Cholera; A Disease Of Poverty

In 2014, an epidemic shook the nation. The country was hit with an outbreak of cholera. This was a nationwide outbreak with Accra, the nation capital as the epidemiology center. The outbreak spread to the Brong Ahafo Region which is geographically located in the middle of the country. In this region a review of data collected during the outbreak was carried out and analyzed descriptively to determine the hot spots and make recommendations for effective response to future outbreaks. Before 2014, there had been cases of cholera outbreak in previous years. However, the severity of the outbreak in 2014, brought to the attention of both the government and general public how important this cholera was. Though measures were put in place to control this epidemic, the subsequent years saw various cholera outbreaks in different parts of the country. According to the Standard Operating Procedures for The Prevention and Control of Cholera in Ghana, Cholera remains a major public health challenge in Ghana. Recent cholera outbreaks have brought to the fore, the challenges of institutional structures to effectively prevent and respond to outbreaks. The key challenge has been the late detection of the early cases making the surveillance system less sensitive leading to late response. There is the need therefore to educate the general public about cholera and everything concerned about it. What therefore is cholera?

Definition.
Cholera is an acute diarrhoeal disease caused by infection of the intestine with the bacterium Vibrio cholerae, either type O1 or O139. Both children and adults can be infected. The disease is characterized by sudden onset of profuse painless watery diarrhoea, occasional vomiting and rapid dehydration leading to death if prompt treatment is not given. Cholera is easy to prevent and treat using fluids (oral or intravenous) with or without antibiotics.

Characteristics of Vibrio Cholerae
A gram-negative bacilli comma-shaped which is usually motile. They possess two antigen ‘O’ & ‘H’. They can survive at freezing point and hence can live in refrigerated food. They Can survive in variety of foodstuff and water up to 5 days in ambient temperature and up to 10 days at 5-10 degrees centigrade. However, they can be destroyed by irradiation and heat above 70 degrees centigrade. They are also sensitive to acidity and drying. Up to one (1) million Vibrio Cholerae are needed to cause the disease.

Risk factors

• Over-populated communities (slum and refugees camps) characterized by:
  • Poor sanitation,
  • Unsafe practices regarding drinking water (not disinfecting nor cleaning water

  sachets bags before opening, storing water in large open containers and not treating

  it before use)
  Poor personal hygiene (low soap utilization, or handwashing practices)

  Poor food hygiene
  Floods leading to contamination of domestic water sources

  Broken down water and waste disposal systems
  Open defecation
  Funeral rituals (touching the body and not disinfecting hands afterwards)

  Mode of transmission
  Cholera transmission is oral-faecal. It is transmitted through the ingestion of:

  • Water contaminated with faeces, vomitus of patients and to lesser extent faeces of carriers (at source and at home storage)
  • Contaminated foods (milk, cooked rice, lentils, potatoes, beans, eggs, sea foods etc.) fruits and vegetables – especially those grown by irrigation with waste-water (sewerage garden and when fruits and vegetables are eaten raw.
  • And through direct contact with not cleaned and disinfected hands, contaminated after touching someone affected or who died of cholera, cholera-soiled clothes, or materials.

  Transmission also occurs through direct contact with not cleaned and disinfected hands, contaminated after touching someone affected or who died of cholera, cholera-soiled clothes, or materials.

Sources of contamination

• Hands and bodies of asymptomatic cholera patients/carriers.
• Contaminated articles (buckets, cups, cloths, etc.)
• Faecal material infiltrating into wells when latrines are situated less than 30 metres away from wells, over-flooding of wells, etc.

• Open defecation

Signs and symptoms

• Incubation period: 12 – 48 hours (shortest), average: 2 – 3 days
• Watery, painless profuse diarrhoea
• Rice water diarrhoea – result from gut debris
• Effortless vomiting – (not preceded by nausea)
• Severe muscle cramps (e.g. calf muscles) due to loss of sodium
• Signs of dehydration
• Circulatory collapse (thin pulse, cold clammy skin, thirst/stupor)

Conclusion.
Cholera is a disease of poverty, linked to poor hygiene, poor environmental sanitation and lack of safe drinking water. During the 2014 cholera outbreak, a total of 28,975 cases including 247 deaths were reported from all the 10 regions of the country. As much as measures are being put into place to control the spread of this infection, individuals must practice and maintain good hygiene and proper environmental hygiene to help eradicate this disease. Cholera may be linked to poverty but poverty it is not an excuse to not maintain proper hygiene. Also suspected cases must be reported as early as possible to control the spread of the disease.

PORTIA ASAMOAH
PHYSICIAN ASSISTANT STUDENT (LEVEL 200)
UNIVERSITY OF CAPE COAST.
AKNOWLEDGEMENT
Dr. Kingsley Preko
Public Health Emergency Management Committee
Ms. Beatrice Donkor