Cholera is an acute intestinal diseases spreads mainly through faecal contamination of food or water contaminated by the bacterium Vibrio cholerae which produces an enterotoxin that causes a copious, painless, watery diarrhoea and vomiting that can quickly lead to severe dehydration and death if treatment is not promptly given.
To understand the devastating nature of disease you would have to talk a look at the devastating mark this epidemic has left worldwide.
An estimated 1.2 billion people worldwide do not have access to safe drinking water (WHO, 2002a; WHO, 2002b). Almost 2.2 million children under the age of 5 years die each year in developing countries due to diarrhoeal diseases associated with fecally contaminated water (WHO, 2002a). In 2007, the majority of worldwide cases (94%) and deaths (99%) were reported
in Africa alone. (citation needed) (focus more on Africa)
Nigeria has been recently affected by torrential rains with over 300,000 victims affeced by flood with 118 fatalities, displacing large numbers of people and spreading the epidemic to new geographical areas .(WHO 2010, UN News Center, 2010). According to the special Assistant to communication in your cabinet, Mrs. Rakiya Zubairu the Sate of Gaubachu also showed that out of the 11 affected states, Bauchi recorded the highest with 1,725 cases of cholera, 53 deaths, and eight local governments affected. This epidemic has left a devastating mark on you country economically, financially and socially long before the recent flooding. Earlier this month the CDC reported that between January and October of 2010, more than 29,115 cases of Cholera have been reported in Nigeria including 1,191 deaths. (citation needed) In many rural areas such as Buchai, it is spread through local water sources such as the Gongola and Jama'are rivers.(citation needed)
The main cause of theses mortality rates is a lack of modern water treatment facilities, which drives lresidents of rural villages to utilize local untreated water supplies such as rivers, boreholes and springs to collect water for domestic purposes. This is the same water source in which they bring lifestock to drink, wash their clothes bath, and collect water for drinking and cooking purposes from sources such as rivers, boreholes and springs (Sobsey,2002).
(additional citation for livestock needed). according to WHO, In addition, the water-storage containers used in theserural households are often not cleaned and are exposed to faecal
contamination due to children who put their hands into the water, unhygienic handling of the water-storage containers, the use of dirty utensils to withdraw water, dust, animals, birds and
various types of insects (Mintz et al., 1995; Reiff et al., 1996;CDC, 2001; WHO, 2002a).
What is being done?
In most Rural areas methods of treatment depending on severity range from the common method of giving oral rehydration solutions (ORS) for less severe cases to
using intravenous drips of Ringer Lactate or saline for severely dehydrated patients and Antibiotics in severe cases. However despite the cost efficient and fairly easy use of ORS as major treatment cholera, this current method of treatment still proves ineffective as Cholera remains a serious public health problem in low-income countries. (Schaetti, et al 2009)
Thus, a new more dynamic approach is required to control cholera and to mitigate its health-related and economic consequences not only by maintaining and improving existing measures like water supply, sanitation and hygiene behaviour but also by assessing new prevention options like OCV mass vaccinations of vulnerable populations which I have detailed below. (Schaetti 2010 pg 2)
(TALK ABT THE FACT THAT MOST ARENT BEING COUPLED WITH EDUCATION PROGRAMS, NOBODY TO MONITOR LONG TERM, AND THE FACT THAT MY PLAN SEEKS TO ADDRESS ALL THE SHORTCOMINGS IN PREVIOUS PLANS)
The Plan
Outbreaks of cholera can easily be prevented by providing potable water, sanitation resources and methods and promoting good personal and community hygiene behaviours as well as safe food handling.
In order to be successful , physical structures as well as community behaviours have to be maintained and monitored throughout its existence. This is why it is important to train local officials and lobby for volunteers from local health care providers and members of the clergy who can not only teach healthy hygiene practices but are also permanent presences in the communities who can monitor this initative long term.
However before plan is put in place residents should be educated on the various epidemic diseases that affect them, in this case the recent outbreak of Cholera and what is the underlying cause. One common issue that I believe is often overlooked is the fact that when affected many residents have no idea why they are sick or even the underlying causes, Fatality rates are increased because many choose to self treat instead of traveling to the nearest hospital, and when it gets worse and they attempt to seek help it might be too late. Education on this disease will help them to understand how this disease is transmitted, how to identify its symptoms so that they will seek help immediately and why it is important to adhere to these preventative measures and to stick with their treatment plan.
I have structured a plan based on a ongoing and thoroughly researched model conducted by. This initiative consists of four key parts:
1) the introduction of hygiene promotion and environmental behavior education program. 2) The introduction and distribution of CDC regulated household water storage containers treated with Sodium hypochlorite solution and 3)the introduction of a new breakthrough Cholera vaccine "Dukoral® to be administered by local clinics. The Hygeine Behavior program is focused on addressing four major components:
Personal hygiene, which will stress handwashing techniques for the entire family for example washing with soap and rubbing hands together for atleast 20 seconds especially after using latrines, before eating, before food preparation and before serving food. Another should focus on other secondary measures such as trimmed nails so as not to trap bacteria under fingernails and wearing footwear while out.
Another component of the behavior program would include Proper handling of water supply which would include the importance of using covered, sterilized containers, which I will further discuss ,and using simple sanitation methods such as boiling or washing utensils with soap and storing them in safe sanitizied containers when not in use.
As Cholera is transmitted mainly through faecal contamination of food or water Proper use and maintenance of latrines is important. The importance of keeping the latrines free of debris and garbage is key to .
Though we wish hope to obtain a dramatic decrease in cholera infections due to these preventative measures, there is no guarantee that all residents will strictly adhere to the policies, or even conduct them properly. As a supplement I propose the use of a vaccine to an additional public health tool to control cholera in low-income countries in times of an epidemic.
Currently only one safe and efficacious vaccine is available on the market - Dukoral® - an oral cholera vaccine (OCV). This is where the establishment of local "Cholera Clinics" will come into play as the drug has to be administered in two doses approximately one week apart. The vaccinaition program is a short term solution and has to be coupled with a Hygeine component as drug trials have shown that it only provides 60-85% protection for six months in young children and about 60% in older children and adults after two years. (Schaetti, et al 2009)
The United States Centres for Disease Control and Prevention (CDC) and the Pan American
Health Organization (PAHO ) carried several studies in developing communities to improve the microbiological quality of stored household drinking water, have reported on the effectiveness of treatments sueh as boiling, heating, sedimentation, filtration, exposure to ultraviolet radiation from sunlight and disinfection with sodium hypoehlorite solutions (Gilman and Skillieorn, 1985;Mintz et al., 1995; Conroy et al., 1996; CDC, 2001; Sobsey, Studies whieh have investigated the shapes and sizes of household water-storage containers showed that the geometric design of household water-storage eontainers played an important role in ensuring that the stored drinking
water does not beeome eontaminated by external faetors such as dirty hands and utensils (Patel and Isaaeson, 1989; Sutton and Mubiana, 1989; Sobsey, 2002). The United States Centres
for Disease Control and Prevention (CDC) and the Pan AmericanHealth Organisation (PAHO) have taken the results fromall of these studies and designed a 20 C household water-storage
container containing a valved spigot, a handle and a mediumsize opening to reduee the risk of external contamination of the water during water-storage (Mintz et al., 1995; Reiff et al.,
1996; CDC, 2001; Sobsey, 2002).
Successful Models
The United States Centres for Disease Control and Prevention (CDC) and the Pan American
Health Organization (PAHO) have taken the results from all of these studies and designed a 20 C household water-storage, container containing a valved spigot, a handle and a medium size opening to reduce the risk of external contamination of, the water during water-storage (Mintz et al., 1995; Reiff et al.,1996; CDC, 2001; Sobsey, 2002).The CDC safe water-storage container together with the addition of a sodium hypochlorite solution has been evaluated in several communities in developing countries (Macy and Quick,1998; Semenza et al., 1998; CDC, 2001; Makhutsa et al, 2001; Sobsey, 2002; Sobsey et al., 2003; Lule et al., 2006; Shestrah et al., 2006). The first study to use the CDC safe water-storage container was carried out in Bolivia (Quick et al., 1996). In this study, 3 study groups were used: one group received the CDC safe water-storage container together with a sodium hypochlorite solution; one group received the CDC safe water-storage container without a sodium hypochlorite solution and one group used their traditional household water-storage container without a sodium hypochlorite solution. Results from this study showedthat the stored water of the households who used the CDC safe water-storage container and a sodium hypochlorite solution had no fecal coliform and Escherichia coli {E. coli) counts compared to E. coli counts ranging between 10 and 100 cfuTOO
mC"' in the households which used their traditional water-storage
containers and the households which only received the CDC safe
water-storage container (Quick et al., 1996).
Three years later another study was carried out in Bolivia
using the CDC safe water-storage container together with a
locally produced sodium hypochlorite solution. The aim of this
study was to reduce the incidence of diarrhoeal disease (Quick et
al., 1999). Two peri-urban communities in Bolivia using groundwater from uncovered shallow wells (hand-dug wells), covered
wells equipped with a hand-pump, and a household tap from neighbouring communities were selected. The results from this
intervention indicated that the water of most intervention households had no E. coli bacteria and contained detectable levels of
free chlorine residual, while the water from households in the control group had counts oí E. coli bacteria in excess of 1 000
cfulOO mC' and contained no detectable free chlorine residual levels (Quick et al., 1999). This study further showed that households with the CDC safe water-storage container and sodium hypochlorite solution had fewer episodes of diarrhoea compared to households without the interventions (Quick et al., 1999).On the African continent, studies with the CDC safe waterstorage container and sodium hypochlorite solutions have been carried out in Guinea-Bisseau (Daniels et al, 1999), Madagascar (Mong et al., 2001), Zambia (Quick et al., 2002), Kenya (Makutsaet al., 2001; Garett et al., 2008) and Uganda (Lule et al., 2005;Shestrah et al., 2006). In other developing countries, the CDC safe water-storage container intervention with sodium hypochlorite has been carried out in Uzbekistan (Semenza et al., 1998),Pakistan (Luby et al., 2001), Guatamala (Sobel et al., 1998),Bolivia (Quick et al., 1996; Quick et al., 1999; Sobsey et al.,2003) and Bangladesh (Sobsey et al., 2003). All of these studies have shown an improvement in the microbiological quality of the water when the CDC safe water-storage container and a sodium hypochlorite solution was used as a combined intervention strategy (Sobsey, 2002; Sobsey et al., 2003; Ciasen et al., 2006).
Schaetti, C., Hutubessy, R., Ali, S., Pach, A., Weiss, M., Chaignat, C., et al. (2009). Oral cholera vaccine use in Zanzibar: socioeconomic and behavioural features affecting demand and acceptance. BMC Public Health, 91-11. doi:10.1186/1471-2458-9-99.
