|East Cape||Free State||Gauteng||Kwazulu Natal||Mpum-
|North West||Northern Cape||Northern Province||Western Cape|
|Total Cases Reported||1||1||63||105247||111||6||0||794||1|
|Number of fatalities||0||0||4||218||4||0||0||2||0|
|Last report Date in 2001||2/3||11/1||10/5||27/7||10/4||15/3||27/2||4/5||7/5|
KwaZulu Natal, Northern Province, Mpumalanga and Gauteng are the four provinces where the problem of cholera is most severe. The KwaZulu Natal Province has the majority of cases (99% of the total number of cases reported nationally) and the highest number of fatalities (96% of the total number of fatalities reported nationally).
Statistics suggest that despite the interventions that the government and other stakeholders are implementing, the cholera situation in the province is getting worse.
Populations at risk
Cholera occurs in epidemic form when there is rapid urbanisation without adequate sanitation and access to clean drinking water. Hence, the focus of epidemics/pandemics has shifted to developing countries over the last century. Other risk factors include poor hygiene, overcrowded living conditions and lack of safe food preparation and handling. Unstable political and environmental conditions such as wars, famines and floods that lead to displaced populations and the breakdown of infrastructure are very important risk factors as far as the cholera disease is concerned.
Economic and social impact
It is important to highlight that people often underestimate the socio-economic impacts of water and sanitation related diseases and this is one of the root causes of the deplorable state of many water supply and sanitation initiatives.
Cholera, like other water related diseases, can cost governments billions of rands to eradicate. Absenteeism by the workforce caused by cholera adversely affects industrial output. Cholera outbreaks can adversely affect tourism and affect tax revenues (productivity losses for business and individual due to the illness decrease tax revenues).
Cholera outbreaks may lead to loss of trade.
People living in high-risk areas can protect themselves by following a few simple rules of good hygiene and safe food preparation. The safe disposal of human excreta is of the utmost importance in control of infectious and other communicable disease. Because of the importance of the safe disposal of human excreta, the building of appropriate sanitation systems often is considered synonymous with improving sanitation. However, experience has shown that this is not necessarily the case; and that unless there is an effective primary health care education programme, the installation of improved sanitation facilities alone may not result in improved health.
As with sanitation, water supply must be seen as a complex system of interrelated factors. The successful water supply system is therefore to be found in the successful organisation of the factors affecting the health and social organisation of the community. The provision of an adequate supply of potable water must just be seen as a part of this system. Studies seem to suggest that improvement of water quality alone would have little effect on water handling practices and the subsequent contamination of other stored water. Domestic activities related to the storage and use of water may have a more important bearing on faecal-oral disease transmission. The mere material improvement of water supplies would doubtless prove to be less effective than if people were advised by means of health education of the sources of their disease problems and how to avoid them. Primary health care education is a vital component in prevention of cholera.
Treatment of Cholera
The most important treatment is rehydration, which consists of prompt replacement of the water and salts lost through severe diarrhea and vomiting Early rehydration can save the lives of nearly all cholera patients. Most can be rehydrated quickly and easily by drinking large quantities of a solution of oral rehydration salts. In individual cases of severe cholera, an effective antibiotic can help shorten illness, though rehydration remains the mainstay of treatment.
Adequate water supply and sanitation are basic requirements for life. Access to clean water and improved sanitation facilities is a fundamental human right. Yet, in many developed and developing countries, water source quality shows continued deterioration and in many cases depleted. These effects are a function of increasing population pressure, agricultural misuse and the inability to keep pace with the increasing demands on the resource. Reported numbers underestimate incidence of water supply and sanitation related diseases, particularly the low endemic diseases that are widespread in both developing and developed countries. A better understanding of the socio-economic, environmental and public health consequences of water supply and sanitation related diseases obtainable through better monitoring surveillance systems, may help the public and policy makers understand the value of microbiologically safe water as well as improved sanitation facilities. In developing countries where resources may be inadequate, particularly in rural communities, basic hygiene education and sanitation programs can be used to improve human health.
Critical needs for future microbiological safety of water include more realistic valuation of water. This requires better education on the value and limitations of the resources for both public and policy makers. The burden of water supply and sanitation related disease is constantly underreported and the surveillance systems are inadequate, thus intervention studies and aggressive surveillance systems are necessary to provide a clearer understanding of disease burden from contaminated water. There is a need for a better understanding of increasingly susceptible populations in transmission of such diseases. Microbiologically safe water cannot be assumed, even in developed countries. The situation will worsen unless measures are immediately taken. The need for safe drinking water as well as adequate sanitation is a need that binds all of humanity into a single, global community.
DEPARTMENT OF WATER AFFAIRS AND FORESTRY (DWAF) (2001) . DWAF website: http://sandmc.pwv.gov/ndmc/cholera/
FORD TE and COLWELL RR (1996) A Global Decline in Microbiological Safety of Water: A Call for Action. A Report from the American Academy for Microbiology, USA.
GENTHE B and SEAGER J (1996). The effect of Water Supply, Handling and Usage on Water Quality in Relation to Health Indices in Developing Communities. Water Research Commission Report No. 562/1/96, Pretoria.
MITCHELL R (1972) Water Pollution Microbiology. John Wiley and Sons Inc., USA.
WATER RESEARCH COMMISSION (WRC) (1993) Guidelines on the Cost Effectiveness of Rural Water Supply and Sanitation Projects. Water Research Commission Report No. 320/1/93, Pretoria.
WORLD HEALTH ORGANIZATION (WHO) (2001) Cholera and the Global Task Force on Cholera Control. Global Task Force on Cholera Control. Geneva, Switzerland, July 2000.
Copyright 2001, Janice Limson. All Rights Reserved