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Busaa fuels cholera as State battles to stamp out outbreak

 Men remove garbage from River Nyando in Kisumu County. Locals fetch water from the river. At least two people have died following a cholera outbreak in the area. [PHOTO: Collins Oduor/Standard]

At least 50 people have succumbed to a cholera outbreak that has struck 10 counties.

The water-borne disease has been reported in Nairobi, Baringo, Kiambu, Nakuru, Kirinyaga, Murang'a, Bomet, Migori, Mombasa and Homa Bay.

With 14 people dead, Nakuru has the highest the number of deaths so far and experts seem to have found why the town has been hard hit. Most of the victims, they say, had taken busaa, a traditional alcoholic beverage.

Open sewers, lack of clean water and poor hand hygiene have been cited as cholera-trigger factors in Kwa Rhonda, Flamingo and Bondeni estates in Nakuru. Most of those infected are men.

Samples of food and drinks, including busaa, have been collected and are being tested at the National Reference Laboratories in Nairobi to find out whether they harbour the cholera-causing bacteria, according to sources.

However, disease surveillance officers have revealed that majority of those who have died and others who are being treated for the disease had consumed busaa prepared and served in unsanitary conditions.

In the other affected parts of the country poor drainage, untreated water, garbage and poor personal hygiene have been cited as having triggered outbreaks.

Health experts say the causes of the current outbreak are the same as those of 2009 and 2010 epidemics, which were exacerbated by a prolonged drought that caused scarcity of clean drinking water. The subsequent rainfall also aggravated matters.

Disease Surveillance and Response head Ian Njeru said the extreme weather conditions have fuelled the outbreak.

"We have had a long spell of drought since around August last year and the current rainfall has converged with poorly maintained sewerage lines leading to the cases especially in the urban areas," said Dr Njeru.

In the 2009 cholera outbreak, there were 11,769 cases and 274 deaths.

Even as careful selection of food and water is advised in the ten affected counties, contaminated water sources remain the greatest risk for residents in another 20 counties placed on a watch list.

Dr Njeru told The Standard advised persons in affected areas with diarrhoea to immediately begin taking oral rehydration salts, which are available in retail shops as they seek further treatment in health facilities.

The doctor says appropriate treatment can eliminate the cholera-causing bacteria known as Vibrio with ORS as the first line of treatment, followed by use of broad antibiotics and administration of intravenous fluids for the severe cases.

"The mainstay of treatment is rehydration to replace lost fluids for those affected," Njeru said, adding that proper hygiene should be strictly observed and sanitation levels improved even after treatment.

Other public health experts who spoke to The Standard warned that banning hawking of food may not eradicate cholera if there is safe clean water and improved sanitation.

If the outbreak persists, health officials at the Ministry of Health are contemplating using the cholera vaccine to tame further spread of the water-borne disease.

However, the use of any of the WHO prequalified vaccines for cholera will be keenly evaluated before roll-out given that it has efficiency of between 58 to 85 per cent, providing protection of about two to three years.

"We are meeting to discuss the possibility of using the cholera vaccine in the most-at-risk populations with low sanitation levels to prevent them from a future outbreak," said Cabinet Secretary of Health James Macharia in a phone interview.

As cited by the World Health Organisation, the priority populations for vaccination in case of fewer doses should be children under five years, persons with limited access to healthcare and those with no access to adequate water and sanitation facilities.

WHO, however, warns that use of vaccines should not disrupt long term interventions to control and prevent cholera like improvement of personal hygiene and sanitation levels.

There have been calls for concerted efforts between all stakeholders; national and county government, private sector, non-governmental organisations, communities, religious and educational institutions to battle the current outbreaks and avert outbreaks in other counties.

Unregulated water sources and poor hand hygiene have also been blamed for the increasing cases in the affected urban slums in Nairobi, Thika, Nakuru and other urban towns.

According to sources who spoke to the Standard, some institutions are not treating their sewage properly leading to the effluent contaminating water bodies.

In arid and semi-arid areas, sharing of shallow communal wells, where open defecation and communal bathing are a common practise, have made control of the outbreak difficult.

The short incubation period–two hours to five day–has led to potentially explosive pattern of outbreaks in the ten counties. The number of those infected now stands at 2,520.

A risk assessment on possible spread of cholera seen by the Standard shows some of the counties placed on the watch list include Lamu, Busia, Marsabit and Turkana while Embu, Bungoma, Isiolo, Wajir, Kisumu and Kakamega. Five others are closely being monitored.

Cholera is an acute, diarrhoeal illness caused by infection of the intestine with the bacterium Vibrio cholerae, usually found in water or food contaminated by faeces from a an infected person.

According to WHO, vaccines provide a short term solution as longer term solutions like improving water and sanitation are put in place.

Over the years, Kenya has experienced an increase in the number of cholera cases since the disease was first reported in 1971 in Turkana district. From 1974 to 1989, there were cholera cases reported annually with about 3.5 per cent of those infected dying.

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