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In Burundi, quick action to contain cholera

By Eliane Luthi

Responding to an outbreak of cholera among Burundians who fled to Tanzania, UNICEF helps health workers track and monitor new cases through mobile phone technology. 

KABONGA, Burundi, 1 July 2015 – “It was on the Monday that we came back that she started to feel sick,” remembers Uziya Nyabenda, speaking of her daughter, Esta. “On Wednesday she began having heavy diarrhea and vomiting, so we brought her to the health centre. I suspected it was cholera – and I was afraid.”

© UNICEF Burundi/2015/Nijimbere
Uziya Nyabenda's 7-year old daughter, Esta (left), recovered from cholera after returning from Tanzania, where the family had taken refuge from rising violence.

Uziya, 28, and Esta, 7, are from Kabonga, a village in southern Burundi just a few kilometres from the border with Tanzania. They are among the more than 62,000 Burundians who have fled to Tanzania since April, when rising insecurity and fear launched a wave of migration to neighboring countries.

“Around here, we heard a lot of rumors; we heard a lot of scooters crossing the border. I was scared, I wanted to go too," she says, recalling the day she finally decided to go to Tanzania. “So I took a wooden boat with my four children and our neighbors. It took a little over an hour to get there.”


Uziya, Esta and the rest of the family arrived at Kagunga, a small stretch of lakeshore where tens of thousands of Burundian refugees awaited transportation to the Nyarugusu refugee camp in Tanzania.

The sudden arrival of such a high number of people, the vast majority of them women and children, quickly led to overcrowding. Limited access to clean drinking water and adequate sanitation led to conditions in which cholera could easily break out.

And when it did, it was transported further – including back home, when some decided to return to Burundi to seek health care.

“On the shores of Lake Tanganyika, cholera is endemic,” explains Dr. Dorothee Ntakirutimana, Health Officer at UNICEF Burundi. “There are outbreaks of cholera here almost every year. This time, the outbreak flared up with the displacement of populations that wanted to flee the country and go to the other side in Tanzania. So the first cases came from the other side, from Tanzania.”

© UNICEF Burundi/2015/Nijimbere
RapidPro, a free SMS-based system developed with UNICEF support, allows local health workers to send an alert to a central database as soon as a new cholera case is detected.

“We were sleeping in the same place as another girl who had diarrhoea,” explains Uziya. “My daughter had a fever, and at first I thought it was malaria, but there was no health centre nearby.”

The situation in Kagunga finally drove Uziya to come back home to Burundi.

“I was in contact with my husband by phone, and he said conditions were not good where we were. So he came and got us by bicycle. It took us two hours to get back here,” she says.

Esta was already unwell as they crossed back over the border. When her symptoms began to worsen further, her parents brought her to the Kabonga health centre. Esta was then transferred to the newly re-established Kabonga Cholera Treatment Centre, where she received treatment including rehydration fluids and zinc.

Real-time tracking

With the sudden appearance of nearly 170 cholera cases (as of 30 June) in Burundi following the spontaneous return of some refugees back over the border, it became essential to quickly identify and track cases in real time. The introduction of RapidPro technology on simple mobile phones has allowed health workers to quickly notify the central level of new cases, and to report on the evolution of each hospitalized case.

“It's the first time we can track cholera cases using SMS alerts,” says Gloriose Nsengiyumva, in charge of the health information systems at the health district at Nyanza Lac. “It’s the quickest way to alert the central level, who can then follow all cases and take actions needed. If we hadn’t had this system in the current outbreak, we would have had more cases of death.”

But responding effectively to cholera does not just mean treating confirmed cases – it also means preventing new ones. Communications tools for use in health centres and in communities are critical to limiting contamination and rapidly containing the illness.

© UNICEF Burundi/2015/Nijimbere
As a cholera endemic area, Nyanza Lac in southern Burundi equips community health workers such as Claver Ndihokubwayo (left) with information and tools about cholera.

Claver Ndihokubwayo, a volunteer community health worker in Rangi, uses illustrations so that community members can easily understand cholera prevention messages.

“I use these tools to explain how to deal with an outbreak – by keeping latrines clean, washing hands, disinfecting water that is collected in rivers before drinking it, and going to a health center in case of illness in order to prevent spread,” Claver says.

Back in Kabonga, Uziya sits with her daughter Esta on the stoop of their home. Five days of treatment have allowed her to regain her strength and her health. And now, Uziya knows exactly what to do to prevent it from happening again.
“I'm very happy that she’s in good health again, and I thank the nurses that helped her get better,” says Uziya, looking at Esta with a smile. “Now I'm trying to explain to our neighbors how to prevent cholera. I think that in this neighborhood, there won't be any more cases.”

UNICEF in collaboration with other partners is supporting the Ministry of Public Health and the fight against AIDS in order to treat and prevent cholera cases in Burundi. The only national provider of cholera kits in Burundi, UNICEF has positioned cholera kits on both sides of the border and supported the re-establishment of two cholera treatment centres along the land border with Tanzania. In addition, UNICEF is supporting the use of RapidPro for the management of cholera cases and is providing communications tools to ensure simple prevention measures, such as handwashing with soap, are promoted at health centres and within communities.



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