March 1, 2006
Doctors Without Borders/Médecins Sans Frontières (MSF) is once again responding to a cholera outbreak in one of Africa's capital cities.
In less than a year the residents of Monrovia (Liberia), Conakry (Guinea), Bissau (Guinea Bissau), Nouakchott (Mauritania), Ouagadougou (Burkina Faso), Lusaka (Zambia), and now Luanda in Angola, have had to deal with cholera outbreaks.
It is the first outbreak in Luanda in more than a decade.
On February 13, the first case of cholera was reported. The outbreak started in Boa Vista, one of the poorest and most overcrowded slums that surround the city center. Within 10 days, the Angolan Ministry of Health officially declared the outbreak. By March 2, 128 cases had been identified, of whom ten died.
"Overcrowded areas with poor sanitation-and-hygiene conditions are key factors for an epidemic disease like cholera," says Joachim Delville, MSF head of mission in Angola. "Our immediate priorities are to reduce mortality and to limit the spread of the disease."
"In Boa Vista there is no access to safe water and wells are infected," says Delville. "The only way people can get drinkable water is to buy it from private sellers. No drainage system exists and latrines are very rare. And in these respects Boa Vista is not an exception. People in many other slums in Luanda live in similar conditions and the outbreak could easily spread to other areas, especially when heavy rains start to fall."
The authorities have begun distributing water to the communities in Boa Vista, but the number of people benefiting from this potable water is still limited, and the outbreak will not be contained until basic hygiene-and-sanitation conditions are followed.
Cholera is most often transmitted through water and food contaminated by vibrio cholerae, the bacterium that causes cholera in humans and is carried in feces and vomit. It can spread directly to other people if they come in physical contact with an infected patient and then fail to wash their hands before eating. If untreated, the mortality rate is between 25 percent and 50 percent: people usually die because of dehydration.
Infected persons (whether symptomatic or not) can carry and transmit vibrio cholerae during one to four weeks. A small number of individuals can even remain healthy carriers for several months. A number of factors conspire to cause a cholera outbreak: poor hygiene conditions, overcrowding, and a lack of safe drinking water.
"At the moment the situation is still controllable, but the expected peak is still to come," says Delville. "Priorities now are: to extend the capacity to admit more cases; to carry out massive sensitization actions while there is still time; to develop a proper mapping of cases to better identify the clusters in the communities, and to directly act in those places."
From 1987 to 1995, Angola–with Luanda and the coastal areas in particular–was affected by a recurrent seasonal epidemic of cholera that resulted in an estimated 90,000 cases and more than 4,500 deaths. Since 1995 there have been no major epidemics in Angola and only occasional reporting of unconfirmed cholera within Luanda. In 1999, MSF worked on the preparation of an extensive cholera preparedness plan for the city of Luanda.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)