Zimbabwe

Zimbabwe Cholera Epidemic Feb 1993 UN DHA Situation Report No. 1

Format
Situation Report
Source
Posted
Originally published
DHA-GENEVA 93/0067A

ZIMBABWE
CHOLERA EPIDEMIC
DHA-GENEVA SITUATION REPORT NO. 1

ON BEHALF OF WHO, THE DEPARTMENT OF HUMANITARIAN AFFAIRS HEREBY
ISSUES AN APPEAL JOINTLY PREPARED BY THE GOVERNMENT OF ZIMBABWE
AND WHO FOR INTERNATIONAL ASSISTANCE TO VICTIMS OF THE CHOLERA
EPIDEMIC AS DESCRIBED BELOW.

INTERNATIONAL ASSISTANCE IN RESPONSE TO THIS APPEAL SHOULD BE
ROUTED THROUGH WHO OR DELIVERED DIRECTLY TO THE MINISTRY OF
HEALTH AND CHILD WELFARE, ZIMBABWE, WITH IMMEDIATE INFORMATION
TO WHO.

THE APPEAL

I. INTRODUCTION

IN THE LAST WEEK OF NOVEMBER 1992, THE FIRST CASE OF CHOLERA IN
ZIMBABWE WAS NOTIFIED FROM TONGOGARA REFUGEE CAMP, IN MANICALAND
PROVINCE, NOT FAR FROM THE BORDER WITH MOZAMBIQUE.

BY THE LAST WEEK OF DECEMBER 1992, CHOLERA HAD BEEN REPORTED FROM
FOUR OF THE EIGHT PROVINCES: MANICALAND, MASHONALAND CENTRAL,
MASHONALAND EAST, AND MASVINGO. REFUGEE CAMPS AS WELL AS HOST
RURAL POPULATIONS WERE AFFECTED. SINCE THE BEGINNING OF JANUARY
1993, MASHONALAND WEST, MIDLANDS, AND HARARE CITY HAVE ALL
REPORTED ADDITIONAL CASES. IN ALL, THERE HAVE BEEN 4,434 CASES
AND 208 DEATHS DUE TO CHOLERA OFFICIALLY REPORTED TO DATE.

II. BACKGROUND

EPIDEMICS OF CHOLERA HAVE BEEN GROWING LARGER AND BECOMING MORE
FREQUENT IN SOUTHERN AFRICAN COUNTRIES SINCE 1973. AT THE
PRESENT TIME, AN UNINTERRUPTED BELT OF INFECTED AREAS STRETCHES
ACROSS THE CONTINENT, FROM ANGOLA TO TANZANIA. IN ADDITION TO
ZIMBABWE, MOZAMBIQUE, ZAMBIA, MALAWI, AND SWAZILAND HAVE ALL BEEN
SERIOUSLY AFFECTED. SEVENTY-NINE MILLION PEOPLE ARE ESTIMATED TO
BE AT IMMEDIATE RISK OF INFECTION. IF REPORTS OF OUTBREAKS IN
SOUTH AFRICA ARE CONFIRMED, THEY WOULD BRING THE TOTAL TO 112
MILLION. THE RISK IS REAL, NOT HYPOTHETICAL. BETWEEN JANUARY
AND DECEMBER 1992, MOZAMBIQUE COUNTED 225,673 CASES AND 587
DEATHS, ZAMBIA 11,218 CASES AND 1,231 DEATHS, AND SWAZILAND 2,228
CASES AND 30 DEATHS. BECAUSE OF INADEQUACIES IN REPORTING
SYSTEMS AND LIMITED ACCESS OF THE POPULATION, ESPECIALLY THOSE IN
RURAL AREAS TO HEALTH FACILITIES, THESE OFFICIALLY REPORTED CASES
ARE UNDOUBTEDLY A GROSS UNDERESTIMATE OF THE ACTUAL SITUATION.

IN MOZAMBIQUE AND ZAMBIA, CHOLERA HAS BEEN OCCURRING SINCE 1989.
WITH THE SEVERE DROUGHT OF THE PAST FEW YEARS, IT HAD BEEN
EXPECTED THAT THE DISEASE MIGHT APPEAR IN ZIMBABWE AT ANY TIME.
FOR THIS REASON, SINCE LAST MAY, THE MINISTRY OF HEALTH AND
CHILD WELFARE OF ZIMBABWE, IN COLLABORATION WITH THE WORLD HEALTH
ORGANIZATION, HAD ISSUED WARNINGS TO THE POPULATION AND ALERTED
THE INTERNATIONAL COMMUNITY TO THIS POSSIBILITY, AND IT HAS BEEN
INTENSIVELY PREPARING FOR THE WORST.

IN JULY 1992, THE INFLUX OF REFUGEES FROM MOZAMBIQUE INCREASED
DRAMATICALLY. AT THE SAME TIME, THE DROUGHT RELIEF PROGRAMME HAD
VASTLY INCREASED THE FLOW OF IN-COUNTRY TRAFFIC. FOR THE POPULA-
TION OF RURAL ZIMBABWE, ONE OF THE IMMEDIATE CONSEQUENCES OF THE
DROUGHT WAS A DRASTIC REDUCTION IN ACCESS TO SAFE WATER AND FIRE-
WOOD, IN TURN FORCING THEM TO ACCEPT LOWER STANDARDS OF PERSONAL
AND DOMESTIC HYGIENE. AT THE SAME TIME, AS THE POPULATION SOUGHT
WAYS TO COPE WITH THE CHANGES BROUGHT ABOUT BY THE DROUGHT, THE
MOVEMENT OF PEOPLE AND GOODS ACROSS INTERNATIONAL BORDERS AND
INFORMAL CROSS-BORDER TRADE ALSO ACCELERATED, FURTHER ADDING TO
THE RISK OF CHOLERA TRANSMISSION. THESE MOVEMENTS INTENSIFIED
DURING THE CHRISTMAS AND NEW YEAR HOLIDAYS, VIRTUALLY ENSURING
THE INTRODUCTION AND RAPID PROPAGATION OF CHOLERA THROUGHOUT THE
COUNTRY.

THE MINISTRY OF HEALTH AND CHILD WELFARE, AS WELL AS OTHER
GOVERNMENT SECTORS, UNHCR, WHO, AND OTHER NATIONAL AND INTERNA-
TIONAL ORGANIZATIONS ALL BECAME ACTIVELY ENGAGED IN RESPONDING
TO THE EPIDEMIC. A NATIONWIDE SURVEILLANCE SYSTEM HAS BEEN
ESTABLISHED, MASS CAMPAIGNS OF PUBLIC HEALTH EDUCATION AND OF
REINFORCING THE TRAINING OF HEALTH PERSONNEL ARE BEING CONDUCTED,
STOCKS OF MEDICAL SUPPLIES ARE BEING MOBILIZED AND DISTRIBUTED,
AND INTERSECTORAL COORDINATION MECHANISMS ARE BEING ACTIVATED.
AT THE PRESENT TIME, CHOLERA CONTINUES TO SPREAD, BUT MORTALITY,
WHICH CAN REACH 50 PERCENT IF LEFT UNCHECKED, HAS SO FAR BEEN
HELD TO LESS THAN 5 PERCENT. STILL, A LACK OF ADEQUATE FUNDS
AND SUPPLIES IS PREVENTING A FURTHER REDUCTION IN PREVENTABLE
MORTALITY, AND THREATENS TO DIMINISH THE CAPACITY OF THE GOVERN-
MENT TO SUSTAIN ITS FIGHT TO BRING THE EPIDEMIC TO A RAPID CON-
CLUSION.

III. ANALYSIS OF THE PROBLEM

CHOLERA IN THE REFUGEE CAMPS

CASES HAVE BEEN REPORTED FROM FOUR OF THE FIVE REFUGEE CAMPS, A
SITUATION WHICH PLACES VIRTUALLY ALL OF THE APPROXIMATELY
100,000 REFUGEES AT RISK, DUE TO THE CLOSE CONDITIONS IN WHICH
THEY LIVE. MANAGEMENT OF CHOLERA IN REFUGEE SETTINGS IS RELA-
TIVELY STRAIGHTFORWARD, PROVIDED THAT ADEQUATE SUPPLIES AND
TRAINED PERSONNEL ARE AVAILABLE. RESOURCES HAVE BEEN AND CON-
TINUE TO BE PROVIDED FROM THE MINISTRY OF SOCIAL WELFARE, UNHCR
AND OTHER NGOS.

THE MAIN CONSTRAINTS TO TOTAL CHOLERA CONTROL REMAINING IN THE
CAMPS ARE THE LIMITED AVAILABILITY OF WATER AND THE RELATIVELY
POOR SANITARY CONDITIONS. ONLY 8 LITRES/PERSON/DAY OF WATER ARE
AVAILABLE FOR ALL PURPOSES (INSTEAD OF THE 15-20 LITRES/PERSON
RECOMMENDED DAILY MINIMUM. RAPID POPULATION GROWTH IN THE CAMPS
HAS OUTSTRIPPED THE ABILITY TO DISPOSE OF HUMAN AND OTHER WASTES
ADEQUATELY.

CHOLERA OUTSIDE THE REFUGEE CAMPS

A CHOLERA TREATMENT CENTRE HAS BEEN ESTABLISHED IN ALL CLINICS
WHERE AT LEAST ONE CASE OF CHOLERA HAS BEEN DIAGNOSED, AN AVERAGE
OF 10-15 PER DISTRICT. MAINTAINING THESE CENTRES AT A HIGH LEVEL
OF PERFORMANCE IS DIFFICULT, GIVEN THE CONSTRAINTS TO SUPER-
VISION, TO COMMUNICATIONS AND TO A REGULAR SUPPLY OF ORAL AND
INTRAVENOUS REHYDRATION SOLUTIONS, ANTIBIOTICS AND LABORATORY
EQUIPMENT. MANY OF THESE CENTRES ARE LOCATED IN RURAL AREAS
AND DO NOT HAVE TELEPHONES OR RADIOS TO ALLOW RAPID COMMUNICA-
TION WITH SUPPLY CENTRES. RECENT HEAVY RAINS HAVE CUT OFF SOME
OF THE CLINICS AND ENDANGERED THE SAFETY OF THEIR WATER SUPPLIES.

AN INTENSIVE HEALTH EDUCATION CAMPAIGN HAS BEEN MOUNTED WITHIN
THE COUNTRY, INVOLVING THE USE OF TELEVISION, RADIO AND NEWS-
PAPERS, THE DISTRIBUTION OF POSTERS TO SCHOOLS AND IN PUBLIC
TRANSPORT VEHICLES, AND THE DEVELOPMENT OF POPULAR DRAMAS.
EXPANSION OF THE HEALTH EDUCATION MESSAGES AND THE MEANS TO
DISTRIBUTE THEM AS WIDELY AS POSSIBLE IN LOCAL LANGUAGES IN
ADDITION TO ENGLISH AND PORTUGUESE WILL REQUIRE ADDITIONAL
FUNDING.

IV. RESPONSE TO DATE

THE GOVERNMENT OF ZIMBABWE HAS RELEASED ZD 3,500,000 (APPROXI-
MATELY USD 650,000 AT AN EXCHANGE RATE OF 1 USD EQUALS 5.38 ZD)
TO THE MINISTRY OF HEALTH AND CHILD WELFARE TO SUPPORT THE CON-
TROL OF CHOLERA. WHO, THROUGH ITS EMERGENCY PROGRAMME, HAS
DONATED USD 30,000 FOR THE PURCHASE OF LABORATORY AND MEDICAL
SUPPLIES, AND FOR THE DEVELOPMENT, PRODUCTION, AND DISTRIBUTION
OF HEALTH EDUCATION MATERIALS. IN ADDITION, WHO ASSISTED THE
MINISTRY OF HEALTH AND CHILD WELFARE TO ISSUE A LOCAL REQUEST
FOR 7,000,000 ZIMBABWEAN DOLLARS, APPROXIMATELY USD 1,300,000.

NORAD HAS DONATED ZD 40,000 (USD 7,435) FOR HEALTH EDUCATION,
AND ODA HAS PLEDGED ZD 807,000 (USD 150,000) FOR THE IMPROVEMENT
OF COMMUNICATION. EEC IS GIVING ZD 2,000,000 (USD 371,000)
SPECIFICALLY FOR CHOLERA CONTROL IN REFUGEE AREAS. THERE HAVE
BEEN EXPRESSIONS OF INTEREST, BUT NO COMMITMENT AS YET, FROM THE
GERMAN, ITALIAN AND SWISS EMBASSIES.

V. REMAINING NEEDS

IN ORDER TO BE ABLE TO MAINTAIN THE EXTREMELY HIGH LEVEL OF
COMMITMENT WHICH THE GOVERNMENT OF ZIMBABWE HAS SO FAR DEMON-
STRATED IN ITS EFFORT TO CONTROL THE CURRENT CHOLERA EPIDEMIC,
ADDITIONAL EXTERNAL FUNDS WILL BE NECESSARY. THESE FUNDS ARE
NEEDED FOR THE PURCHASE AND EFFICIENT USE OF MATERIALS WHICH
FALL INTO THE SPECIFIC CATEGORIES LISTED BELOW. EXAMPLES OF
REQUIRED MATERIALS ARE PROVIDED:

1. MEDICAL SUPPLIES: ORAL REHYDRATION SALTS, RINGER'S LACTATE
SOLUTION FOR INTRAVENOUS ADMINISTRATION AND GIVING SETS, ANTI-
BIOTICS INCLUDING TETRACYCLINE, DOXYCYCLINE, AND FURAZOLIDONE
FOR TREATMENT OF SEVERE CASES.

2. HEALTH EDUCATION: MATERIALS FOR PRODUCTION AND MASS REPRO-
DUCTION OF POSTERS AND BOOKLETS. RESOURCES FOR ADVERTISING, MASS
MEDIA PUBLICITY, ETC.

3. LABORATORIES: MATERIALS FOR SPECIMEN COLLECTION AND ANAL-
YSIS, INCLUDING CONTAINERS, CHEMICAL REAGENTS, CULTURE MEDIA AND
PLATES, MICROSCOPES, DIFFUSION DISKS FOR ANTIBIOTIC SENSITIVITY
DETERMINATIONS.

4. WATER: SPARE PARTS AND PUMPS. TRANSPORTATION OF WATER INTO
REFUGEE CAMPS.

5. SANITATION: MATERIALS FOR LATRINE CONSTRUCTION, ESPECIALLY
CEMENT.

VI. PROPOSED BUDGET
PROPOSED BUDGET RECEIVED REMAINING NEEDS
LOGISTICS
ZD 3,500,000
USD 650,000
ZD 3,500,000
USD 650,000
---
---
MEDICAL SUPPLIES ZD 2,000,000
USD 371,700
ZD 100,000
USD 18,600
ZD 1,900,000
USD 71,100
HEALTH EDUCATION ZD 482,800
USD 89,700
ZD 100,000
USD 18,600
ZD 382,800
USD 71,100
LABORATORIES ZD 260,000
USD 48,300
ZD 50,000
USD 9,300
ZD 210,000
USD 39,000
COMMUNICATION ZD 865,400
USD 160,900
ZD 807,000
USD 150,000
ZD 58,400
USD 10,900
WATER ZD 1,345,000
USD 250,000
ZD 161,400
USD 30,000
ZD 1,183,600
USD 220,000
SANITATION ZD 538,000
USD 100,000
---
---
ZD 538,000
USD 100,000
TOTAL ZD 8,991,200
USD 1,671,000
ZD 4,718,400
USD 877,000
ZD 4,272,800
USD 793,100


END OF SITUATION REPORT

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