Zimbabwe Cholera and Health Situation - WHO Response And Needs: 1 Dec 2008

Situation Report
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Overall Health Situation

Zimbabwe's overall health service has been steadily declining for the last five years. Once a system that neighbouring countries referred patients for special care to, the Zimbabwean health service today is wracked by critical shortages of essential drugs and skilled and experienced personnel.

Another challenge is there has been no comprehensive assessment of Zimbabwe's health system since 2006, making it difficult to assess its true state. Also, its disease surveillance and early warning system, which depends on a weekly epidemiological system, has been compromised in terms of timeliness and completeness of data, which is only around 30%. Staffing and financial limitations are impacting on Zimbabwe's ability to
produce a national health profile.

Universal access to basic health services is compromised due to deteriorating infrastructure, staffing and financial resources. Reactivating primary health care services should keep being
addressed as a matter of emergency.

Zimbabwean health facilities face a massive gap - estimated this year at 70% - in required medicines
due to reduced local manufacturing capacity, which has been weakened by a lack of foreign currency.
This is despite support received from different partners through UNICEF's procurement systems.

Cholera Update

A large cholera outbreak is affecting most regions of the country, with more than 11 700 cases and 473 deaths recorded between August and 30 November. This represents a case fatality rate (CFR) of 4.0% nationally, but reached 50% in some areas during the early stages of the outbreak. The CFR benchmark should be below 1%.

Cholera outbreaks in Zimbabwe have occurred annually since 1998, but previous epidemics never reached today's proportions. The last large outbreak was in 1992 with 3000 cases recorded.

Areas recording high CFRs have been demonstrating weaknesses in case management and/or infection control practices. Potential causes of the high CFR that must be addressed are 1) delays in people seeking treatment: 2) poor accessibility to health facilities: 3) gaps in case management: and 4) inadequate infection control. Cholera cases have also been reported either side of Zimbabwe's border with South Africa, Botswana and Mozambique, demonstrating the subregional extent of the outbreak. In South Africa, the Ministry of Health has confirmed more than 160 cholera cases, including three deaths. Cases have also been reported in Johannesburg and Durban.

This cholera outbreak has strained Zimbabwe's overburdened health care system and resulted in a nationwide shortage of medicines and other materials for treatment, aggravating the scarcity of health care providers and the poor access to overall care. The outbreak can spread quickly into areas without access to safe water and sanitation. Case fatality rates may rapidly escalate in populations without rapid access to simple treatments.

Cholera is easily preventable by ensuring access to safe water and appropriate hygiene, while deaths can be prevented with quick access to simple, standardized treatment regimens.