Alarming outbreak of cholera in the Central African Republic begins to subside

By Jacqueline Chu-Montell

BANGUI and NDIMBA, Central African Republic, 3 February 2012 – Véronique Yassambatendji was awakened late one night in October when her husband began experiencing severe diarrhoea and vomiting. The 30-year-old mother of four brought him directly to the local health centre in Ndimba, where he was treated with oral rehydration salts.

Unfortunately, the treatment was not enough.

“He died at 4:00 the next afternoon,” Ms. Yassambatendji recalled. “My children and I stayed in the hospital to clean ourselves, and then we took off our clothes and threw them in the river. Afterwards, health workers sprayed everything in the house with disinfectant.”

Ms. Yassambatendji’s husband was one of 19 people killed in the country’s cholera outbreak last year. More than 300 people cases were reported, and an epidemic was declared on 30 September 2011.

It was an alarming development. Though neighbouring countries, including Cameroon, Chad and the Democratic Republic of Congo, have experienced outbreaks over the past decade, the Central African Republic had not seen a cholera case in as many as a dozen years.

Emergency response

Cholera is an acute intestinal infection, linked to consuming contaminated drinking water or food, that causes severe diarrhoea and vomiting. Young children are especially vulnerable to death from dehydration. But with proper treatment, the death rate can be reduced to 1 per cent.

A cholera crisis coordination committee sprang into action. The committee was led by the Central African Ministry of Public Health, Population and Fight against HIV. It also included UNICEF, the World Health Organization, the international NGOs Médecins Sans Frontières and Action Contre la Faim, as well as other partners.

UNICEF provided cholera kits containing oral rehydration salts, intravenous fluids and antibiotics to health centres and cholera treatment centres in affected regions. Specialized water, sanitation, hygiene (WASH) teams, as well as health and communication teams, were dispatched. UNICEF-supported social mobilization teams travelled door-to-door conveying hygiene and sanitation messages in affected communities – where most people had no prior knowledge of cholera transmission or treatment.

There was also concern about the spread of cholera to Bangui, the most densely populated region in the country. Education was a primary focus in this area, with UNICEF deploying social mobilizers to deliver information about cholera treatment and prevention.

“Initially, there was poor knowledge of cholera’s modes of transmission. People with classic symptoms – diarrhoea and vomiting – were put into public taxis for transport to hospitals,” said Patrick Laurent, UNICEF Central African Republic’s Emergency WASH Coordinator. “Despite high-risk practices like these, only one death occurred among 15 cases in Bangui. I think the present downturn can be attributed to the rapid coordinated emergency response and some measure of good luck.”

Today, the cholera outbreak is finally on the decline.

Preventing future outbreaks

During a November visit to Sékiamoté Village – one of areas hardest hit in the epidemic –Prime Minister Faustin-Archange Touadéra and officials from the Ministry of Public Health, Population and Fight against HIV spoke to a crowd about the importance of hand-washing and other sanitation measures. They also commended the community’s efforts to contain the infection.

But communities must also remain vigilant against the disease.

UNICEF continues to actively supporting cholera-related activities, emphasizing preventative measures that rely on the involvement of communities. Its WASH section is leading the Community-Led Total Sanitation (CLTS) programme in 85 villages in the affected areas. The CLTS approach relies on communities to analyze their sanitation and waste situations and, through collective action, end poor hygiene practices and open defecation.

Plans are also underway to provide water facilities in underserved areas, and UNICEF is stocking materials and medical supplies to ensure a prompt emergency response should cholera return to the country.

Today, residents in Ndimba are confident they know how to prevent and respond to future cholera outbreaks.

“Even the greater community surrounding Ndimba is practicing better hygiene now,” said the Director of the Ndimba Health Centre, Josian Badakara. “Before, people didn’t understand the importance of washing their hands. Now they wash their hands with soap and they use latrines and treated water for cooking and drinking.”