Ghana, located in the world’s tropical region, is faced with the unavoidable task of having to deal with the perennial flooding which occurs in low-lying areas during the rainy season.
The floods do not only destroy lives and properties but also trigger explosive outbreak of Vibrio cholerae, the bacterium that causes cholera.
Victims of the disease, contracted by eating food or drinking water that has been contaminated by the faeces of an infected person, suffer from profuse watery stools alongside uncontrollable vomiting.
Early detection leads to successful treatment with oral rehydration fluids but if not treated, it can lead to dehydration and can kill within hours.
The situation in recent years has worsened, with the disease killing more than 50 people nationwide any time there is an outbreak.
This year alone, over 4,000 cases and 64 deaths have been recorded nationwide, following the outbreak of the disease in the first quarter of the year. The Accra metropolis is said to be leading with 2,756 cases and 31deaths. And we are still counting as reports across the country paint a worrying scenario.
During the last outbreak, hospitals were filled with cholera patients on admission and doctors were alarmed at the rate of patients coming in with the infection.
Health practitioners at the various hospitals were also surprised at the death rates occurring within short periods of time.
Contrary to the notion that most outbreaks occur during the rainy season and in flood-prone areas in low-lying regions of the country, last year, the disease was recorded in the dry season and in places which previously were not earmarked for the outbreak. The situation appears to be the same this year.
The disease, known to show symptoms within three to five days, manifested itself within a few hours, after a person came into contact with the cholera bacteria. It killed people rapidly.
Health officials intensified their educational campaigns as they deployed health personnel and equipment to regions to support their counterparts in dealing with the disease.
The Accra Metropolitan Assembly (AMA) also increased the enforcement of its sanitation laws in the metropolis as a means of curbing the menace.
Free medical treatment was granted to patients to facilitate the effective treatment of the disease.
Nonetheless, cholera is still thriving in various parts of the country, with new cases being reported daily, in spite of the efforts put in place by health authorities.
Cholera In Ghana
According the World Health Organization (WHO), cholera was discovered in the 19th century when scientists wanted to know the cause and prevention of the disease after its first global epidemic started in South-East Asia in 1817.
The epidemic crossed over into Africa through successive trade routes, and colonial armies, according Myron Echenberg’s book, ‘Africa in the time of Cholera: History of Epidemics from 1817 to the Present’.
Echenberg notes in his book that cholera was one of the most devastating diseases at the time. It killed millions of people.
But over time, the virulence of the dominant strains of the disease has abated and mortality rates have dropped sharply, particularly with the introduction of the highly effective oral rehydration treatment.
Ghana also recorded her first outbreak of the disease in the 1970s in various parts of the country.
Major epidemics were recorded subsequently in 1971, 1977, 1983, 1989, 1991, 1995, 1998 and 2005 in all 10 regions, with localized outbreaks cropping up in coastal regions.
Heavy rains in 2010 led to the opening of the spillways of the Bagre Dam in Burkina Faso and Akosombo Dam in the Eastern Region of Ghana. Coupled with poor personal sanitation, food hygiene and the lack of potable water, it set the stage for an epidemic.
Statistics made available to the DAILY GUIDE from the Ghana Health Service (GHS) for 29th September 2010 to 27th March, 2011 indicated that from the 10 districts in Greater Accra, cases reported stood at 4,499 infected with 36 deaths.
This was followed by 573 cases, with nine deaths, from 12 districts in the Eastern Region; 554 cases and 24 deaths from seven districts in the Central Region; eight cases and no death from one district in the Upper West and 32 cases with no death from West Gonja district in the Northern region.
The Greater Accra Regional Health Directorate of the Ghana Health Service, at the start of this year’s rainy season, issued a cholera alert, cautioning the public about a possible outbreak of the disease if strict sanitation practices were not observed.
The statement signed by the Regional Director of Health Services, Dr. Edward Antwi, said anyone who experienced frequent loose watery stools and vomiting should immediately seek treatment at the nearest clinic or hospital.
Dr. Antwi said all government health facilities in the region were equipped to handle cholera cases, stressing that treatment was free.
“Wash hands with soap and water before eating, cooking and after visiting the toilet. Wash all fruits and vegetables thoroughly with water before eating, wash all plates and cooking utensils thoroughly before and after use, eat foods while hot and avoid buying/eating food which is exposed to flies and dust,” he warned.
He also cautioned food vendors over the exposure of food to dust and flies. “Keep the environment clean,” he said.
However, the situation seems unchanged, with the country’s hospitals still recording reported cases of cholera and Accra recording the highest cases of mortality.
Media reports indicate an upward turn of events.
About 4,000 cases were recorded at the end of the first quarter of 2012, compared to 6,960 reported cases recorded last year, most of which occurred between January and July, 2011.
The nationwide death toll sits at 64 in the first quarter of 2012 as compared to 62 for last year. Greater Accra leads with 2,756 reported cases and 31 deaths.
According to documents from the Ghana Health Service, Accra Metropolis Health Directorate, the disease has been reported in all the hospitals under the sub-metro.
The hospitals in Ashiedu Keteke, Ayawaso, La, Okiakoi and Osu-Klottey all recorded at least three deaths. Ablekuma has confirmed cases but no deaths.
Tony Goodman, Public Relations Officer of the Ministry of Health, says the cases in the Greater Accra Region are fluctuating.
“It goes up this week and the following week it is down,” he says. “Last month it was down, now it’s shooting up because of the rains we had for a few weeks.”
Goodman admits the situation is nothing to write home about comparing the number of cases recorded between the two years.
“The difference is high,” he says.
In the Brong-Ahafo Region, Atebubu, five people have been reported dead in a fresh sub-type of cholera (Ogawa) outbreak, with 97 cases reported.
The public health director in the region, Dr. Emmanuel Tinkorang, together with the district assembly, in his bid to prevent the disease from further escalating, has rolled out some interventions and banned social activities in the district.
The disease has also claimed the lives of four people, with more than 57 people on admission in Navrongo in the Upper East Region.
At Elubu in the Jomoro District of the Western Region, two lives have been lost to the preventable disease, with 33 people battling the disease for their lives.
Prevention
Dr. Simpson Anim Boateng, public health director of the AMA, says the assembly has been able to reduce the number of reported cases in the metropolis.
He says there have been fewer cases this year in the metropolis thanks to the AMA’s efforts to improve sanitation and educate the population.
“We are giving health education to the community. We are telling them what to do and what not to do so they won’t get the disease,” he says.
As at the end of the 23rd week of the year 2012, the metropolis had recorded 22 deaths out of 44 confirmed cholera cases.
Goodman says the ministry has done a lot to prevent the recurrence of the disease. “The focus now is on the environment and food hygiene,” he says. “The hand washing advert really helped. I believe that particular advert has really gone down well. You now have kids in schools washing their hands under buckets.”
He adds emphatically that the situation is a national issue and thus everybody should get involved.
He says people should be cautious of where they buy food and water.
Giving an example, he notes that tankers that sell water to residents for domestic use sometimes use the same vehicles to supply ‘stream’ water to construction sites.
“These tankers draw water from streams that are mostly contaminated and then sue the same tanker to supply water for residents for use,” he says. “You don’t know what he might have done with that tanker before he gives you the water you requested.”
Solutions
The option of vaccinating the public against cholera as a means of preventing the disease came up but Goodman says vaccination is not foolproof.
He says even with the introduction of the vaccine the country would still record cholera cases as the lifestyle of the public is the main cause of the disease.
He says people have relegated the basic hygiene, such as washing hands, keeping food warm and away from dirt and insects and keeping the environment clean, thought in schools, to the background.
“The only thing we can do is to educate the people on how to prevent the spread of cholera,” he says. “Let’s keep educating our people.”
He believes everybody should come on board. He says the district assemblies, through the provisions the 1992 constitutions of Ghana, should enact bylaws to stop bad behaviors that pollute the environment.
“Our goal is to see this thing out of this country, but we will say we are endemic,” he says. “No matter what you do, you will have some parcel of them but we are just hoping that it won’t be at the larger scale as we see now.”
By Jamila Akweley Okertchiri
