UNIVERSITY OF PENNSYLVANIA - AFRICAN STUDIES CENTER
U N I T E D N A T I O N S Department of Humanitarian Affairs Integrated Regional Information Network for Central and Eastern Africa
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IRIN background brief on cholera epidemic in western Kenya, 19 November 1997
Some 4,571 cases of cholera have been reported in Kenya's western Nyanza province in an epidemic which started in June. Figures from the provincial authorities show 228 people have died in the current outbreak, representing a case fatality rate of almost five percent. This is within normal ranges for other African countries, but under ideal medical conditions, only one patient in every 100 would die.
Health experts fear many more people may have died as the official death toll is based on those who sought treatment at medical centres and hospitals. Some victims live far away from hospitals and are in no fit state to travel, others are reluctant to seek treatment. Cholera (scientific name: Vibrio cholerae 01) can kill in a matter of hours as the body dehydrates.
Meanwhile, Tanzania has reported an even more serious outbreak, with more than 900 deaths reported between January and September, raising fears of a regional cholera epidemic and focusing attention on the need for cross-border control programmes. Uganda, west of Nyanza and linked to Tanzania by Lake Victoria, has not yet registered any cholera cases, but its health authorities are monitoring the situation closely.
The Provincial Health Officer, Dr Richard Muga, told IRIN during a recent visit to Nyanza the "situation is under control". Health authorities added, however, that eight cases have been reported in Siaya, north of Kisumu, an area spared the epidemic until now. The first case in Kenya's 1997 cholera epidemic was reported in June from the Migori district, in southern Nyanza. It then spread northwards, affecting four other districts (Suba, Homa Bay, Rachuonyo and Kisumu municipality).
Muga says new cases are still arriving in health centres in the province and the fatality rate remains "significant". Medical sources say the disease has an "open environment" in which to spread, thanks to a mobile population. One public health worker said an agricultural show held in Migori in July had undoubtedly contributed to the spread of cholera. Health services and clean water supplies are insufficient throughout the region: access to latrines is available to between 20 and 45 percent of the population and only 28 percent are connected to a piped water supply.
The epidemic has seen a mobilisation of resources to care for sick people, supply medicines and disinfectant, and establish isolation wards in health centres. Faced with growing numbers of cases, village dispensaries have been authorised to take in cases and relieve over-stretched health centres in the most-affected villages.
However, local authorities regard prevention and education programmes as their priority. Health workers are instructed to inform the families and communities of infected people about preventative measures in hygiene, clean water and food preparation. Information campaigns have used local officials, churches, women's groups and schools to pass the message. The lack of health agents and logistics to reach remote villages over a wide area and a certain lack of motivation have been among the difficulties faced by campaigners. The Kenyan Red Cross has also launched a door-to-door health education campaign.
An obstacle to the success of the prevention effort is an aspect of local custom. The Luo, the dominant ethnic group in the area, traditionally hold funeral banquets attended by dozens of people around the corpse. In many cases, participants of a funeral feast have contracted cholera. Local authorities have made new regulations so that the corpses of cholera victims should be buried immediately, without a feast. The authorities have also stepped up controls on markets, food kiosks, and outdoor food vendors. The Oyugis market, near Kisumu, was closed for several days for refurbishment so as to bring it up to the required standard of hygiene.
Muga has received extra help from both government and international bodies, but stresses the need to develop a plan for the provision of safe drinking water and sanitation across the whole province. The international NGO, Medecins sans Frontieres, has an office in the area for an AIDS control programme and has been able to give local health structures technical and logistical assistance as well as training. Other organisations, including the Kenyan Red Cross, CARE and World Vision have started programmes to reinforce local bodies.
The situation has been further complicated by a separate outbreak at the beginning of November on the Kenyan coast. According to AFP, this has killed 12 people. Large-scale displacement due to communal clashes in August and recent heavy rains are given as possible factors in that outbreak.
In Tanzania, a series of outbreaks has affected 17 out of 20 regions, including Dar es Salaam and the coast, the central regions and the west. A recent AFP report indicated that over 15 days at Dodoma, 30 deaths were recorded among 236 reported cases - a fatality rate of 13 percent.
According to WHO, Africa has registered the highest incidence rates of cholera in the world since 1982 and the disease is endemic across the whole continent. However, it has not been regarded as particularly endemic in Kenya.
The last epidemic in Nyanza was in 1974, although some cases were reported in 1992. Tanzania suffers regular outbreaks. WHO says the latest outbreaks have once again highlighted the need for international coordination in order to stop it spreading both within and across national borders.
Nairobi, 19 November 1997
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Date: Wed, 19 Nov 1997 17:58:49 +0300 (GMT+0300) From: UN IRIN - Central and Eastern Africa <firstname.lastname@example.org> Subject: Kenya: IRIN background brief on cholera epidemic in western Kenya 97.11.19 Message-ID: <Pine.LNX.3.91.971119175756.32498Aemail@example.com>
Editor: Dr. Ali B. Ali-Dinar, Ph.D
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