United Republic of Tanzania : Cholera outbreak 2015 Situation Report No.1 (as of 10th November 2015)

Situation Report
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  • Cumulative number of suspected/confirmed cholera cases for URT is 8,185 with 116 cumulative total deaths as 9th November.

  • 10 regions on mainland reported a total of 104 new suspected Cholera cases on 9h November.

  • Tanga Region accounts for 32 of the new cases.

  • Zanzibar has reported a total of 256 cholera cases and 4 deaths.

  • Start of the rainy season compounds the risks

  • Government released eq. of TSH 900 million (US$450,000) to Ministry of Health for cholera response

  • CERF approved allocation to WHO and UNICEF of 1,5 million USD

Situation Overview

Tanzania is battling a major cholera outbreak which has so far affected nineteen of the twenty eight regions in the country. The outbreak started in Dar es Salaam, the capital city with a population of 4.4 million, in late August 2015, and has progressively extended to nineteen regions of Tanzania, stretching local capacities and resources, with high risk in terms of lives and economic impact. Cumulatively, 8,185 cholera cases (both Mainland and Zanzibar) and 116 deaths have been recorded (as of November 9). Over 50% of the cases are reported from Dar es Salaam.
The case fatality rate of 1.4% is considered high by WHO standards.

In Zanzibar the outbreak was first reported 19th September 2015 and a total of 256 cases have to date been reported from the two major Islands of Unguja and Pemba. Pemba’s first case was reported on the 1st November 2015. There are a total of 256 cases (181 from Unguja and 75 from Pemba) as of 10th November 2015 and 4 deaths making the Case Fatality Rate 1.6%.

Urban and West districts in Unguja and Wete district in Pemba are the most affected districts. A multi-sectoral Coordination Committee was set, up under the leadership of the 2nd Vice President’s office, to tackle the cholera outbreak in Zanzibar. Case management, community health education and social mobilization, contact and community death tracing and treatment of water sources are undergoing.
The current outbreak is unusual because of its vast geographical spread within a short period of time. The beginning of the rainy season will have an adverse negative affect of the containment of the situation.

Poor communities living in unplanned settlements are disproportionally affected largely because of poor access to safe water and environment. Women and children are more vulnerable due to patterns of water collection, handling and storage practices at home. Additionally, women and adolescent girls bear a disproportionate burden of HIV largely as a consequence of gender inequalities. Dar es Salaam where the majority of cholera cases are occurring has an HIV prevalence of 9% among adults. Generally people living with HIV are at increased risk of diarrheal disease and enteric infection. Women are also more vulnerable to infections because they are the traditional caretakers of the sick at home thus exposing them to infections more than males.

The last major outbreak was in 2010 reported 1,997 cases but this was limited to Tanga and Dar es Salaam regions. The current outbreak follows the same pattern as the outbreak in 1997, when there was an El Nino and Tanzania registered 40,000 cholera cases. The meteorological department has again issued a warning that an El Nino similar to the one of 1997 should be expected this year. The concentration of cases in Dar es Salaam, the main commercial city of Tanzania, conjugated with a very mobile population across the country, further enhances this risk.

Joint rapid assessments led by the Ministry of Health and Social Welfare (MOHSW) involving the Regional and Local Government Authorities development partners have been done in the affected areas. Results from water quality survey reveal that the source of the outbreak is contaminated water from shallow wells, deep wells and tap water. Vibrio Cholerae has been isolated from all these sources. Poor hygienic practices and lack of sanitation facilities in poor households is also an associated factor to the outbreak. Regular water quality monitoring is ongoing by the MOHSW laboratory and at the Regional and LGAs levels.