As Harare reports 307 cholera cases in suburbs ranging from overcrowded Mbare to leafy Mount Pleasant, the Harare Metropolitan provincial authorities have ordered the closure of all unlicenced and unclean food outlets in the four local authorities in Greater Harare.
The metropolitan province now has the second highest total of cholera cases since the outbreak began three months ago, with Manicaland the worst on 481 and that province now upgrading its anti-cholera drive to include surveillance of funerals and other gatherings.
Other provinces that have reported cholera cases are Matabeleland South (231), Mashonaland West (121), Mashonaland Central (80) and Masvingo (41).
Midlands, Matabeleland North, and Mashonaland East have reported just the odd suspected case while Bulawayo Metropolitan has not had a confirmed case since the beginning of the outbreak in February.
Speaking at a press conference yesterday, Harare Metropolitan Provincial and Devolution Permanent Secretary Mr Tafadzwa Muguti said most of the cases in his province had been reported in Budiriro, Glen View, Dzivaresekwa, Mount Pleasant, Mbare and Waterfalls.
He said the closing of dubious food outlets was part of a host of prevention and control measures in place to mitigate the cholera outbreak.
“During this outbreak all local authorities have been directed to stop all unlicenced shops and unclean food outlets from operating in open spaces.
“All shops, restaurants and food outlets to have clean toilets with running water,” he said. The local authorities are: Harare City Council, Chitungwiza Municipality, Epworth Local Board and Ruwa Local Board.
Schools and all office buildings were also encouraged to ensure that toilets have running water and soap.
There are two major problems of water and sanitation that make Harare Metropolitan a time bomb for water-borne diseases.
The huge spread of unplanned and illegal settlements have no sewers and no piped water, with people reliant on boreholes, wells, latrines and septic tanks. The danger is greater where shallow wells and Blair toilets predominate.
The second problem is that Harare City Council, which supplies water for the whole province, has allowed its two water purification plants to become so run down that they are able to operate at only around half installed capacity, leaving swathes of the province with no piped water and intermittent supplies in much of the rest.
Mr Muguti raised concern over the proliferation of those illegal settlements in the province where shallow wells are being used as drinking water sources.
“If you look at most places where there are cabins, people have dug shallow wells and shallow Blair toilets and this is definitely going to affect the water table. There are also people who are also drilling wells right next to a latrine.
“We have started sending people to these areas to shut those wells. We actually have point areas where cholera emanated from and our teams have gone in to rectify those places, either by closing down those wells or putting in other measures,” he said.
He also implored members of the public to report any suspected cholera case to ensure early management.
Proper sanitation and hygiene has been touted as one of the best measures to prevent and curb the spread of cholera, but the weak infrastructure in most areas makes this lacking.
Last week, Cabinet announced that the Water and Sanitation Hygiene sector was distributing non-food items including aqua tabs, buckets and soap as part of first-line defence in cholera prevention.
“The sector is also involved in hygiene promotion in affected areas, with 500 community health volunteers having been trained on cholera prevention and management,” said Information, Publicity and Broadcasting Services Minister during the post-Cabinet briefing.
It is expected that the sensitisation of communities about cholera and the availability of such consumables will help in reducing the spread of the outbreak.
In Manicaland, village health workers are playing a major role in disease surveillance in communities as well as educating the public on cholera.
Manicaland Provincial Medical Director Dr Munyaradzi Mukuzunga said six out of the seven districts in the province had reported cholera cases with the most affected areas being Chimanimani, Mutare rural, Mutare city and Mutasa districts.
Emphasis has been on monitoring public gatherings such as funerals which have been identified as one of the causes of the spike in cholera cases in the province.
“We are putting an emphasis on monitoring of gatherings as well as funerals because we realised that the rise in cases was actually attributed to funerals which we were not aware of and the communities were also not aware that the person had died of cholera. That became a transmission area,” said Dr Mukuzunga.
“We are happy that both the community and health workers are picking up the cases which means people can access healthcare early and avoid complications and deaths.”
He said the provincial and district civil protection units had been activated to mobilise resources through the pillars they work with to contain the cholera outbreak.
Refresher training has also been provided for health workers in the most affected districts and for village health workers who are a vital cog in terms of community surveillance, contact tracing as well as monitoring contacts in the community.
Dr Mukuzunga said the province had also rehabilitated some water sources in affected areas while water quality monitoring was also ongoing to ensure that the water sources being used by communities are safe.
He said the provision of containers, soap and detergents to communities was also being looked at.
“We are happy that our environmental health practitioners on the ground are doing contact follow ups currently as we are rolling out the Covid-19 vaccination campaign and next week we will have polio vaccination; we are integrating this with community engagement on cholera to make sure that people are taking precautionary and measures to make sure they are safe from cholera,” he said.
In Mashonaland West three people have now succumbed to cholera in Zvimba district on the borders of Harare province, with the Ministry of Health and Child Care worried about communities refusing defying medical attention.
While officials from the ministry are working to ensure that suspected cholera cases reported in Wards 9 and 12 are contained, they are believed to be having a very difficult time in attending to a community deeply rooted in religious belief under Chief Chirau’s area.
One of the infected persons according to a situation report compiled the district medical officer, Dr Terrence Dandadzi, died on Sunday. The other two including a 72-year-old man died Wednesday and Friday last week.
Among other efforts, health experts have started collecting water samples from boreholes, supplying aqua tabs to the community, and disinfecting homes, vehicles involved and suspected areas.
Cholera awareness campaigns have also been intensified among healthcare workers and the community including inspections of public places, shops and schools.
Said Dr Dandadzi: “Cumulative confirmed cases to date are two, and three deaths. There are 13 confirmed suspected cases and a total of five rapid diagnostic tests have been done and two tested positive,” he said.
There were at least 10 active cases with five admitted at a camp set at Chirau Clinic yesterday evening.
The deceased and a dozen other family and church members currently ill, were said to be refusing medical care based on their religious beliefs.
Reports suggest that the home of the initial death has no suitable toilet and there is a homestead of the Johanne Marange which acts as a clinic where people of the sect who have health challenges go and seek help resulting in the assembly of many people.
According to a situation report from the Ministry, seven were Sunday said to be admitted at the cholera treatment camp.
The patients’ ages ranged from 11 to above 60 years.
One of the villagers, Mrs Angeline Zimbwani Mikiri said there was a need to enforce health measures.
“The family is deeply rooted in religious beliefs,” she said. “Our community is not safe from the people who refuse medical attention and risk spreading the deadly disease.”
Despite calls by the Government for apostolic communities to embrace scientifically proven solutions to ailments including deadly pandemics like cholera and Covid-19, officials from the Health and Child Care Ministry were faced with resistance when they visited the infected area on Sunday.
Mashonaland West acting health director, Dr Gift Masoja said officials had to request for back-up from the police.
“When the team returned to the said village, almost everyone who was supposed to be taken for test went into hiding. This is making the whole situation difficult to deal with,” he said.
The apostolic sect in question, is known for shunning medical attention and only believes spiritual warfare.