National Assembly, Wednesday 26th September 2018
SITUATION ON OUTBREAK OF CHOLERA
THE MINISTER OF HEALTH AND CHILD CARE (HON. DR. O. MOYO): Hon. Speaker Sir, I have the honour to present to you today the current situation regarding cholera. An outbreak of cholera was declared in Harare on the 6th of September 2018. Due to exponential increase in cases within Harare and beyond, coupled with high numbers of community and institutional deaths, the outbreak was elevated to a national disaster level by His Excellency. As of the 26th of September 2018, more than 10 000 persons have been presented to the screening and treatment centres. 6 645 suspected cases have been reported, of which 96 of them tested positive for vibrio cholerae and 49 have died to date.
I must also make special mention of the fact that 21% of the cases and a similar proportion of the deaths recorded to date are children below the age of five, the youngest patient being eight months old. We realise that this is a unique outbreak from those experiences in that there has been high levels of resistance to the commonly available antibiotics - high fatalities despite the outbreaks being predominantly urban and in that it is happening in the same areas that are heavily affected by typhoid. That raises the possibilities of dual infections. For these reasons, plans for vaccination for both cholera and typhoid are at an advanced stage with the cholera vaccine expected in the country today.
A number of responsive activities are ongoing simultaneously at both national and sub-national levels. Within the City of Harare, two cholera treatment centres situated in Glenview and Beatrice Road Infectious Diseases Hospital, a cholera treatment unit at Budiriro and a screening unit set up at Harare Central Hospital. Surveillance has been intensified in Harare and nation-wide to pick cases early for effective treatment at the static clinics and the established cholera treatment centres.
All provinces and city health departments are on high alert. They have activated their rapid response teams and therefore have been reporting the cases. I must hasten to say that immediately on realising that we have this outbreak, we activated a prompt emergency response plan. The determinants of the outbreak are being addressed in the affected suburbs throughout and all of the determinants. One of the determinants is availability of water to the affected suburbs and especially targeting schools for safe drinking water through restoring municipal supplies, supporting installation of water tanks and trucking, water quality testing for the main water works reservoirs and community points, fixing of sewers and burst pipes. Provision of mobile toilets in the key hot spots of Glenview and Budiriro has been effected. Community mobilisation and school hygiene promotion, distribution of non-food items, aqua tablets, buckets with taps for drinking water, water containers with taps for hand washing, protective clothing and detergents for toilet cleaners, shovels and wheel barrows for solid waste management to affected and potential high risk communities and organising of cleaning up campaigns. The planning for the emergency vaccination for cholera followed by typhoid is very relevant at this stage.
Let me indicate that from mid August 2008, if you all remember that period to July 2009, an unprecedented outbreak of cholera was reported in Zimbabwe. By the end of the outbreak, 98 592 and 4 288 deaths were recorded. Multiple factors interacted to make the outbreak widespread and devastating. Many are still un-addressed in 2018. By the end of the outbreak, 79% of the total recorded cases had been reported in Mashonaland West, Harare, Manicaland, Masvingo and Mashonaland Central provinces with Harare accounting for around 20% of the total cases. I have a list here with all the figures; I can make this available for the benefit of all hon. members.
As I indicated, the total number of deaths is now at 49 and the number of cases who have come through the clinics is at 6 645. Most cases came from Glenview 8 and Budiriro 1 and Budiriro 2. A 25 year old woman who was brought in collapsed and died on the same day, the 5th of September. A sample from the woman was positive for vibrio cholerae, ogawa.
All the patients have typical cholera symptoms like excessive vomiting and diarrhoea with ricy watery stools and dehydration. During the night of the 5th of September, more patients were admitted. By early morning of the 6th of September, 2018 – 52 suspected cholera cases had been admitted. On the 6th of September, 11 cases were confirmed to be positive of vibrio cholerae. 39 stool samples were taken for culture and sensitivity. Of these 39 samples, 17 were confirmed to be positive for vibrio cholerae type ogawa species.
Contaminated water sources and shallow wells including boreholes and wells are suspected to be the source of the outbreak. Sewerage was flowing on the ground all over the affected areas due to the blocked and damaged sewer pipes. On the 6th of September, the outbreak of cholera was declared in Harare and His Excellency the President of the Republic of Zimbabwe Cde E.D. Mnangagwa declared cholera as a state of disaster in line with Sub section 1, Section 27 of the Civil Protection Act on the 12th of September, he managed to visit the epicenter, which is Glenview and Budiriro area accompanied by his two Vice Presidents. Her Excellency, the First Lady Amai Mnangagwa also visited the centre.
Mr. Speaker Sir, let me give you the coordination and the interventions that have taken place. This is very vital for the members to know that there has been action which has been going on. A District Health Executive meeting was convened in Glenview to strategise on the response. Weekly meetings of the inter-agency coordinating committee on Health have been held since the outbreak was confirmed. Following this meeting, Thematic Committees were formed and these include case management, wash, health and hygiene promotion, surveillance, laboratory and logistics.
The Permanent Secretary in the Ministry met with the City of Harare team and partners. I have to emphasise that there has been a very good working relationship between the Ministry and the City of Harare officials. On 12th September a Cabinet Committee on Preparedness was reactivated.
Let me also now indicate the case management. We have had pediatricians attending to the cases of cholera treatment at the centres which I mentioned. We have about 60 volunteers who have been deployed to support cholera treatment centres in Budiriro and Glenview. We have had 7 200 door to door visits and interpersonal communication at health facilities have been conducted. An interactive SMS base demand driven cholera hub which enables subscribers to ask questions and receive cholera messages has reached more than 75 000 to date.
There have been public service announcements, talks and discussions on cholera and these continue to be aired on ZBC television. Our health promotion unit and UNICEF are currently developing tools for rapid assessment of knowledge, attitudes and practices. Our partners, I have to indicate Madam Speaker, have been taking part in the promotion and their response has been fantastic and these include Higher Life, Zimbabwe Catholic Bishops Conference and UNICEF. UNICEF has mobilised four partners for the epicentre and case spread. OXFAM is working in Glenview and Budiriro. OXFAM has distributed 5 000 buckets, soap, jerrycans, aqua tablets and so on. Higher Life Foundation supporting with NFI in community mobilisation in liaison with OXFAM. Higher Life comes out of Econet Wireless.
Let me go to the final pages of my report. The request for vaccines to the WHO has been made in order to protect over a million people in Harare and beyond as a first emergency measure and we have been provided with 500 000 doses which as I said are arriving today. It will be relevant for me to also advise you on the logistics. We have received two cholera central reference complete kits which are for cholera testing and very relevant. The global and regional WHO, UNICEF and CDC officers have arrived in the country and are supporting the vaccination teams. Arrangements are in process for additional supplies to arrive in the next couple of days.
Naturally, there are some challenges which I have to advice the House. Municipal water supply is sometimes interrupted during sewer repairs and the communities spend hours without clean water, and no mobile water tanks are in place to supply water to some of these residents. There is a low supply of aqua tablets and accessibility of household bleach and water guard. I am glad to report however, Madam Speaker that we have managed to get further supplies today from the Chinese Embassy of these particular products. There are so many other organisations and corporates who have come forward and have been giving a lot of assistance. The partners have conducted communication and social mobilisation activities and medium monitoring continues to be held.
Finally, I must point out that this is the first time that Zimbabwe is using oral cholera vaccine. Therefore, external support is required for them to be able to guide us. That is why WHO has come in and we are very grateful for that immediate response from them.
Recommendations, priority follow-up actions and the coordination mechanisms at national; we will continue doing so developing and reviewing our systems. I think with that, we should be able to strengthen our water sanitation and hygiene for the long term. I have to finally indicate that what we have put in place is just a temporary measure. What is being talked about by my colleague, putting the water systems, boreholes and so forth are temporary measures. We need to have long term solutions and I am glad to hear that the Ministry of Local Government is working on that. I thank you Madam Speaker.