Strengthening the coordination of healthcare in African countries regarding cholera
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Haganum Model United Nations 2015| 13th of March –15th of March 2015
Strengthening the coordination of
healthcare in African countries
regarding cholera
1 RESEARCH REPORTSHaganum Model United Nations 2015| 13th of March –15th of March 2015
Forum: Special Conference
Issue: Strengthening the coordination of healthcare in African
countries regarding cholera
Student Officer: Zuzanna Nowak
Position: Deputy President
Introduction
Cholera is a diarrheal illnes caused by ingestion of the bacterium Vibrio Cholerae.
The bacterium is mainly to be found in faeces-contaminated water, which is why the cholera
is a problem of an epidemic scale in the countries with the poorest sanitation. Approximately
5-10% of patients face severe stage of disease, which is characterized by profuse diarrhea,
leg cramps and vomiting. Such symptomps can relatively quickly lead to fatal dehydration if
left untreated. However, in case of cholera treatment plays a significant role and is not at all
hard to implement. Measures such as oral or intravenous rehydration can reduce the ratio of
fatality to less than 1% (meaning that with proper treatment less than 1 in 100 patients will
die of cholera). In developed, well-infracstructured countries cholera is a rarely occuring and
not so dangerous illnes. In Africa, however, its range is overwhelmingly big and it kills
thousands of people every year. The main reason for such frequent occurance of cholera in
this particular region is its limited access to safe water as well as lack of hygiene and poor
sanitary conditions.
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Definition of Key Terms
Diarrhea
The main symptom of cholera, likely to cause patient’s dehydration due to rapid fluid
loss.
Rehydration
A process of replenishing fluids lost by a patient in a course of disease by delievering
them from the outside, which can be done eighter oraly or intervenously. Rather inexpensive
and uncomplicated method of treatment, especially effective in cholera cases.
Dukoral® and ShanChol®
Two types of WHO*-prequalified, effective oral vaccines for cholera available on the
market. Both of them are licensed in over 60 countries. Dukoral provides short-term
protection of 85-90% among all age groups while ShanChol provides long-term protection
among children under five years of age.
*World Health Organization
Background Information
Why Africa?
One of the most important things to realize about cholera is that the death rate among
treated patients remains very low, while the disease left untreated can kill an adult person
within hours. That is why healthcare plays such a significant role here. Unfortunatelly, poor
economic condition of the country does not favour implementing effective and pro-active
healthcare, which is partly the reason for African countries to find cholera so bothering.
Furthermore, the weaker a patient’s immune system is, the more severe course will his
illness take. Malnourished, neglected people, suffering from famine and poverty are the ones
most exposed to the fatal outcome of cholera infection. The percentage of people dying from
reported cholera cases remains higher in Africa than enywhere else in the world.
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Because Vibrio Cholerae bacteria are present in contaminated water, it is
understandable why the disease spreads so wildely in underdeveloped African states, such
as Sierra Leone, Niger, Guinea or Zimbabwe. Cholera transmission is closely linked to
inadequate environmental management. Typical at-risk areas include peri-urban slums,
where basic infrastructure is not available, as well as overcrowded camps for internally
displaced people or refugees, where minimum requirements of clean water and sanitation
are not met. In Africa cholera remains a global threat to public health and a key indicator of
lack of social development. Recently, the re-emergence of cholera has been noted in parallel
with the ever-increasing size of vulnerable populations living in unsanitary conditions.
How does cholera spread so rapidly?
Another factor that contributes to the epidemic scale of cholera is the fact that not all
infected people will develop recognizable symptoms. Why is that so dangerous? Statistically
speaking, in case of one hundred people getting infected, about one person in five will get
severe diarrhea (without proper treatment, up to half of them may die). The rest of the
infected people will develop mild symptoms or no symptoms at all. In fact, the majority of
them might not even realize they carry the bacteria in their system. Given their fine physical
condition, they will feel well enough to function - travel, for example - and potentionally infect
others. A perfect example of how dangerous this mechanism is would be the cholera
outbreak in Haiti, where the infection began in only one of the departments and within just
over a month it spread all across the country. That is one of the reasons why awarness
raising must be emphasized. People of Africa need to realize that their not-well-being may
potentially be much more dangerous to the community than they would assume.
What do the numbers show?
For the reasons of cholera occuring in underdeveloped areas and its symptoms being
similar to a number of other diarrheal diseases, it is drastically under-recognized and
underreported. Therefore the statistics regarding cholera are rather inacurate. An estimated
number of cholera cases reaches up to 3–5 million every year, with about 100 000–120 000
deaths. Now, an exceedingly important massage is that over 90% of patients could be
succesfully treated if provided with proper medical attention.
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Major Countries and Organizations Involved
UNICEF
“UNICEF currently provides strategic technical support and guidance including the
UNICEF Cholera Toolkit (available in English and French), surge capacity, training, supplies
and logistical support for cholera and diarrhoeal disease outbreak prevention, preparedness
and response worldwide. UNICEF supports governments, the World Health Organization
(WHO) and partners in the following areas: advocacy, coordination, assessments, planning
and prioritization, surveillance, early warning systems and alert mechanisms, service delivery
and communication. In addition, UNICEF supports the appropriate use of the oral cholera
vaccine (OCV) with other priority cholera control interventions and has been a key partner in
the development of the Global OCV Stockpile.”
(http://www.unicef.org/cholera/)
World Health Organization (WHO)
The organization of an international range of activity and interest, supporting UNICEF
in its attempts to combat cholera outbreaks in Africa, cooperating with local medical facilities
and introducing scientific studies aimed at reducing harmfulness of cholera. Also, they are a
main source of statistical data regarding infectious diseases, such as cholera itself.
Somalia, Sierra Leone, Congo, Mozambique, Nigeria, Zambia, Zimbabwe, Guinea,
Uganda, Rwanda
The examples of African countries in which cholera outbreaks took the most dangerous form.
Hundreds of citizens with no access to safe water got (and still get) infected with V. cholerae.
In areas such as peri-urban slums, where people live on the brink of poverty, toilets are
frequently replaces with latrines or ground pits. The faeces are likely to contaminate soil or
get eluted with rain and further contaminate the environment. Knowing that slums inhabitants
use mainly unfiltered water from rivers, streams, makeshift wells or even puddles, the
bacteria spreads among them relatively quickly and the outcome is dramatic. Because of the
5 RESEARCH REPORTSHaganum Model United Nations 2015| 13th of March –15th of March 2015
quantity of patients and inadequate number of healthcare facilities, a vast majority of infected
people - including large number of children - do not receive proper treatment, nor basic
education about how cholera spreads, how to protect yourself from it or how to aproach your
symptoms. At the worst times, hospitals are so overcrowded they cannot take in any more
patients. Lack of required equipment and educated staff does not help eihter, which results in
thousands of deaths every year.
Timeline of Events
Date Event
1817 Cholera on the move, spreading across
continents
1860 - 1975 Worldwide outbreaks, chronologically and
geographically divided into so-called seven
cholera pandemics
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2000 African countries officially account for 87%
of reported cholera cases
August 2010 Cholera outbreaks in Nigeria
October 2010 Cholera outbreaks in Haiti and Dominican
Republic
2011 Cholera outbreaks in Somalia, Democratic
Republic of Congo and Nigeria
2011/2012 Cholera outbreaks in all African regions
(e.g. Sierra Leone) with the exception of
North Africa
Since 2010 Fatal cholera outbreaks have been reported
in Haiti, Dominican Republic, Cuba,
Venezuela, Iraq, Nepal, Pakistan, Iran,
Bangladesh, Myanmar, Laos, Cambodia,
Vietnam, Afghanistan, India, China, Nigeria,
Sierra Leone, Kenya, Uganda, Zimbabwe,
Zambia, Angola, Somalia, Ethiopia, Ivory
Coast, DRC, Congo, Mozambique, Ghana,
Guinea, Mali, Ukraine, and Niger.
Relevant Documents/Publications
● Protecting and Promoting Human Health (Agenda 21, Chapter 6)
● A world fit for children (A/RES/S-27/2)
● “Multi-sectoral Cholera Prevention and Control Plan” by UNICEF
● “Cholera Outbreak - Assessing the Outbreak Response and Improving
Preparedness” by WHO Global Taskforce on Cholera Control
Previous Attempts to solve the Issue
There were some attempts made by NGOs (to some degree cooperating with local
governments and WHO) aiming at awarness raising and implementing sanitation. A number
of hygiene promoters took part in collective efforts towards tackling cholera by going door to
door and providing citizens with basic health education. UNICEF has also been trying to
deliver rehydration kits to as many Africans in at-risk areas as possible, to enable them to
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treat new cholera cases urgently. What is more, UNICEF sets up numerous handwashing
facilities as a part of their cholera-prevention plan. Infusions, antibiotics and drips are sent to
local hospitals, to by any means increase their effectiveness and scope of action. Also,
existing feeding centers for malnourished children are provided with safe drinking water.
Chlorine supplies - used for treating unsafe water sources, such as wells - are being
distributed across African countries. Those fundamental measures are certainly helpful, but
rather extemporary. Lack of quality medical facilities, educated staff and basic equipment
leaves thousands of Africans defenseless in face of cholera infection. Deplorable sanitation
and widespread poverty of the region make it even more difficult to successfully implement
prevention measures, let alone treat an overwhelming number of infected patients. Water
supplies deliverd by NGOs and their partners are salutary, but not big enough. Same
problem applies for rehydration kits, medicines and qualified menpower.
Possible Solutions
Well, solutions for this problem are not as much complicated, as they are hard to
implement. To resolve the question of cholera epidemic we must dive deeply into its causes
and try to treat the issue at its very core. I would suggest adressing poverty and famine
(especially in peri-urban slums) as the main reasons for cholera to constitute such danger in
this particular region of the world. Furthermore, please remember that raising awarness
always plays a significant role in cases like this. With so many Africans still not knowing what
cholera is, how it spreads or how to properly aproach an actual infection, the problem is only
likely to grow and evolve.
As for prevention, which is a next exceedingly important element of healthcare,
limited access to safe water in African countries is a key factor here. While writing your
resolutions, try aiming at implementing solid sewege systems, as well as delivering running
water and WHO-certificated reservoires to residential areas. Remember: sanitation and
hygiene can never be over-emphasized when it comes to water-born diseases. Keep in mind
that the majority of cholera infected Africans are children under the age of five. They
therefore represent the age group that ought to be surveilled most closely and taken the
greatest care of. Other than that, you might want to think ahead and include in your
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resolutions creating new facilities, organizations or funds. It could be a chain of specialized
clinics, widespread vaccination program or whatever you can think of.
Last but not least, I would suggest acknowledging NGOs’ actions. Without
governmental resources (both human and financial) the NGOs are not able to solve the
problem all by themselves, but their work does create a solid foundation for you to build on
and a framework to turn into quality ideas.
Bibliography
"Cholera in Africa." Centers for Disease Control and Prevention. Centers for Disease
Control and Prevention, 07 Nov. 2014. Web. 15 Jan. 2015.
"Prevention and Control of Cholera Outbreaks: WHO Policy and Recommendations."
WHO. N.p., n.d. Web. 17 Jan. 2015.
"The African Cholera Surveillance Network." Cholera Outbreaks in Africa. N.p., n.d.
Web. 17 Jan. 2015.
David A. Sack. "Cholera Burden of Disease Estimates." John Hopkins Bloomberg
School of Public Health. Department of Internetional Health, n.d. Web. 17 Jan. 2015.
"Cholera." WHO. N.p., n.d. Web. 17 Jan. 2015.
"Cholera Country Profiles." WHO. N.p., n.d. Web. 17 Jan. 2015.
"Cholera." UNICEF. N.p., n.d. Web. 17 Jan. 2015.
9 RESEARCH REPORTSHaganum Model United Nations 2015| 13th of March –15th of March 2015
"Cholera Outbreaks and Pandemics." Wikipedia. Wikimedia Foundation, n.d. Web. 11
Feb. 2015.
"Infectious Diseases Through Time." Disease Detectives. N.p., n.d. Web. 11 Feb.
2015.
1 RESEARCH REPORTS
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