The hygiene, mindset battle in squashing cholera

Traders captured cleaning fish inside Top Market in Nakuru. [Caroline Chebet, Standard]

In the world of epidemiology, a figure named John Snow emerged as a real-life hero who revolutionised disease control.

During the Victorian era in 1854, when London was plagued by the ravaging third cholera pandemic, Snow’s insightful observations led to groundbreaking discoveries on how the disease spread and how it could be halted.

Today, his legacy lives on, forming the foundation of global water, sanitation, and hygiene (WASH) interventions aimed at preventing cholera outbreaks.

Despite recent progress, the battle against cholera rages on. Kenya, in particular, finds itself locked in a fierce struggle against this tenacious foe. Eight long months have elapsed since the initial outbreak at a wedding in Limuru, but new cases continue to emerge. Something is amiss, and it compels us to ask: Why can’t Kenya conquer this insidious enemy?

The World Health Organisation has documented a staggering 50 per cent increase in cholera outbreaks during 2022—a trend that stubbornly persists into 2023. These outbreaks have gripped 13 countries that were previously untouched by cholera or deemed non-endemic, yielding the highest case fatality rates recorded in over a decade.

Historically, cholera transmission has been linked to overpopulation, inadequate water and sanitation infrastructure, and penury. The prevailing notion, mostly based on research conducted in Asia, posited that endemic cholera areas served as reservoirs, waiting for triggers like droughts, floods, temperature changes or conflicts to spark outbreaks.

Research in Africa has uncovered a startling reality: seasonal outbreaks in many previously considered endemic areas are now the result of foreign cholera bacteria, genetically distinct from earlier outbreaks. For these regions, the end of an outbreak marks the elimination of the causative strain, meaning the critical challenge lies in preventing the reintroduction of cholera from somewhere else.

African countries have often adopted interventions employed elsewhere without considering their efficacy in their unique contexts. However, the COVID-19 pandemic has starkly revealed that diseases do not unfold uniformly across different regions. The “copy and paste” approach to public health issues can have dire consequences, outweighing any potential benefits.

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Reliance on emergency efforts in endemic areas following each outbreak proves unsustainable. It harkens back to the mistaken historical belief that cholera forced European cities to improve their water, sanitation, and healthcare infrastructures. In reality, those nations were already progressing due to their financial prosperity and political will.

Now is the time for African countries to invest time and resources into systems thinking while fostering domestic pharmaceutical production and health research. When addressing the cholera pandemic, early identification, outbreak control measures, vaccination, and improved WASH practices remain crucial.

However, for many areas in Africa, investing in enhanced surveillance is paramount to detect and contain outbreaks at their earliest stages. Furthermore, the oral cholera vaccine has proven indispensable, and nations should strive to establish robust manufacturing capabilities instead of solely relying on donor funding.

The writer is a medical doctor with a passion for making a positive impact