Seven essential steps to fight deadly cholera

By Rachael Cummings & Dr Unni Krishnan

Cholera cases create a new danger for children in the cyclone Idai-ravaged areas of Mozambique. There will be another disaster if cholera spreads.

Cyclone Idai, which made landfall in Mozambique over two weeks ago, is one of the worst weather-related catastrophes in Africa in recent times. It left a long trail of death and destruction in Mozambique, Zimbabwe and Malawi, and the flooding and contaminated water caused by the storm pose a huge threat to survivors, including thousands and thousands of children.

Cholera is an acute diarrhoeal disease that can kill within hours if left untreated. Cholera, or any disease outbreak, complicates relief efforts and stretches health systems. If not contained quickly, it can spread like wildfire.

Strong leadership, quick decisions and simple measures can go a long way to contain an outbreak.

The World Health Organization says up to 80 percent of cases can be successfully treated with oral rehydration solution in normal settings. 

However, the best way to predict the future of a cholera outbreak is to prevent it. Based on our experience of working in cholera settings, there are seven essential steps to fight a deadly cholera outbreak and stop it in its track.

1. Quick decisions and strong leadership. This can make or break relief operations. Once contracted, dehydration from cholera can kill children in a few hours, so the battle against cholera is a race against time. The test of true leadership in such humanitarian settings is the ability to prioritise actions. Cholera should remain a priority, as slow decisions or inaction may cost lives. In Mozambique’s case, the Government is leading on the cholera response and has triggered the cholera response protocols.

2.         Acknowledge. Being open about the prevalence of cholera is a key step to fight it. It is good to note the Government of Mozambique has quickly acknowledged the problem and is setting up a mass vaccination campaign together with partners in the Sofala province. This will help to shift gears quickly and instil trust and confidence in the system. Continuous surveillance remains key. 

3.         Clean water and soap. Access to safe, clean water and sanitation is critical to control the transmission of cholera and other waterborne diseases. The Centres for Disease Control and Prevention lists clean water (to drink) and washing hands with soap and clean water as two of the five basic cholera prevention steps.

Severe cholera cases need rapid treatment with intravenous fluids and antibiotics. Cholera vaccination can be complementary to these activities, but not a replacement for the prevention through clean water, sanitation, hygiene and other control measures.

4.         Children first. Cholera affects all age groups but it has a bias against children - half the cholera-deaths worldwide are among children under five. Children, pregnant women and nursing mothers are particularly vulnerable. Undernutrition and cholera make a deadly combination. Reaching people in remote places is vital.

In a disaster zone, there are a hundred things to be done. Children are a vital place to start. Save the Children has deployed its Emergency Health Unit (a global pool of public health and medical experts) into Mozambique to supplement the efforts of the government.

5.         Collaboration and funding. Health is a first casualty in disaster zones. Cyclone and cholera are putting pressure on an already stretched health system and it is important to maximise collective efforts.

In addition to cholera, floodwater poses the risk of mosquito and other vector-borne diseases like malaria. Resources to fight both immediate and long-term needs are key. There is an overall lack of health staff, especially in rural areas. According to the World Health Organization, Mozambique has one doctor for 60,000 people in rural areas. By contrast, in Europe, there is a doctor for approximately every 300 people. Rebuilding health centres and expanding health coverage will require long-term support. The world needs to be generous. Thankfully, the UK’s Disasters Emergency Committee have appealed for funds.

6. Media and public broadcasting. Fighting cholera is not just about medical prescriptions – social and other media can play a vital role in urging the public to take preventive measures and mobilise communities. Singers, artists and radio programmes can help to demystify health messages and reach a wider audience.

7. People’s power. The success of the fight against cholera is directly proportional to the mobilisation of the impacted communities. Everyone has a role to play and it is vital to recognise the power of ordinary people. The Sphere Humanitarian Standards says treating disaster survivors with dignity and creating space for them to be involved, are critical in battle against cholera.

Rachael Cummings is Director of Save the Children’s Humanitarian Public Health Team.

Dr Unni Krishnan is the Director of the Emergency Health Unit, Save the Children Australia.