Cholera in Zambia: Short- and Long-Term Solutions

By Mwizenge S. Tembo, Ph. D.

By Mwizenge S. Tembo, Ph. D.

Emeritus Professor of Sociology

I was shocked when I read the news a few days ago. There was another new cholera epidemic in Zambia; 351 people were dead and 9,000 cases of infections were registered. Images and video clips of rows of patients in beds in the Heroes Stadium in Lusaka transformed into a large makeshift emergency ward were heart breaking. Why is this cholera outbreak happening again? According to the World Health Organization, the last cases of the cholera epidemic in Zambia were in 2017. At this moment in Zambia, cholera affects 9 provinces and 39 districts. But why is cholera such a problem during the rainy season in Zambia? Is cholera endemic, epidemic, or a pandemic in Zambia? Can we as Zambians end cholera to never strike again forever?

This article may not answer all of these and other questions in great detail. The article will define the cholera disease and its causes, symptoms, treatment of the disease and its history in Zambia, and why it keeps striking in Zambia.  Lastly, the article will discuss the short- and long-term solutions. I will discuss why I agree with President Hakainde Hichilema that part of the solution would be for residents of densely populated areas in towns and cities to migrate to rural areas and villages.

What is Cholera and its causes?

The bacteria vibrio cholerae causes cholera illness. The bacteria get transmitted into the body through the oral-fecal route or through the mouth and feces. The cholera illness is caused by contaminated food, water and other drinks. The cholera bacteria can be found on contaminated raw or uncooked food including meat and fish. The bacteria are spread through unhygienic or unsanitary conditions. Our stomachs acid often kills many bacteria before they can harm us or cause illness. One of the risks of cholera illness is if our stomach for some reason has reduced levels of stomach acid, then we can become victim of the cholera bacteria once we have eaten food or drink water that is contaminated.

Symptoms and Treatment

If you or someone is showing signs of cholera illness, urgently seek medical treatment immediately as the illness can kill in a matter of hours if not treated. The major symptoms of cholera include: Very watery diarrhea in which the stool appears pale and milky, feeling fatigue, weakness, tiredness or kufoka. Feeling very nauseous and vomiting, dehydration or thirst, dry mouth and loose skin because of loss of fluids in the body.  Electrolyte imbalance and low blood pressure, rapid heartbeat, and weight loss or kuyonda or becoming thin. According to the World Health Organization (WHO) website, “People with low immunity – such as malnourished children or people living with HIV – are at a greater risk of death if infected”. I would like to add that even adults who are malnourished can be victims of cholera.

The cholera illness is fortunately very easily treatable. According to the World Health Organization (WHO), the majority of people who have the illness can be treated successfully through the application of Oral Rehydration Solution (ORS). “The WHO/UNICEF ORS standard sachet is dissolved in 1 litre (L) of clean water. Adult patients may require up to 6 Litres of ORS to treat moderate dehydration on the first day”.

According to the WHO, if the patient is severely dehydrated, they are at risk of shock and require the quick or rapid application or administration of Intravenous Fluids administered through the drip. Almost all the photos I saw of the many cholera patients at Heroes Stadium emergency had drips attached to them which means they were severely dehydrated. A 70 kg adult will require at least 7 Litres of Intravenous fluid, plus Oral Rehydration Salts (ORS) during their treatment. “These patients may also be given appropriate antibiotics to shorten the duration of diarrhea, reduce the volume of rehydration fluids needed, and shorten the amount and duration of V. cholerae excretion in their stool”.

The WHO website concludes its discussion of treatment stating: “Rapid access to treatment is essential during a cholera outbreak. Oral rehydration should be available in communities, in addition to larger centres that can provide intravenous fluids and 24-hour care. With early and proper treatment, the case fatality rate should remain below 1%.”

History of Cholera in Zambia

Is cholera epidemic, endemic, or a pandemic in Zambia and the rest of the global world? A disease is an epidemic when at a particular time it is widespread all over the community, country, society or the world. Common examples are the flu or the recent Covid 19 epidemic. An endemic is when a disease frequently and regularly occurs within an area, village, community, country, or society. Cholera is fortunately not endemic in Zambia as it first occurred only in 1977 and again in 2017according to the WHO. If it was endemic the disease would occur in Zambia every day all year round. Malaria, on the other hand, may be endemic in Zambia. A disease becomes a pandemic when it occurs all over the country or the world at any particular time.

The World Health Organization (WHO) says: “During the 19th century, cholera spread across the world from its original reservoir in the Ganges delta in India. Six subsequent pandemics killed millions of people across all continents. The current (seventh) pandemic started in South Asia in 1961, and reached Africa in 1971 and the Americas in 1991. Cholera is now endemic in many countries.” According to WHO Researchers, 1.3 to 4.0 million cases, and 21,000 to 143, 000 deaths are estimated to occur worldwide due to cholera1.

Why Cholera Strikes in Zambia

The WHO Africa report says that over the last two years in 2022 and 2023, 16 African countries have reported cholera outbreaks. These now include six countries including Zambia, Burundi, Cameroon, Ethiopia, Malawi, and Zimbabwe recently reported a total of 1,334 new cases.

In virtually all the descriptions of the causes of the cholera epidemic in Zambia,  African and other countries, one set of causes are mentioned and emphasized over and over again: “…dire water and sanitation conditions,” “…. contaminated water and food,” “…inadequate access to clean water and sanitation facilities.”

I am not saying this with hate of my fellow Zambians who might live in those neighborhoods. Because as a citizen, I have friends, relatives and a long history of having some of my best times in those neighborhoods since the late 1960s. Cholera happens during the peak of the heavy rainy season in densely populated areas of the Capital City of Lusaka. According to the Relief Web website, 94% of Cholera cases and 97% of the 351 reported deaths in Zambia have occurred in Lusaka Province. What has made cholera worse and more likely to happen this year is the severe or heavy flooding during the rainy season due to climate change. During the last 2 years cyclones have hit neighboring Mozambique that have resulted in  many deaths. The cyclones have spread into parts of Eastern and Southern Zambia causing deadly floods displacing millions.

When these floods hit major large cities such as Lusaka with many densely populated compounds, chances of cholera outbreaks increase and these highly densely populated areas are located in low lying swampy areas and lack proper sanitation and water drainage. I remember in February 2021 driving through Kanyama compound after heavy torrential rains, the flooding was so serious that cars and vehicles could not drive through as flood water surrounded homes and was above the bonnets of the cars. We had to reverse and drive out without completing our business.

Short Term Cholera Solutions

Short term cholera epidemic solutions are the easiest to implement. We may have some of the best medical facilities compared to other not just African but other countries in the world. This is both in the rural and urban areas. We have many well trained Zambian medical doctors, nurses, technicians, equipment, drugs and other medicines. I can say this because I have seen and personally experienced the change from 60 years ago or since 1964 when Zambia got its independence from British colonialism. I don’t want Zambians hitting me on the head to say I don’t know what I am talking about because medicines are not available in public hospitals and clinics. I am aware of this but I am referring to acknowledging the positive change and advances that have happened over the last 60 years. There is always room for improvement.

This change of having highly qualified effective Zambian doctors, medical personnel and experts means that the cholera outbreak epidemic emergency can be effectively attended to. The government in conjunction with WHO and other national and international medical non-government organizations can treat the cholera outbreak and stop it from spreading. Other immediate effective policies that are in place as of right now are that  public gatherings are banned including attending public burials of the cholera victims. The banning of public burials sounds very cruel for grieving relatives of the deceased person but this is to stop the spread of the cholera bacteria. Street vending of foods has been banned.

Cholera patients should be quickly identified, isolated, admitted to hospital or clinic wards. They should quickly be treated with Oral Rehydration Salts, Intravenous Fluids, and antibiotics as needed. The public should remain vigilant until the end of the rainy season.

Long Term Cholera Solutions

The long-term solutions are the most challenging. That’s why it was heartwarming for me when I read the news headline: “Zambia cholera: President Hakainde Hichilema urges people to move to villages”.  I am in complete support of a policy that would encourage residents of highly densely populated areas in towns and cities such as in Lusaka near the Heroes Stadium to relocate or migrate to rural areas where there is more open space.

I remember in the 1970s when there was high unemployment and crime among the youth in towns and cities in Zambia. President Kaunda and the United National Independence Party (UNIP) were urging youths to return to rural areas through what was called the “Rural Reconstruction Programme”.  The youths did not migrate because at that time rural areas were not very livable. There was no electricity, the small rural shops didn’t stock essential commodities such as cooking oil, sugar, mosi beer, soft drinks, there were no telephones, fewer clinics and schools. Jobs were very few. Today rural areas are very livable. There is solar power, borehole pumps for clean drinking water, farming has some income, some jobs and business are available, cell phones are everywhere, schools and clinics are everywhere. Improvement of transportation and the paving or tarring of major roads is on-going.

The other aspect of long-term cholera solutions is that sanitation and providing of clean water has to be a high priority in densely populated compounds of towns and cities. This requires the government and town and city municipalities to invest capital in sanitation technology and equipment. Compounds and townships should have piles of rubbish removed and good toilets installed and inspected at least before every rainy season if not all the time. All of this requires money and good public planning on the part of both government and leaders in township and city municipalities. This is why the United Party for National Development (UPND) were right to appeal to all Zambians from all political parties to unite in the fight against the cholera outbreak. “Zambia’s UPND Calls for Unity to Combat Cholera Outbreak.”

Sources

1. https://www.afro.who.int/health-topics/cholera#:~:text=Cholera%20transmission%20is%20closely%20linked,clean%20water%20and%20sanitation%20facilities.
2. https://www.bbc.com/news/world-africa-67931876
3. https://bnnbreaking.com/zambias-upnd-calls-for-unity-to-combat-cholera-outbreak
4. https://news.sky.com/story/zambia-cholera-outbreak-families-face-desperate-wait-to-find-out-if-loved-ones-are-dead-or-alive-13047959
5. https://reliefweb.int/report/zambia/zambia-cholera-outbreak-update-dg-echo-un-ocha-zambia-national-public-health-institute-echo-daily-flash-12-january-2024
6. https://www.afro.who.int/health-topics/cholera#:~:text=Cholera%20transmission%20is%20closely%20linked,clean%20water%20and%20sanitation%20facilities.
7. https://www.unicef.org/press-releases/cholera-cases-continue-rise-parts-southern-africa-unicef-calls-increased-focus#:~:text=Since%20the%20first%20reported%20case,are%20now%20reporting%20cholera%20cases.
8. causes of cholera – Search (bing.com)