GLOBAL HEALTH | Addressing the world’s health challenges
09 December 2008
United States Gives $600,000 to Fight Zimbabwe Cholera Epidemic
Hundreds dead, tens of thousands ill from highly preventable disease
Washington — The U.S. Agency for International Development (USAID) is providing $600,000 in critical aid to Zimbabwe, in southern Africa, where since August the infectious but preventable bacterial disease cholera has taken the lives of nearly 600 people and sickened 14,000.
USAID also sent a team of experts to the beleaguered nation to focus on water, sanitation and hygiene and public health interventions. The team, including an expert from the U.S. Centers for Disease Control and Prevention, will offer technical help and recommendations for further U.S. assistance.
In the ongoing epidemic, 43 of Zimbabwe’s 62 districts have reported cases of a disease that is occurring amid a political, economic and humanitarian crisis, and during a time of year when the cholera-causing bacterium Vibrio cholerae, which occurs naturally in the environment, thrives.
The outbreak, Dr. Rita Colwell, a professor at the University of Maryland and the Johns Hopkins University Bloomberg School of Public Health, told America.gov, “is a tragedy that has befallen the very poor and the most helpless, particularly young children. And it’s highly preventable. It’s a disease that we in the United States have controlled extraordinarily successfully, as has Western Europe and most countries of Asia. It simply requires sanitation and safe drinking water.”
The country is experiencing spiraling inflation, failure to form a new government, deteriorating physical infrastructure, erosion of livelihoods, food insecurity, rising malnutrition, a severe impact from HIV/AIDS and a public sector unable to deliver basic social services.
In the nation’s capital, Harare, U.S. Ambassador James McGee told America.gov, the epidemic is “totally out of control. It is a reflection of the inability and unwillingness of the [Robert Mugabe] government to take care of its people. This is a situation that did not need to happen, but the government is unwilling to put the money into taking care of its own people.” (See “‘Well Past Time’ for Zimbabwe’s Mugabe to Leave, Rice Says.”)
Over the past eight weeks, according to a United Nations statement, the crisis has deteriorated with the collapse of basic services. Schools and hospitals have closed, patients have no access to health care, and teachers, nurses and doctors have been unable to go to work.
HELP IN A CRISIS
The United States joins several countries and organizations, including the World Health Organization (WHO), in sending help to Zimbabwe.
“A high-level WHO team is in Harare to support our country operations,” WHO spokesman Gregory Hartl told America.gov in e-mail correspondence. “Dr. Eric Laroche, assistant director-general for health action in crises, met December 8 with Zimbabwe's minister of health and offered WHO's support,” he said.
The meeting, Hartl said, follows a December 2 call from Health Minister David Parirenyatwa seeking international assistance with the cholera outbreak and overall strengthening of the country's health services.
Laroche offered WHO support for coordinating the cholera response and for overall health interventions, Hartl said. WHO is holding a meeting December 9 of all humanitarian partners in Harare.
For USAID, the contribution is in addition to a $4 million water, sanitation and hygiene emergency program already being implemented in Zimbabwe, bringing total U.S. humanitarian assistance for Zimbabwe’s food and health crisis to more than $220 million since October 2007.
PREVENTING DISEASE
Vibrio cholerae attaches itself to microscopic waterborne copepods, microorganisms that feed on plants called phytoplankton that bloom when water temperatures rise. A single copepod can have as many as 10,000 Vibrio cholerae cells.
The bacterium produces a toxin that, when people drink copepod-contaminated water from rivers or streams, attaches to the surface of the intestine and affects the transport of sodium and potassium in intestinal cells. Cholera victims lose an extraordinary amount of fluid through vomiting and diarrhea, and this severe dehydration can kill.
Oral rehydration salts — salt and sugar mixed in clean water and given by mouth — can be used to treat mild and moderate cases of cholera, according to WHO, or about 80 percent of cases. Antibiotics are not critical but can reduce the disease duration and diminish the volume of rehydration fluids needed.
Filtering water also helps. From September 1999 through July 2002 in 65 villages of rural Bangladesh, Colwell and colleagues taught women to pour the river water they used as drinking water through sari cloth, available even in the poorest households, folded into eight layers.
The simple filtration method, used by 133,000 individuals over the study period, reduced cholera in the villages by 48 percent.
“Since untreated water from such sources serves as drinking water for millions of people living in developing countries,” Colwell, former head of the U.S. National Science Foundation, said during a presentation there in 2002, “filtration should prove effective at reducing the incidence and severity of outbreaks, especially in places that lack fuel wood for boiling water and/or municipal water treatment plants.”
Colwell is working to establish an international center of excellence in Kolkata, India, she said, “to deal with these kinds of controllable infectious diseases that are so devastating, especially to children under age 5.”
She is working with Dr. G. Balakrish Nair, director of the National Institute of Cholera and Enteric Diseases in Kolkata, Dr. Yoshifumi Takeda, former head of Japan’s Infectious Disease Institute, colleagues in Sweden and others to raise funding for the center.
