Zambia: Cholera Outbreak Lusaka - Emergency Plan of Action Final Report (MDRZM011)

Situation Report
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A. Situation Analysis

Description of the disaster

Cholera is endemic to Zambia and outbreaks occur almost every year in Lusaka, Southern, Northern and Luapula provinces. The 2017/2018 cholera outbreak was declared on 6th October 2017 after a laboratory confirmation of two initial cases reported by Chipata Level One Hospital on 4th October 2017. This year, the outbreak happened just before the rainy season which is unusual, but it followed a period of inadequate water supply during the summer period. With inadequate water supply more people are forced to use unsafe water. This was the main driver of the recent outbreak.

By December 2017, the outbreak spread to other parts of Lusaka namely: Garden Chilulu, Kabanana, Ngombe, Chipata, Kanyama, Chibolya, Bauleni, Matero, Mazyopa, John Laing, Makeni villa, Chazanga, Jack, Mandevu, Kuomboka, Zingalume, Twikatane, Chunga, and Zanimuwone with Chipata and Kanyama being the most affected. As such, on 15 December 2017, IFRC launched a DREF operation for CHF 222,351 to contribute to the reduction of mortality and morbidity linked to cholera disease outbreak within the affected communities of Lusaka province, through the provision of health services, clean and safe water supply, sanitation and hygiene activities to about 70,000 people (14,000 households).

With intensification of the rains, new cases raised on a daily basis reaching a peak on the first week of January 2018 with over 700 cases reported (See figure 1). As the results of robust intervention by the government and its partners, including ZRCS, the epidemic declined significantly between epidemiological weeks 2 and 5 (2018) recording about 100 new cases per day by end of February 2018.

Nonetheless, cholera cases started to rise again in epidemiological week 10 recording more than 200 cases. In response, an Operation Update was published on 06 March 2018, summarizing the progress made and the new needs on the ground and extending the operation timeframe until 18 April 2018. The Operation update also revised the number of targeted people from 70,000 to 200,000 and the operation was granted an additional allocation of CHF 26,354, to support supplementary costs for volunteer incentives as they conducted door to door hygiene promotion. The overall budget for this operation was thus brought to CHF 248,705.

Thanks to this response operation, as well as the commitment of ZRCS volunteers and partners of the ZRCS, the outbreak started decreasing continuously from end of March to May 2018 when new cases were recorded in single digits. By 25th March 2018 when DREF operation activities were being rounded up, Lusaka recorded 19 new cases with a cumulative total of 4,768 and 89 deaths while national cumulative totals were 5,190 new cases and 103 deaths.

Looking at the current trend of the epidemic, supported by trends2 from previous years, the 2017/18 cholera outbreak in Zambia was confirmed combated by end of May 2018. With the outbreak showing signs of being contained, the government, through the Ministry of Health started to loosen some restrictions, e.g. the National Heroes stadium which was the main cholera treatment centre (CTC), has ceased its activities and reverted to its usual purpose. The figure below is a histogram showing the number of reported cholera cases and related events, by week, in Lusaka, Zambia, during October 2017–May 2018.

The major donors and partners of the Disaster Relief Emergency Fund (DREF) include the Red Cross Societies and governments of Australia, Austria, Belgium, Britain, Canada, Denmark, Finland, Ireland, Italy, Japan, Luxembourg,
Monaco, the Netherlands, Norway, Spain, Sweden and the USA, as well as DG ECHO, the UK Department for International Development (DFID), AECID, the Medtronic and Zurich Foundations and other corporate and private donors. On behalf of the Zambia Red Crescent Society (ZRCS), the IFRC would like to extend its gratitude to all partners for their generous contributions.