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Willard Duri, Correspondent

Cholera continues to threaten public health, particularly in regions with inadequate access to clean water and sanitation. Zimbabwe has witnessed recurrent cholera outbreaks, highlighting the enduring vulnerabilities faced by communities grappling with these underlying challenges.

The 2023 cholera outbreak in Chegutu resulted in a devastating impact, with approximately 100 reported deaths and nearly 5 000 confirmed and suspected cases. Beyond its immediate health consequences, the outbreak has strained the healthcare system, exacerbated issues of malnutrition, and disrupted education, particularly affecting vulnerable populations.

Cholera remains a persistent and severe threat to global public health, especially in regions lacking clean water and adequate sanitation facilities.

The Ministry of Health and Child Care (MoHCC) confirmed the first suspected case on February 15, followed by a second case on February 17. By February 26, Chegutu district reported 37 suspected cholera cases, including two confirmed positive cases and no recorded deaths. However, by April 18, 2023, the situation had deteriorated significantly, with 579 suspected cholera cases, including 102 culture-confirmed cases and nine documented deaths. Alarming proportions were reached by August 27, 2023, resulting in 3 894 cholera cases and 96 fatalities.

Notably, this pandemic extended its reach to all 10 provinces across the country.

The profound health impact is the most immediate and pressing concern. The tragic death toll represents only a fraction of the suffering endured by those affected.

Concurrent outbreaks of endemic diseases, such as malaria, stretch the already existing healthcare systems to their limits. Malnutrition, particularly among children, is exacerbated due to the crisis. The scarcity of clean water amplifies the devastation, with cholera’s dehydrating effects setting a vicious cycle of disease.

Children, especially those from low-income families, are among the most vulnerable. They confront a dual challenge: limited access to healthcare and delayed arrival at healthcare facilities. Healthcare centres already operating with restricted resources and staffing are overwhelmed by the sudden surge of patients due to the cholera outbreak. The cholera outbreak has incited a significant migration of people from affected areas, resulting in a loss of labour and economic input and a decline in financial income.

Moreover, these migrations risk introducing cholera to other areas or communities previously untouched by the outbreak. For those who run food carts, the fear of selling contaminated food looms large as flies swarm their cooking areas.

Meanwhile, some patients have bravely shared their personal experiences, shedding light on the profound toll and challenges faced by those afflicted by the outbreak. Climate change cannot be dismissed as one of the major contributors to the surge in cholera cases not only in Zimbabwe but also in the whole continent. This is because water ecosystems can be rather sensitive to evolving or sudden changes in weather parameters.

These changes can result in alterations in the natural habitat of pathogens, vectors, and human hosts, as well as in the transmission dynamics and geographic distribution of infectious agents. However, the interaction between climate change and infectious disease is rather complicated and not deeply understood. In this narrative review, we discuss climate-driven changes in the epidemiology of Vibrio species-associated diseases with an emphasis on cholera. Changes in environmental parameters do shape the epidemiology of Vibrio cholerae. Outbreaks of cholera cause significant disease burden, especially in developing countries.

Improved sanitation systems, access to clean water, educational strategies, and vaccination campaigns can help control vibriosis. In addition, real-time assessment of climatic parameters with remote-sensing technologies in combination with robust surveillance systems could help detect environmental changes in high-risk areas and result in early public health interventions that can mitigate potential outbreaks.

In the context of climate change, rainfall patterns are dynamic. Heavier and frequent precipitation in some areas can overwhelm waste-water treatment plants and septic systems, resulting in contamination of surface water and wells. On the other hand, lower rainfall in other regions may cause droughts and water scarcity, leading to increased microbial load in limited water supplies, use of contaminated rainwater, or competition for scarce water.

The World Health Organisation (WHO) has played a vital role in supporting Zimbabwe’s efforts in combating cholera. During their visit in February 2023, WHO provided essential aid, including cholera kits containing medicines and laboratory re-agents. They also offered technical support to enhance the capabilities of front-line health workers, helping to improve their capacity to respond effectively to the outbreak. WHO highlighted the key challenges that required immediate attention, emphasising the importance of collaborative efforts among WHO, Zimbabwe, and other partners to address the cholera outbreak effectively. However, it is important to acknowledge that while WHO’s aid is crucial in the short term, heavy reliance on external aid can pose a challenge to sustainability.

Effective responses to cholera outbreaks require short-term training and a focus on continuous professional development, infrastructure improvement, and resource allocation. For long-term effectiveness, Zimbabwe must develop self-reliance and build its capacity to manage cholera outbreaks independently. In addition, the sustainability of these improvements is limited if there is insufficient investment in building local capacity.

The Government’s response has been multi-faceted and swift. They established a Cholera Treatment Centre in Chegutu town, a critical step in providing immediate medical care to those affected. To curtail the spread of cholera, the Government-imposed restrictions on large gatherings, implemented heightened surveillance at ports of entry, and enforced specific measures to reduce the risk of transmission. Funeral attendance has been limited to no more than 50 people, and physical contact, including handshakes, has been discouraged. Furthermore, participation in outdoor church camps and open markets has been discouraged to minimise the risk of exposure.

An inter-ministerial committee, co-ordinated through the Cholera Secretariat of Zimbabwe, convened a National Task Force for Cholera Elimination. This task force developed a comprehensive Multi-Sectoral Cholera Elimination Plan, guided by the Global  Task Force on Cholera Control’s (GTFCC) global roadmap. Additionally, the Government has worked on strengthening surveillance and laboratory capacity to enable early detection and rapid responses to cholera outbreaks.

While immediate responses to cholera outbreaks are crucial, it is essential to acknowledge that cholera control is an ongoing process. Sustainable efforts are required to address cholera’s root causes and prevent future outbreaks. This involves investing in long-term solutions such as improving access to clean water and sanitation infrastructure, which is critical for cholera prevention.