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SITUATION OVERVIEW
A cholera outbreak which was first reported in October 2023 has seen a dramatic increase in transmission since mid-December. The country has now recorded a cumulative 8,276 cases and 333 deaths, with 446 new cases and 23 deaths in the past 24 hours according to a daily update from the Ministry of Health2 resulting in a case fatality rate of 4%. Thirty-one percent of the cases are in children under five years old.
The outbreak initially emerged in peri-urban areas of Lusaka Province, which still has the most cases. But due to the high rate of transmission, the disease is now affecting people across multiple geographical areas. Since the start of the current cholera outbreak, nine out of the ten provinces have reported cases of cholera with seven provinces confirming cholera outbreaks. Out of 116 districts, 39 have confirmed outbreaks and 46 have reported cases. This rapid escalation of the disease has caused concerns among stakeholders and the community who feel threatened by the alarming rise in cholera cases.
The country experienced its last major outbreak from October 2017 to June 2018 with a total of 5,935 reported cases and 114 deaths (CFR 1.9%). Although the outbreak gradually spread to seven other provinces in the country (all epi-linked to the Lusaka outbreak), 92% of these cases occurred in Lusaka district.
For this outbreak, the cases and spread of the disease are increasing daily. The figures underscore the persistent challenges faced by health authorities in Lusaka, emphasising the need for robust public health interventions and containment strategies.
Lusaka district 3 is densely populated (100 people per square kilometre) with a large portion of the population living in the peri- urban areas, where overcrowding, poor solid waste management and inadequate access to safe water and sanitation are prevalent. In addition, there is inadequate drainage systems with associated frequent flooding in the rainy season. These peri-urban areas also consist of highly mobile populations that further increase the risk of the spread of communicable diseases. Lusaka, being a central transit point, can lead to outbreaks spreading quickly to other districts.
The rapid escalation of cases has put a strain on local health care provision for other essential services. There is reduced outpatient and inpatient services due to the closure of health facilities, repurposing of the health workforce, and stock-outs of medicines and other supplies. There is also a diversion of resources from routine services to respond to the cholera response activities. Regular health services are stretched, including isolation facilities, intensive care units, laboratory and other diagnostic services as well as ambulances services.
In response to the surge in cholera cases, the government has designated Lusaka’s National Heroes Stadium as a Cholera Centre as township health centres are now struggling to cope. Schools in Zambia will remain closed for an additional three weeks following the festive holidays, causing a delayed start to the academic year.
In-country movements during the Christmas break and the start of the rainy season may have contributed to the escalation of cases and extended the outbreak to new areas. A recently released Flash Flood Monitor weather advisory (9 January 2024) indicates that Lusaka is at higher risk of flash floods and water logging in the coming weeks, which may further worsen the already complex cholera outbreak situation.
If the situation is left unchecked, cases will continue increasing in Lusaka with the threat of an escalation in cases in other provinces and districts. With recent outbreaks in neighbouring countries, the cross-border linkages to Malawi, Zimbabwe, and Mozambique highlight the interconnectedness of the regions, posing further challenges to containment efforts.
Reported challenges contributing to the escalation include poor sanitation coverage in the affected areas; transmission of cases outside of Lusaka which are intensifying the outbreak; challenge of following cholera cases and implementation of cholera interventions across international borders in Luangwa and Petauke districts; and inadequate ambulances to support the transfer of patients.
The priority actions for the government are to continue the whole of society response activity, with improved risk communication and community engagement in this fight against cholera; heightened surveillance in all provinces to enhance early detection and respond to cases; need for additional human resources and commodities at Hero’s Stadium with additional personnel and commodities; scale-up the provision of safe water in the affected communities, with ongoing water quality monitoring; continue engagement with other line ministries and partners to support the responses; prepositioning of commodities for the surrounding districts and provinces to prevent further escalation; and support for the vaccination campaign due to commence.
To date, the Zambia Red Cross Society (ZRCS), with the support of partners,4 has been able to contribute to the government’s response as follows:
• Deployed volunteers who are supporting the cholera response activities through door-to-door visits in Lusaka sub-districts, Kafue, Chilanga, and Chongwe.
• Identifying and monitoring of individuals exposed to cholera through ongoing contact tracing efforts.
• Supported the Ministry of Health (MOH) in setting up 28 oral rehydration points (ORPs) in all six sub-districts which are being supported by MOH staff.
• Supporting the disseminating hygiene messages by conducting radio programmes and public address activities, reaching over 3.3 million people in Lusaka Province.
• Continued to carry out community sensitisations on cholera prevention in four districts of Lusaka Province.