Cholera in subsaharan africa Helen Thomas, Ph.D student Walden University PUBH 8165-2 Instructor: Dr. Howard Rubin Summer 2011

Purpose of presentation Eradication of cholera Address stakeholders Negative outcome of cholera on health Advocate for changes in African health policies Hello everyone! My presentation focuses on the eradication of cholera in sub Saharan Africa. It will give a deeper assessment of the problem of cholera and the capacity to provide necessary environmental public health services. This presentation will also provide a broader understanding for stakeholders to contribute more aggressively to the eradication of cholera. It is my hope that this presentation will serve as a tool to inform or educate the public about cholera and its negative outcome on human health. This presentation can also be used to better advocate for changes in African health policies and for other international entities to increase resource allocation to improve environmental health in Africa.

Objectives of presentation To improve collaboration of partners to enhance efforts and coordination of activities and resources Identify organizations with an agenda to improve national environment public health capacity to eradicate cholera Indentify organizations that are committed to researching cholera and provide a good surveillance system for data collection Identify new or existing resources to fight cholera Identify sources to provide urgent and long term investments needed to strengthen capacities for early detection and timely effective response Identify both governmental and non governmental organizations to find ways to refocus their efforts to address water problems in Africa The objectives will provide international and national basis for implementing public health interventions that are effective in responding to cholera. It is my believe that at the end of my presentation, you will be able to understand the incidence and prevalence of cholera in Africa and use the information acquired as a tool to fight cholera. Furthermore, the tools can be an efficient way to promote information and decision that are timely. The information can be used as effective advocacy, collaboration and resource mobilization effort by local health officials, government and international community to eradicate cholera.

What causes cholera Vibrio cholerae bacteria According to mayo clinic 2011, the Vibrio cholerae bacteria causes bacteria infection. A toxin referred to as CTX carries the deadly effect of cholera by attaching itself to the walls of the small intestine and interrupt the functions of sodium and chloride. As a result, the body secrets massive amounts of water, resulting in diarrhea and loss of fluids and electrolytes.

Vibrio Cholerae Bacteria The vibro cholerae has been identified as the etiological agent that causes cholera in humans. The conditions associated this bacteria are overcrowding, inadequate housing, inadequate human waste disposal systems, lack of portable water, flood, practices that are not hygienic, poverty, and civil wars that forces population into refugee camps where both food production and distribution systems are unhygienic.

Vibrio Cholerae Bacteria continues This slide shows the picture of a refugee camp in Africa. They are the population displaced by war living in condition that make them susceptible to cholera. Presently. There are numerous wars in Africa; wars between Muslims and Christians, and tribal wars. It has been reported that since 1980, 28 of the 58 nations in sub Saharan Africa have been at war resulting in population displacement, inadequate water supply, unhygienic waste disposal and disruption of healthcare(Gaffga et al. 2007). Mortality rate at refugee camps is so high that it excarcibates the unsanitary condition. Statistics has shown that 63% of the population in sub Saharan Africa has no sustainable access to proper sanitation, 44% has no sustainable access to clean water (Kriga et al. 2009).The fact is that most African countries have no access to water at all. Most countries are land locked resulting in frequent drought especially in areas where there is little or no rain fall. In fact, the United Nation hast asked the international community for three hundred million to fight drought victims in Ethiopia and Somali. It is sad to say that some have moved to refugee camps, while other drink and eat whatever is available. For these individuals, survival takes precedence over health. However, they live under the constant threat of cholera outbreak because of the unsanitary conditions. Evidence shows that 90% of reported cases happened in Africa and occurrence have been consistent. Statistics show that in 1999, South African countries accounted for 50% of all cholera cases resulting in 405 death; Mozambique had 44,329 cases resulting in 1,194 deaths (CRF 3%); Malawi had 26,508 cases resulting in 648 deaths (CFR 2%); Madagascar had 9,745 case resulting in 542 deaths (CFR 6%); Zambia had 11,535 cases resulting in 405 deaths (CFR 2%); Zimbabwe had 442 cases resulting 312 deaths (CFR 7%); Comoros had 1,180 cases resulting in 42 deaths (CFR4%) (WHO-AFRO, 2003-2007).

Symptoms of Cholera Profuse watery diarrhea Vomiting Rapid heart rate Loss of skin elasticity Dry mucous membranes Low blood pressure Thirst Muscle cramps Restlessness or irritability Reference: CDC and Prevention retrieved from http://cdc.gov/cholera/disease.html Cholera is an infectious disease. CDC describes it as an acute disease that causes diarhheal The bacterium vibrio cholerae infects the small intestine resulting in water and electrolyte disorders. The CDC noted that severe cases of cholera can lead to acute renal failure, severe electrolyte imbalances and coma, and severe dehydration can quickly lead to shock and death if left untreated. The CDC also noted that profuse diarrhea produced by infected individuals has large amounts of infectious vibrio cholerae bacteria that can be transmitted to others if ingested, and contaminated water and food can lead to more cases.

A young girl being checked for symptom of cholera This slide shows a young girl being checked for cholera symptoms. This image is also disheartening because of the unsanitary conditions. Access to improved sanitation is a persistent problem in Africa. This situation can easily be averted if resources are provided for Africa to have sustainable sanitation and water.

Prevention and control of cholera Access to clean and safe water Community heath and education for behavioral change Ensure food safety Access to improved sanitation Reference: WHO, 2011. Global task force on cholera control>position on oral dehydration Salts to reduce mortality from cholera. Retrieved from www.who.int/cholera/technicalprevention/control/en/index/.html Basic cholera prevention measures involve access to water and improved sanitation. Communities should also be educated about hand washing after they use the bathrooms in order not to contaminate food supply. WHO recommends that information be disseminated through different media sources as well as recruiting religious and community leaders to organize health campaigns. WHO also recommends that workers in charge of water and sanitation be included in the response strategy in the wake of an outbreak.

Cholera treatment Rehydration Antibiotics Zinc Reference: CDC/WHO Since Cholera caused dehydration, rehydration has been recommended as the best treatment (CDC). Oral rehydration salts (ORS) has to be administered promptly, and in severe cases intravenous fluids have to be administered to reduce or prevent fatalities. Antibiotics can be used to shorten the duration of cholera infection and intake of fluids. Tetracycline, Furazolidone, erythromycin, or ciprofloxacin are the antibiotics administered in treating cholera infection (CDC). Zinc has proven to successfully reduce the duration of diarhheal for children up to five years (WHO).

A child being treated for cholera This slide shows a young child being treated for cholera The clinics as well as the hospitals in Africa lack proper sanitation and most cases, there are no medications available to treat patients. We cannot look straight in the eyes of these children and do nothing to help them. It is this people who live and die with the consequences of our decision to stand idol and ignore their inaccessibility hygienic environment which play a vital role in both human health and development.

The cost of Cholera Reported cholera cases Cost involved Life expectancy Reference: Krigia, J. M., Sambo, l. G., Youkouide, A., Soumber-Alleys, E., Muthuri, L. K., & Kiriga, D. G. (2009). Economic burden of cholera in the WHO African region: BMC International Health and Human Rights, Vol. 9, special section p1-14, 14p. D)!:10.1186/147-689x-9-8 A study conducted by researchers found that in 2005, 125,018 cases of cholera reported by WHO in African region resulted in the loss of $39 million among people with life expectancy of 41 years, $53.2 million with 53 years life expectancy, and $64.2 million with life expectancy of 73 years. 203,564 cases reported in 2006, resulted in the loss of $91.9 million with life expectancy of 40 years, $128.i million with life expectancy of 53 years, and $156 million with life expectancy of 73 years. 110,837 cases reported in 2007 resulted in the loss of $43.3 million with life expectancy of 40 years, $60 million with life expectancy of 53 years, and $77.7 million with life expectancy of 73 years (Kriga et al. 2009). For African impoverished countries, the burden is enormous. I hope this will raise awareness of the public, government officials and other stakeholders on the economic burden of cholera in Africa, and change policies that are not effective.

Conclusion The burden of cholera A plea for help References: Herro, A. (2006). Water and Sanitation “Most neglected Public Health Danger” World Watch, Vol.19 Issue 5, p4-4, 1/2p Sack, A.D., Sack, R. B.,& Chaignat, C. (2006). Getting Serious about Cholera: England journal of Medicine,00284793, Vol.355, Issue 7 The incidence of cholera is very high in Africa and conditions have remained the same for many years. In the 21st century, this should not be a major health burden. Cholera can be easily prevented, controlled and treated. Basic highly feasible rehydration treatment is highly successful, and oral vaccines have been proven to prevent majority of cholera cases (Sack, Sack &Chaignat (2006). Africa is plagued with unsanitary conditions and access to clean water. It is logical to eradicate cholera by tackling the problem from the root. Many water borne diseases are preventable and little efforts by international charities to provide access to sanitation and water will help lessen the burden of cholera (Herro, A. 2006). Herro puts the cost of providing safe water, adequate sanitation, and hygienic training at $25. This should be in the forefront of any resolution to be made by stakeholders. The eradication of cholera is an extraordinary goal and it can be done. Once more, I am appealing to both governmental and non governmental international organization, members of the public, government official , and other stakeholders to make eradication of cholera in Africa a priority by donating funds and creating programs to alleviate the problem of water and good sanitation in Africa. Financial support is also needed to develop accurate surveillance systems for data collection, researches on cholera , and to introduce new technology and knowledge for timely response to Africa where cholera deaths can be prevented. This presentation has shown that cholera has negative outcome on human health, and changes in African health policies are needed in order to provide necessary environmental public health services in Africa. This is the end of my presentation. Thank you for taking the time to listen to my presentation. I am ready to answer any question that you might have. /c/References/c/ Kriga,J.M., Sambo, L.G., Yokoude, A., Soumber-Alley, E., Muthuri, L. K., & Kiriga, D. g. (2009). Economic burden of cholera in the WHO African region: BMC International Health and Human Rights, Vol. (, special edition p1-14. 14p DO1:10.1186/1472-698x-9-8 WHO (20!!) Global taskforce on Cholera Control> WHO Position on Oral dehydration Salts to reduce mortality from cholera. Retrieved from www.who.int/cholera/technicalprevention/control/en/index/.html Gaffga, N. H., Tauxe V. R., & Mintz, D. E., (2007). Cholera: A new Homeland in Africa? American Journal of Tropical Medicine and hygiene. Vol. 77, No 4, 705-713. Retrieved from www.ajtmh.ag/content/77/4/705 CDC-Cholera-Disease Retrieved from http://www.cdc.gov/cholera/disease.html Herro, A. (2006). Water and Sanitation “Most neglected Public health Danger” World Watch, Vol.19 Issue 5, p4-4, 1/2p Sack, A, D., Sack, R. B., & Chaignat, C. (2006). Getting serious about cholera: England Journal of Medicine, 00284793, Vol 355, Issue &