From a preventable disease to a Persistent Headache

Figure 1: Residents strive for water in an informal settlement in Nairobi, water shortage is a major risk factor to cholera outbreak. image source: Nairobi Water and Sewer company

Kenya faces a reemerging series of cholera outbreaks since 2015.  In 2017 alone, an estimated 4000 cholera cases were reported across the country, with the country’s capital accounting for 70% of the cases.  In the WHO epidemiological week 13 report 2019, the country accounted for 35.4% of the 3,385 total cholera cases reported within the Eastern and Southern Africa Region (ESAR) since the year began. The cyclone- hit Mozambique came second at 31% ≈1048 cases.

Cholera is a disease of global significance, accounting for approximately 21,000-143,000 deaths worldwide every year. Children stand as major victims of the cholera outbreak incidences. Transmitted through consumption of food and water contaminated with the bacterium Vibrio cholerae, the disease is associated with unsafe water sources, poor hygiene, and sanitation. Untreated cases can lead to death within hours to patients who were otherwise healthy, due to severe diarrhea and body dehydration.

Figure 2 children suffer most in Cholera outbreaks image source: Businessday.ng

However, formally attributed to the informal settlements (slums and refugee camps), famous of congestions, clogged drainage systems, and water scarcity, cholera is now a common snare in Kenyan prominent joints, learning institutions and social gatherings. In 2017 a team of prominent health officials in for a health conference fell victims. This was after consuming contaminated food at a high end joint, that hosted the conference. The incidence left 47 victims hospitalized in various hospitals within the capital.

Most recent is the outbreak at Nairobi Hospital that saw the facility record 52 cases and one death. The victims comprising of doctors, nurses, and attendants at the facility cafeteria. Cholera outbreaks have also been reported in premier estates like Nyayo Estate, Tassia, Avenue1-3, Pipeline, South B, Donholm, and their neighborhoods.

The continued endemicity of the otherwise preventable disease puts Kenya’s preparedness to fight the otherwise preventable disease at the spotlight. But why the huge burden? Are the concerned parties doing enough? Is there a sustainable solution to the snare disease?

Response

Cholera incidences are first slammed with denial from the concerned health authorities. The cholera outbreak in the 2017 health conference serves as a clear example. Similarly, the recent supply of contaminated water in Umoja estates and some Central Business District(CBD) commercial buildings was greatly refuted despite residents in the localities taken ill with diarrheas cases on consuming the water unknowingly. At some instances the tap water smelling sewer. “The water we are getting in our taps is raw sewage. My baby has become sick after drinking the water.” Mary Wacuka told the Daily nation team out to survey the situation. The claims coming in amidst the county health director alarming alert in the city.

The health sector has also been more reactive than proactive. Outbreaks come as a surprise.  Inadequate contact tracing, see most cases go unsuspected, lack of a consistent public health campaign on hygiene and sanitation also deter the concerted efforts to curb the emergence of the disease.

A preventive approach to reducing cholera cases is achievable and sustainable!!

Figure 3: A poster on personal hygiene practices on a Zambian street, public education campaign on hygiene and sanitation\ image source: ZNBC

Unclean water

Contaminated water is a major predisposing factor to a cholera outbreak. Unsafe water is estimated to cause 502 000 diarrheal deaths each year, globally. According to UN statistics, 18 million Kenyans lack access to clean water. Recent surveillance in cholera-stricken  Kajiado and Narok Counties revealed contamination of Environmental samples taken in a river shared by the two counties. The surface water runoff soiled with human waste, due to widespread open defecation in the vicinity.

Investing in management of freshwater ecosystems and sanitation facilities will go a long way in curbing water-borne diseases.

Figure 4: Tapped water-investing in safe and accessible water sources, will go a long way in curbing cholera image source:Globalwaters.org

Improved infrastructure, that can deliver safe drinking water in nature of design and construction, is necessary and a key indicator of the Sustainable Development Goal 6 .1, that builds on the quality of the drinking water. To meet an improved water source threshold, any source should be in close proximity, supply water when need, and free of fecal and others contaminants.

 

Policy

Lack of a political will put Kenyans at unnecessary risk. Preparedness is influenced and a mandate of government institutions that are mandated to ensure right infrastructures are put in place. Illegal constructions, clogged drainages and open sewer lines in slums are a major threat to disease outbreaks. This settlements house two-thirds of Nairobi inhabitants.

Provision of health education and maintenance of sanitation facilities are mandated solely enclaved on the policy. Absence of legit health policy is a major fallout in the fight of cholera.  A ban on streets and food hawking in 2017 was for instance short-lived though the country still poses a huge burden.

Cholera is preventable let’s kick it out before it does!

 

 

 

 

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