Published Date: 2011-07-31 14:37:44
Subject: PRO/EAFR> Cholera-Congo DR (07)
Archive Number: 20110801.226449

CHOLERA - DEMOCRATIC REPUBLIC OF CONGO (07)
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A ProMED-mail post
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International Society for Infectious Diseases
http://www.isid.org

[1]
Date: Wed 27 Jul 2011
Source: The Washington Post, Associated Press (AP) report [edited]
http://www.washingtonpost.com/world/africa/unicef-congo-cholera-outbreak-kills-279-government-declares-outbreaks-in-4-provinces/2011/07/27/gIQAMwu2cI_story.html



Congo cholera outbreak kills 279; government declares outbreaks in 4
provinces
----------------------------------------------------------------------
A UNICEF official says a cholera outbreak in Congo has killed at 279
people and infected more than 4000 others in the last 4 months.

Dr Ibrahim Cisse said Wednesday [27 Jul 2011] that northeastern
Orientale province is worst affected, with more than 1400 cases and
102 deaths. The Congolese government has declared an outbreak in 4
provinces in the large Central African nation. Cisse says the capital
of Kinshasa has seen 124 cases and 14 deaths since mid-June 2011.

Cholera is an easily preventable waterborne bacterial infection that
is spread through contaminated water. It causes severe diarrhea and
vomiting that can lead to dehydration and death within hours.

--
Communicated by:
ProMED-EAFR
<promed-eafr@promedmail.org>

******
[2]
Date: Mon 25 Jul 2011
Source: AllAfrica, Medecins Sans Frontieres (MSF) report [edited]
http://allafrica.com/stories/201107261961.html


The 3 major factors that have promoted the spread of cholera in other
towns along the Congo River are all currently present in Kinshasa:
dense urban population; a lack of hygiene and little access to clean
water; and the confirmed presence of the disease in several locations.

"I had no choice. My youngest son was going out like a candle." In a
roughly constructed building with walls, floor, and roof made from
lengths of plastic sheeting, a worried father sits by his son's side
on a low bed. The main ward of MSF's Cholera Treatment Centre (CTC)
in Mbandaka, the capital of Equateur Province in the Democratic
Republic of Congo, has a partition dividing it in 2. The affected
child and his father are in the 2nd 'ward', for recovering or less
severely-ill patients.

"To get to the MSF treatment centre, we spent all night travelling
down the Congo River," the father continued. "At first I thought my
son had malaria, but after a week of treatment in our village he was
still throwing up and having diarrhoea. I heard about the cholera
epidemic on the radio and then I knew the only option was to get to
the treatment centre as quickly as possible. That evening I held my
son in my arms and we got a place on the last motor-powered boat
going to Mbandaka. All night I watched over him; I didn't dare close
my eyes for a second."

Spreading down the Congo
------------------------
The cholera epidemic, which has so far caused more than 250 deaths,
started in March 2011 in Kisangani, the capital of Oriental Province
and the last stop on the Congo River for the cargo barges that are
the main form of transport in this largely roadless area. An MSF team
treated more than 1000 cholera patients in Kisangani, and, by
mid-April 2011, the situation there was under control. But with
thousands of people travelling up and down the Congo River every day,
sporadic cases started appearing in towns and villages along the
river.

"It was early June 2011 when the epidemic started exploding again,"
said Felix Tran, project coordinator of MSF's mobile emergency team
in Congo. "The town of Bolobo in Bandundu Province started reporting
3, then 5, then 20 cases a day. We sent a small team of experienced
emergency experts who built a treatment centre and have treated
nearly 1000 patients so far.

"Then it was Makanza, Lisala, Mbandaka and a string of other port
towns along the river that started notifying cases. We do not have
enough staff to mount a response in every town, so we monitor the
epidemiological situation, we send a small evaluation team to the
places that are reporting increasing numbers of cases and we go for a
full medical response where we fear the highest potential for a major
epidemic. That was why we chose Mbandaka, a big town with serious
water and sanitation problems and a rising number of cases."

The emergency team in Mbandaka
------------------------------
"We landed at 11 o'clock on a Friday and by midday I was here at the
site of the Cholera Treatment Centre (CTC), opposite the big public
hospital," said Vale Eye, MSF emergency team logistician. "We hired a
lot of manual labour and got to work immediately. When I left at
one-o-clock in the morning, the CTC had taken form. By Sunday, we had
a treatment centre that was ready to receive patients. That's how we
work; we get a lot done in a short time. We've met the minimum MSF
standards and now there are just some details to finish off to bring
it closer to the maximum standards. Given the gravity of the
situation here, we had to just get going and produce a functioning
CTC fast."

A steep learning curve
----------------------
Although the eastern parts of DRC have frequent cholera outbreaks, it
is more than 10 years since the western provinces have had an
epidemic. Joel NyimiNyimi is an MSF emergency team nurse, and in
charge of all medical aspects of the treatment centre in Mbandaka.

"One of my main roles is to train the Ministry of Health doctors and
nurses in how to treat cholera patients. Ideally they will do most of
the treatment and I will have a supervising role. So far we have
treated more than 350 cases so it is busy, and I have a lot of
supervision to do, particularly at night. In other cholera
emergencies I have done, if patients die it is usually at night. The
patients don't stop being ill if the staff are tired and are paying
less attention. I am here during the day and I also visit at 11 pm, 1
am, and 3 am to check that each patient is being properly cared for."

Fear of cholera
---------------
It's not just the medical staff who need to be told about cholera.
The local people know enough about cholera to be very concerned, but
not enough to know how to protect themselves, recognise the symptoms,
and take the appropriate course of action. [A woman] is sitting with
her 7-year-old son in the recovery ward of MSF's CTC, waiting
patiently to be given the all-clear to return home. "When I got back
from the market I was surprised to find [my] son already in bed at 5
pm. Just as I approached the bed he started violently throwing up. 3
times that night he had bad liquid diarrhoea. His eyes were sunken
and he was pale and weak. I got very frightened and I started crying
and praying. I started thinking he might die. I had lost control of
the situation. Then I remembered the radio announcements they had
been playing about the cholera epidemic."

Spreading the word
------------------
Dieudonne Bokwala is the emergency team's health promotion
specialist. One of his 1st actions was to produce a radio message in
the local Lingala language and to schedule for it to be broadcast
several times a day on the 3 main local radio stations. Many of the
patients say that they came to the CTC because they had heard about
it on the radio. Dieudonn has also been training a network of local
volunteers, 1 or 2 in each neighbourhood, to actively spread
information about cholera and the free service offered at the CTC as
widely as possible.

Moving to Kinshasa
------------------
Since 20 Jun [2011], 92 suspect cholera cases have been registered in
Kinshasa, the capital of DRC.

"The port of Kinshasa on the Congo River sees thousands of people
embarking and disembarking every day. If the epidemic takes root in
Kinshasa the consequences could be disastrous," said Luis Encinas,
operations coordinator for MSF. "This is why it is absolutely
essential to immediately take major preventative measures: reinforce
the epidemiological surveillance; limit the spread of the disease;
and treat each end every patient who falls sick from cholera."

The 3 major factors that have promoted the spread of cholera in other
towns along the Congo River are all currently present in Kinshasa:
dense urban population; a lack of hygiene and little access to clean
water; and the confirmed presence of the disease in several
locations. MSF is building a CTC in the crowded suburb of Kingabwa
that will be used to treat patients and also to provide a training
centre for all medical and non-medical personnel involved in the
capital's outbreak response.

Preparing to go home
--------------------
While more patients arrive daily in Mbandaka and the preparations are
under way in Kinshasa, back in Ward 'B' of the Mbandaka CTC, [the
man] is preparing to return home with his son. "I have mixed
emotions; I am so relieved for my son, but at the same time I'm
worried for the other people with the same symptoms in my village.
There are many people with the same illness but they don't know it's
cholera and they may not have the same instinct as me, to come to
Mbandaka for treatment. But the important thing for me is that [my
son is] much better -- they say that soon he'll be able to go home."

--
Communicated by:
ProMED-EAFR
<promed-eafr@promedmail.org>

[Cholera continues to spread along the Congo River favored by dense
populations along the river as well as poor access to safe water and
sanitation facilities. Though response to the current cholera
outbreak continues, the current reports indicate that access to
cholera treatment centres (CTC) is still limited and more CTCs need
to be set up to contain the current fatality rates (7 percent).
Additionally the unmet need for communication interventions to
improve awareness about cholera, its prevention, and availability of
treatment services is still huge and needs to be bridged by
sensitising more local volunteers and engaging the local leaders to
mobilise communities to contain the cholera outbreaks.

A map showing the provinces in the Democratic Republic of Congo can
be seen at
http://en.wikipedia.org/wiki/Provinces_of_the_Democratic_Republic_of_the_Congo.

The HealthMap/ProMED-mail interactive map of the country is available
athttp://healthmap.org/r/01ek. - Mod.JFW]

See Also

Cholera - Congo Republic: WHO 20110724.226042
Cholera - Congo DR (06): WHO 20110723.226041
Cholera - Congo DR (05) 20110721.225943
Cholera - Ethiopia: susp. 20110717.225753
Cholera - Congo DR (04) 20110715.225687
Cholera - Ghana (13): (Central) 20110714.225566
Cholera - Cameroon (06) 20110710.225350
Cholera - Nigeria (10): (Plateau) 20110630.224868
Cholera - Cameroon (05) 20110630.224867
Cholera - Nigeria (09): (Niger), confirmed 20110625.224562
Cholera - Cameroon (04): (North) 20110623.224466
Cholera - Cote d'Ivoire (04): (Abidjan) 20110621.224295
Cholera - Niger: (Tillaberi) 20110620.224197
Cholera - Congo DR (03): (Budandu) 20110618.224043
Cholera - Ghana (12) 20110612.223505
Cholera - Cote d'Ivoire (03): (Abidjan) 20110612.223483
Cholera - Cameroon (03): nationwide update 20110611.223478
Cholera - Nigeria (08): (Adamawa) susp, RFI 20110610.223396
Cholera - Zimbabwe (07): (Manicaland) 20110609.223393
Cholera - Uganda: (Hoima) susp, RFI 20110607.223117
Cholera - Nigeria (07): (Abia) susp. 20110602.222848
Cholera - Nigeria (06): (Abia) susp. 20110601.222697
Cholera - Somalia (02): Mogadishu 20110531.222482
Cholera - Cameroon (02): nationwide update 20110529.222455
Cholera - Mozambique: (Maputo) 20110503.221703
Cholera - Cameroon: nationwide update 20110502.221659
Cholera - Zimbabwe (06): (Manicaland) 20110502.221658
Cholera, diarrhea and dysentery (02) - Somalia 20110428.221508
Cholera - Congo DR (02): (Orientale) 20110413.220970
Cholera - Nigeria (05): (Taraba) susp. 20110408.220718
Cholera - Zimbabwe (04): (Masvingo) RFI 20110407.220677
Cholera - Ghana (11): (Central) 20110402.220489
Cholera - Ghana (10): (Eastern) 20110331.220420
Cholera - Congo DR: (Orientale) 20110327.220252
Cholera - Burundi: (Bururi) 20110322.220094
Cholera - Ghana (09): 20110320.220028
Cholera - Ghana (08): (Greater Accra) 20110318.219947
Cholera - Somalia: (Mogadishu) 20110312.219671
Cholera - Ghana (07): (Greater Accra) 20110311.219623
Cholera - Ghana (06) 20110309.219532
Cholera - Ghana (05): (Eastern) 20110305.219333
Cholera, diarrhea and dysentery - Somalia 20110228.219036
Cholera - Ghana (04): (spread) 20110224.218808
Cholera - Cote d'Ivoire (02): (Lagunes) 20110221.218538
Cholera - Ghana (03): (Greater Accra) 20110214.218175
Cholera - Nigeria (03): (Kogi) 20110211.218069
Cholera - Ghana (02): (Greater Accra) 20110209.217943
Cholera - Cote d'Ivoire: (Abidjan) 20110207.217845
Cholera - Nigeria (02): (Kano) 20110207.217844
Cholera - Zambia (02): (Southern) 20110203.217836
Cholera - Ghana: (Greater Accra, Central) 20110203.217835
Cholera - Cote d'Ivoire: (Abidjan) 20110203.217834
Cholera - Zimbabwe (03) 20110127.217664
Cholera - Zimbabwe (02): (Manicaland) 20110116.217208
Cholera - Nigeria: (Niger state) 20110116.217207
Cholera - Tanzania 2011 (01): Dar es Salaam 20110108.216933
Cholera - Zambia 2011 (01) 20110108.216930
Cholera - Zimbabwe 2011 (01): Harare 20110108.216929
...................................jfw/mj/be