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SITUATION ANALYSIS
Description of the disaster
Acute Watery Disease-Cholera
As of 5 September 2022, the Epidemiology and Disease Control Division (EDCD) of the Ministry of the Health and Population (MoHP), Nepal reported a total of 76 cases of cholera with null mortality cases within the Kathmandu Valley since the outbreak was detected in July 2022. The cases were confirmed via the stool culture method, Rapid Diagnostic test and hanging drop test. The detected causative agent was Vibrio cholera O1 Ogawa Serotype. Out of 76 cases, some required hospital-based case management, whereas most were in home management. The sporadic cases were identified in different locations within the valley, precipitated by higher mobility and a dense population. The Sukharaj Tropical and Infectious Diseases reported the very first two cases from the same family.
The initial field investigation, conducted by a joint team from the Kathmandu District Health Office (DHO), Kathmandu Metropolitan Office, EDCD, Department of Food Technology and Quality Control and WHO revealed that the use of tap water for drinking without boiling was the major potential cause of cholera in Kathmandu. Most cases have been linked to drinking from commercial jar water, which is a common practice among the valley’s population. Out of 53 water samples from the valley, 38 samples tested positive for Escherichia coli, which denotes that most water sources for drinking purposes in the valley are contaminated with human faeces. The status depicts a high probability of other diarrheal diseases along with cholera, which is more common during the monsoon season. The response action was based on these findings.
A major modification was made to the operational plan of this DREF operation. The DREF was primarily targeted for the acute watery diarrhea (AWD) response and was revised to address dengue prevention and control action along with AWD. The EDCD bulletin of dengue updates and the Government of Nepal’s situation update on diseases provided information on the severity of dengue within the Kathmandu valley and led to a revision of the operation plan to reach the most vulnerable within the operations. Volunteers were reoriented on dengue preventive measures, and activities were redesigned to target mobile populations and places with possible mosquito breeding sites.
Dengue
Along with the cholera cases in Kathmandu, Lalitpur and Bhaktapur districts, as of 31 October 2022, a total of 50,011 dengue cases were identified, with Bagmati province reporting the highest number (38,951), followed by Lumbini province (4,743), Province-1 (2,021), and other provinces respectively as reported by the EDCD.
As per the EDCD report, the reason for the drastic increase of cases was a combined effect of the rainy season and impact of climate change. Due to climate change, vector breeding sites are now more favorable in high hills and even mountain areas. The number of cases spiked upward in the epidemic curve of June 2022, which was the monsoon period.