The worsening Cholera crisis in Cameroon


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Courtesy of OpenStreetMap

You’ll have heard many reports about the ongoing Ebola crisis in West Africa at the moment. It has already claimed many lives and it will claim more. It’s first outbreak was in 1976.

However, there is something else in Africa at the moment and it’s existed for much longer than Ebola. That thing is Cholera.

This most recent outbreak is related to the actions of Boko Haram. I have previously blogged about their terrorist actions in Nigeria that have included murders, bomb blasts, schoolgirl abductions and the disruption of important sources of income for local families. Their actions have caused many to flee Nigeria into the likes of Cameroon. The first three cases of Cholera in this outbreak are as a result of refugees. According to figures, 24,683 cases of Cholera have been reported in Nigeria this year.

“People in northern Nigeria cannot get to health clinics in time due to the awful security situation and that’s one reason why they come across the very porous border where they have family or tribal ties,”

However, if the Nigerians who caused this didn’t cross the border, the latest outbreak could have easily been started by the domestic population.

The violence in the region (partly caused by Boko Haram), has also resulted in delayed treatment for many people. That violence is also why the UK Government advise against all travel to that area.

The history of the disease in Cameroon

All of the stats in this section do not include the present outbreak.

The World Health Organisation has a comprehensive history of the disease in Cameroon. The document I liked to was last updated in 2012, although there is still plenty of detail.

The first reported case in the country was in 1971 and there have been outbreaks since then in various forms. More than 1000 cases were reported in 1985. In 1991, 4000 cases were reported. 1996 saw 5786 cases.

More recently, there were 8,000 cases in 2004, 2487 in 2005 and 922 in 2006.

Between 2009 and 2011, there was the worst Cameroonian Cholera outbreak to date.

Locations of notified cases in 2011

The above map shows that in 2011 alone, there were a significant number of cases and many were in the Northern region – a place where the present outbreak is.

From May 2010 to September 2011, there was 27,880 reported cases. A CNN article dated August 17th, 2011 tells you that 13,000 cases had been reported by that point in the year. I think you can agree that this was a vast increase on previous outbreaks since 1971.

So far, I have told you about cases reported. That does not necessarily equal deaths though. In fact, treatment for Cholera means that there’s a much high recovery rate than the likes of Ebola.

If you do any research into this, you’ll come across ‘CFR’. It’s an abbreviation that means ‘Case Fatality Rate’, or how many of the reported cases result in death.

In some of the more historical cases, the CFR ranged from 8.3% to 15%. However, it’s important to note that 15% was the starting point and the figure improved from there. 2005 and 2006 saw even lower percentages – 3.86 and 3.8 respectively. You would think that improved healthcare in Cameroon and knowledge of the disease caused that.

However, the 2009-2011 outbreak had an initial CFR of 13%. Over time it improved though. First it decreased to 6.1% and it eventually went as low as 3.7%. This is the lowest historical CFR that I have found. Despite this decrease, it is still one of the worst reported outbreaks. Figures for the actual number of deaths vary based on the time period analysed, but the World Health Organisation reports that 22,433 deaths happened because of Cholera in 2011.

So, what is Cholera?

It’s all well and good hearing about the outbreak, but I definitely think it’s worth knowing something about the condition, so you can put the dangers in context.

The first outbreak started in India in 1817. It spread to the likes of Russia and lasted until 1824.

The disease is an infection of the small intestine and is transmitted through food and water. Poor sanitation can often be a major problem. Other issues can include crowding and famine.

The following is a list of risk factors:

  • Living in or travelling to areas where there is cholera
  • Symptoms
  • Abdominal cramps
  • Dry mucus membranes or dry mouth
  • Dry skin
  • Excessive thirst
  • Glassy or sunken eyes
  • Lack of tears
  • Lethargy
  • Low urine output
  • Nausea
  • Rapid dehydration
  • Rapid pulse (heart rate)
  • Sunken “soft spots” (fontanelles) in infants
  • Unusual sleepiness or tiredness
  • Vomiting
  • Watery diarrhoea that starts suddenly and has a “fishy” odour

Treatment often involves fluid and electrolytes. An oral WHO treatment is presently used internationally.

If treated early on, people can make a recovery.

Finally…

This quote from Cameroon’s Minster of Public Health should give you an idea of what’s going on:

“”I have asked them to boil water from suspicious sources before drinking,” he said, “and to stop their children from defecating in bushes and streams, adding that people should not dig pit toilets near water wells””

Cameroon most recently reported population is 22,253,959. That’s a lot of people who could be affected by Cholera unless the treatment process is expedited. To put it in perspective, imagine if a group of people 2.8 times the size of the London population were infected by a deadly disease.

As I mentioned earlier in the post, sanitation can be a factor in the transmission of Cholera. Unfortunately, the most recent figures show that only 45% of the country has access to what is called ‘improved sanitation‘ (toilets with flushes, septic tanks, sewer systems, etc). This makes them worse than the likes of Yemen.

Effective treatment means they need decent healthcare. Unfortunately, the Global Corruption Barometer shows that 61% believe medical services are corrupt and 33% reported paying a bribe to someone in that profession. The country’s health expenditure is 5.1% of GDP, which is lower than that haven of peace and tranquillity known as the Democratic Republic of Congo.

Maybe it’s time for other countries to step in. Whilst Cameroon certainly has access to internationally recognised treatments, their infrastructure and problems with violence is causing them great problems. At present, the likes of the UK offers no international aid to the country. The last budget year was 2011/12. Of the 5 historical projects, none were related to health and sanitation. I find this strange as those two things have required significant improvements for a long time.

Africa is a continent known for being the source of modern humankind. Unfortunately, it’s also known for the premature death of modern humans due to disease.

So, what do you think?

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