Cholera infections sky-rocket in S.Africa

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Yahoo! Asia - News World Thursday, February 1 2:01 AM SGT

Cholera infections sky-rocket in S.Africa JOHANNESBURG, Jan 31 (AFP) - The rate of cholera infections in South Africa is skyrocketing and there is no end in sight to the epidemic ravaging poor rural communities in the east of the country, health workers said Wednesday.

Health authorities in KwaZulu-Natal, where the epidemic is concentrated, said on Monday 1,010 new infections had been reported in the previous 24 hours, the highest number since the outbreak began in August. On Tuesday, a further 886 were reported.

This compares to between 20 and 50 new cases a day last year, and the provincial health department noted that "the largest increase of daily infections is of great concern."

A total of 32,742 people have been infected in the province and 82 have died.

"We have been expecting the worst and it seems to be happening," the spokesman for South Africa's Cholera Control Centre, David Mcglew, told AFP.

"It is very unlikely that this is going to go away. It can take a long time to wipe out."

Mcglew said infections have increased for two reasons -- the return to the province of migrant workers for the holidays and the fact that February and March are the months when the risk of cholera is highest.

He said the vast majority of the victims were poor people living in rural areas that lacked access to tap water but instead relied on now contaminated streams and rivers.

Attempts to curb the epidemic by sending in emergency water supplies and teaching communities to purify water were fraught with difficulty because the cholera-struck areas were large and often remote, he added.

"Some of the districts here are the size of Scotland or Wales ... and some of the areas are very rugged and hard to reach."

In addition communities were sometimes superstitious about adding bleach to their water supply.

"It is very sad because cholera is such an easy thing to prevent by adding bleach to water and letting it stand, but it is very difficult to get people to change their behaviour.

"We are fighting superstition ... some people say if we add this muti to our water we won't be able to have children." Muti is the name given to traditional herbal medicine.

Jo-Anne Colling, a spokeswoman for the department of health, agreed that health authorities had "great difficulty in containing the disease at this level as people sometimes find it hard to take the advice we give them."

"We can tell people to boil water but sometimes this is very difficult as they do not have firewood. We have been supplying bleach but sometimes this runs out and the people are not able to replace it."

In a country where seven million people do not have clean water, things are not going to change overnight, she said.

"The underlying conditions are not going to change in the face of this crisis alone. People are still living in underserviced areas with very poor sanitation."

Colling said the national death toll since August stood at 84 on Tuesday, adding that earlier reports putting the figure higher were misleading.

Apart from the 82 deaths in KwaZulu-Natal, there have been two fatalities in other provinces where cholera has reared its head since the start of this year and several hundred infections.

Most victims were migrants from KwaZulu-Natal, Colling said, but cholera has also been found in a river running through Alexandra township outside Johannesburg.

Mcglew said though the river later tested clear it was impossible to say what would happen here in future.

"Cholera is the hardest disease in the world to predict. It might be flushed out or it could become rampant."

Local Government Minister Sydney Mufamadi has warned that cholera could turn into a "national disaster" and has given experts from the water and health departments until February 9 to produce a strategy to combat the epidemic.

The World Health Organisations' director for Southern Africa, Welile Shasha, said the body would send "field experts" including an epidemiologist to South Africa to help find the cause of the outbreak and solutions.

"Cholera can lie dormant for 10 years and then suddenly there is an outbreak. We don't know why this happened now but I think it is an important wake-up call for the country to provide services in poor areas."

http://asia.dailynews.yahoo.com/headlines/world/afp/article.html?s=asia/headlines/010201/world/afp/Cholera_infections_sky-rocket_in_S.Africa.html



-- Martin Thompson (mthom1927@aol.com), January 31, 2001

Answers

Headline: Prevention fails to halt South Africa's well-treated cholera epidemic

Source: The Lancet, Volume 357, Number 9252, 27 January 2001

URL: http://www.thelancet.com/journal/vol357/iss9252/contents

WHO officials have lauded South African health workers for achieving perhaps the lowest ever case-fatality rate in a cholera epidemic. But the praise is hollow comfort for many thousands of people now at risk from the disease in Johannesburg, after the first urban river tested positive for cholera last week.

The country's largest cholera outbreak for almost 2 decades has has caused at least 25 500 infections and 73 deaths since August, 2000, mostly in AIDS-stricken KwaZulu-Natal province. The WHO team that reviewed epidemic management there reported on Jan 15 that "successful case management" accounted for the "exceptionally low" death rate, estimated at 029%. However, the opposition Democratic Alliance counters that people are dying in remote areas before cholera is diagnosed. And cases have steadily increased since the end of 2000, with KwaZulu-Natal still recording at least 500 new infections a day. Five of nine provinces are now affected, including Gauteng, where authorities are on full alert since cholera was detected in the Jukskei River on Jan 18.

Cholera now threatens many thousands of informal settlers along the river, because, despite emergency education, some residents continue to use the contaminated river as their only source of water. This situation is familiar to the majority of residents living below the poverty line in affected areas throughout the country. The government claims it has provided 64 million people with clean water, but the epidemic has demonstrated shameful inadequacies in rural development in South Africa: at least 8 million people are still without tap water and inadequate roads are hampering water delivery. WHO has also encountered shortages of health-promotion workers, ineffectiveness of education programmes, lack of community involvement in education efforts, and over-pressurised hospitals.

But water and sanitation remain the key issues. In the Sunday Independent on Jan 21, Ebrahim Asmal of the South African Human Rights' Commission noted that about 60% of households in affected areas had inadequate sanitation and, in one province studied, up to 90% of new water connections were not fully functional. He also alluded to last year's assertion that the epidemic started after water supplies were cut because users could not pay newly introduced water fees. Community cost-recovery programmes, promoted by the International Monetary Fund, are a key component of the government's much-criticised macroeconomic policy. Yet, Asmal notes that the country spends approximately R4 billion (US$ 500 million) treating diarrhoea and dysentery a year, whereas only about R750 million was spent on water in the past financial year.

-- Andre Weltman (aweltman@state.pa.us), February 02, 2001.


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