Cholera Reactions in Sierra Leone

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National Library of Medicine – The World’s Largest Medical Library,A. D. A. M. Medical Encyclopedia, May 30th 2012. ” If left untreated, it can kill within hours and almost eighty percent of cases can be successfully treated with oral rehydration salts. People get infected by eating or drinking contaminated food and water and it usually manifests in places with poor sanitation, crowding, war, and famine like Africa, Asia, India, Mexico and South and Central America.

The availability of safe drinking water and proper sanitation is critical in reducing the impact of cholera and other waterborne diseases.

Oral cholera vaccine also reduces the risk of death by fifty percent . Sierra Leone, a West African country that has been ravaged by wars for years , experienced the worst Cholera outbreak in fifteen years. As of september 19th of this year, 19000 cases and 274 deaths have been reported.

It was unusual for the Cholera outbreaks to occur in February , the middle of the dry season because most cholera outbreaks take place in the rainy season. At the onset of the cholera outbreak, the Ministry of Health and Sanitation, WHO , UNICEF and Medecins Sans Frontieres-Belgium worked together to detect, confirm ,treat and prevent the cholera outbreak .

Lauren Savaglio

But when it started raining in June, cholera spread rapidly and by August, 2000 cases were reported per week. The Ministry of Health and Sanitation have also set up a network for all health centres to report daily cases of outbreaks and have been working with WHO and partners in spreading messages about safe drinking water, hand washing and food preparation.

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WHO has also brought in additional experts in epidemiology, surveillance, logistics, social mobilization, water and sanitation from other WHO country offices and set up a ‘ Cholera command and control centre’.

Inspite of all these efforts, there is a severe shortage of oral rehydration salts and they are expecting 32 000 cases in this outbreak. The health of a country is often based on infant and mother morbidity and mortality rates. ” In 2007, Sierra Leone had the highest level of child mortality in the world. Maternal mortality is also one of the highest in the world. One in eight women risk dying during pregnancy and childbirth. The infant mortality rate of Sierra Leone is 123 deaths per 1000 live births in 2009 .

Babies born in Sierra Leone in 2005 had a life expectancy of only 38 years. So it can be said that public health is generally poor in Sierra Leone. “Epidemiology is the study of the distribution and causes of health and illness in populations. ” In the case of the cholera outbreak in Sierra Leone, the infections started in the western area of the country where the capital, Freetown, is located. Cholera outbreaks usually occur in the rainy season but the outbreak in Sierra Leone started in February which is in the middle of the dry month.

According to World Health Organization, “ Cholera is an extremely virulent disease. It affects both children and adults and can kill within hours. About 75% of people infected with V. cholerae do not develop any symptoms, although the bacteria are present in their faeces for 7–14 days after infection and are shed back into the environment, potentially infecting other people. Among people who develop symptoms, 80% have mild or moderate symptoms, while around 20% develop acute watery diarrhoea with severe dehydration. This can lead to death if untreated.

People with low immunity – such as malnourished children or people living with HIV – are at a greater risk of death if infected. ” Therefore the risk factors of transmission of Cholera in a developing country like Sierra Leone is very high since there is no adequate environmental management and no minimum requirements for clean drinking water and sanitation. Like Jacobsen states in the textbook, Introduction to Global Health, “… eep in mind socioeconomic, political, behavioral, and environmental risk factors that contribute to creating the context in which the disease occurs. ”

Since cholera causes dehydration, the disease is treated using oral rehydration therapy, which is basically a solution made with water, sugar and salts. They can be bought as prepackaged mixtures or can also be made at home by combining clean, boiled 1 litre of water with 8 teaspoons of sugar and 1 teaspoon of salt.

But sometimes, severe cases of cholera require intravenous fluid replacement. Antibiotics can shorten illness, but should still be used in combination with the Oral Rehydration Therapy. The most basic way of preventing cholera is making sure communities prone to these epidemics have access to clean water and proper sanitation . Communities should also be educated about the importance of proper hygiene like hand-washing with soap after using the restroom and before cooking or eating . They should also be educated about safe handling , preparation and storage of food .

Media such as radio, television or newspapers and even community and religious leaders can also be effective in spreading health education messages. And at times, early detection of the outbreak and timely provisions of treatment , like in the Sierra Leone case, is also necessary to reduce the number of deaths.

I think, at the onset of the outbreak, Sierra Leone’s Ministry of Health and Sanitation did a great job in working with the government and other health sectors to confirm the outbreak of the disease even though the country has very few resources and capacity.

With the help of WHO, the Ministry of Health and Sanitation and partners including UNICEF and Medecins Sans Frontieres-Belgium was also able to detect, treat and prevent the spread of cholera. They also set up a “ cholera command and control centre” and trained health workers in cholera treatment and prevention.

They were successful in reducing the number of outbreaks to fewer than 40 per week but when the rainy season started in June, the epidemic spread rapidly to other districts and the number of cases arose to 2000 per week. But it should be noted that in Freetown, where the first outbreak occurred, there has been ignificant reduction of cases. WHO’s Representative in Sierra Leone, Dr Wondimagegnehu Alemu, states that many villages affected by the epidemic still face a shortage of Oral Rehydration Therapy solution, the most effective and life saving treatment for an outbreak like this.

The cholera epidemic in Sierra Leone made me realize how health inequalities does exist between the poor and rich population and how “ even with improved prevention and therapeutic techniques, infectious diseases continue to be health risk in all populations. ” It is also evident that the Socioeconomic status of Sierra Leone has played a major role in the cause and prevention of this cholera epidemic. Like Dr. Alemu mentioned in the article, an outbreak like this is a “major crisis for a country with a fragile health system recovering from several years of conflict.

But looking at the bright side, Dr Eugene Lam, epidemic intelligence service officer from the Centers for Disease Control and Prevention working for the Global Polio Eradication Initiative,states that “ Messages about safe drinking water, hand washing and food preparation will not only reduce the cholera infections but also reduce all diarrhoeal disease, a big killer of children under-five in Sierra Leone. Jacobsen states in the preface to the textbook “ If health is a human right, then basic health care and protection from preventable diseases should be available to all people , regardless of the condition that have made them vulnerable to illness, disability, and premature death. ”

I only hope one day by working together as a global community , we can make sure every single human being, irrespective of their socioeconomic status , can achieve a “state of complete physical, mental and social well- being”.

References

1. Health topics:Cholera in Sierra Leone: the case study of an outbreak; World Health Organization, September 2012. Retrieved from http://www. who. int/features/2012/cholera_sierra_leone/en/index. html on September 30th,2012.
2.  National Institute of health ,U. S. National Library of Medicine – The World’s Largest Medical Library,A. D. A. M. Medical Encyclopedia, May 30th 2012 . Retrieved from www. ncbi. nlm. nih. ov/pubmedhealth/PMH0001348/ on September 30th,2012
3. Health statistics of Sierra Leone;World Health Organization,2012. Retrieved from http://www. who. int/countries/sle/en/index. html on september 30th, 2012 .
4. Introduction to Global Health, Kathryn H. Jacobsen .
5. GCH-205-DL2 (FALL 2012), Module 4, Lauren Savaglio.