experienced its highest ever reported numbers — more than 137 000 cases and 4 062 deaths in 19 countries.

It has persisted in Africa partly because of poor sanitation, unreliable water supplies and worsening socioeconomic conditions.

For instance, when people’s incomes can’t keep up with inflation they move to more affordable housing — often this is in congested, unsanitary settings where water and other hygiene services are already stretched to the limit.

In addition, in the last decade, many African countries have witnessed an upsurge in population migration to urban areas in search of livelihoods. Many of these people end up in urban slums where water and sanitation infrastructure is a challenge.

Displaced populations — a major concern in several African countries — are vulnerable to water and food contamination.

It’s important to control cholera because it can cause severe illness and death.

In mild cases, cholera can be managed through oral rehydration salts to replace lost fluids and electrolytes.

Severe cases may require antibiotic treatment. It’s vital to diagnose and treat cases quickly — cholera can kill within hours if untreated.

In 2015, it was estimated that over one million cases in 44 African countries resulted in an economic burden of US$130 million from cholera-related illnesses and treatment.

African governments must acknowledge that the burden of cholera is huge. In my opinion, governments in endemic areas don’t recognise cholera as a major issue until there’s a big outbreak, when it’s out of control. They treat it as a once off.

The burden of cholera could get worse unless governments put measures in place to control and prevent outbreaks. They need to address water and hygiene infrastructure challenges.

There must also be community engagement. For instance, widespread messaging encouraging handwashing, boiling water and other preventive measures.

Community health extension workers are key in getting these messages across and distributing supplies during an outbreak.

For the most vulnerable populations we must apply oral cholera vaccines.