Cholera in DRC: fighting an age-old disease with a new strategy
The rapid response implemented by UNICEF through its partners on the ground has played an important part in reducing the human to human transmission of the disease in areas like Sake.
The cholera treatment centre in Sake, 20 km east of Goma, the capital of North Kivu province, is almost empty. Just one year ago, most of the 17 beds would have been occupied by patients being treated for suspected cholera. One of the beds is occupied by 9-year-old Deborah who was rushed to the hospital a few hours earlier by her grandmother Fitina with symptoms of cholera. “I was at work in the fields when a neighbor called me to tell me that Deborah was not well. I went home as fast as I could and found her vomiting and having diarrhea. I took her immediately to the hospital”, says Fitina. A nurse comes in to replace Deborah’s intravenous drip, under the watchful eye of Fitina. Deborah drifts in and out of sleep, visibly weak and dehydrated. Her grandmother’s quick response probably saved her life, as cholera can kill a healthy person within hours if not treated promptly.
A rapid response to prevent outbreaks
A few minutes later, a Red Cross cholera response team comes in to check the patient register and take note of new admissions. This is the first step of the cholera rapid response approach that consists in following up 80% of suspected cases in less than 48 hours to interrupt transmission through the implementation of a cordon sanitaire, a sanitary barrier covering 15 to 20 households around each suspected case. This approach, which has helped end a deadly cholera outbreak in Haiti in 2019 has been particularly successfully in North Kivu, where the transmission rate dropped to 12% in 2020 from 39% in 2019.
“The rapid response approach focuses on breaking the chain of transmission: we intervene as soon as we have just one suspected case by setting up the cordon sanitaire and investigating that one case”, says Joseph Kasongo, Secretary General of the Red Cross in DRC, UNICEF’s partner organization implementing the rapid cholera response in North Kivu.
The Red Cross team quickly reaches Fitina’s house, some 5 kilometers from the hospital. There, some team members begin spraying Fitina’s house and 20 surrounding houses and latrines with a chlorine-laced solution, while other team members hands over a one-month supply of oral rehydration salt, water chlorination tablets, soap, a jerrycan and a bucket with tap to Fitina and each of the 20 households. They then chat to Fitina and her family to detect the source of infection and advise her on how to prevent further spreading of the disease. She admitted that the only clean water supply in the village is not always operational and that she often uses unclean sources of water.
Inroads in the fight against cholera
Cholera is an acute diarrheal infection caused by eating food or drinking water contaminated with the Vibrio cholerae bacteria. It can be particularly deadly for children under 5 who made up 25% of total cases and 15% of all deaths in 2017 and 2018 in DRC. In places with poor sanitary conditions, the stool of infected people can contaminate water that can then transmit the disease to others.
The rapid response implemented by UNICEF through its partners on the ground has played an important part in reducing the human to human transmission of the disease in areas like Sake. This goes hand in hand with recent improvements in the water and sanitation infrastructure in the targeted areas and better monitoring and surveillance of cholera. For Kasongo, community engagement and hygiene awareness are also key to tackling cholera. “Eradication of cholera very much relies on community engagement and appropriation of the hygiene practices we promote through our activities, such as regular hand washing, maintaining a clean environment at home and only drinking water from safe, clean sources”, Kasongo says. This approach has paid off in Sake: by the end of September 2020 there were 41% less reported cases of cholera compared to the same period in 2019.
Sustaining fragile gains
Between 2013 and 2017, DRC reported about 151,000 cases and 3,304 cholera-related deaths. In 2018 and 2019, the number of suspected cholera cases were fairly similar, but in 2019 there was a 51% decrease in the number of deaths compared to 2018. Between January and early October 2020, there was 30% decrease in the number of suspected cases and 30% decrease in the number of deaths compared to the same period in 2019.
However, the results achieved in recent months are still fragile and the current funding levels are insufficient to reach the last mile – cholera elimination in DRC. Sustaining these results requires stable funding over two to three years to continue implementing the cholera rapid response, maintaining disease surveillance, and improving the water and sanitation infrastructure in the affected areas. For this, UNICEF has appealed for US$ 21.4 million for 2020-2021. Only 5% of this amount has been funded so far.
Back in Sake, Deborah has made a full recovery and is happily playing jump rope with her friends. Her grandmother Fitina is keen to share the lessons learnt from this experience: “The doctor advised me to keep my home and surroundings clean, feed my child well, and use the water purifying tablet that the team gave me. Our community doesn’t think about cholera…but I’m going to raise awareness among my neighbors on how to protect their families from this disease”, Fitina says.
Thanks to ECHO and the Government of Norway as part of the Global Humanitarian Thematic funding for their support to the cholera reponse.