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Posted by on Jan 7, 2009 in Ethics, Infectious diseases

The Mess That Is Zimbabwe Gets Messier

The Mess That Is Zimbabwe Gets Messier


In a country checked by stratospheric inflation and political corruption, a persistent cholera epidemic in landlocked Zimbabwe has now taken more than 1700 lives and sickened 35,330, according to the latest report from the World Health Organisation.

Since August 2008, the epidemic has affected all provinces in the country, reveals WHO; however, a large percentage of cases have been documented in Budiriro, a congested suburb of Harare, and in Beitbridge, a border town with South Africa. The overall fatality rate of disease is reported at 4%, but death rates have escalated to 20%-30% in remote areas.

The organization Medecins Sans Frontieres (Doctors Without Borders) reports a “clear shift” in cholera cases from Zimbabwe’s urban areas to suburban and rural towns, which logistically confounds disease management. Nevertheless, unlike WHO, MSF reports an overall decrease in the number of cholera cases in Zimbabwe. MSF suggests that tally differences between the 2 organizations may be a function of the spread of disease and disease-reporting capabilities. Sources cited at Wikipedia indicate that the cholera epidemic has spread to neighboring countries Botswana, Mozambique, South Africa, and Zambia.

Cholera, caused by the bacterium Vibrio cholerae, is primarily transmitted through contaminated food or water. The characteristic symptom of copious, watery diarrhea, caused by the bacterial enterotoxin, can lead to death through dehydration. The collapse of clean water supplies, sanitation measures, and garbage collection in Zimbabwe are aggravating factors of the epidemic. Professional medical care in Zimbabwe has also been stymied by the country’s economic crisis. To top it off, the rainy season began in November.

WHO currently urges proper food safety and personal hygiene, as well as the use of oral rehydration salts to reduce the mortality risk associated with cholera. Prophylactic antibiotics are discouraged, and once an outbreak has begun, the “internationally available WHO prequalified oral cholera vaccine” is not recommended. (The parenteral cholera vaccine was never recommended by WHO because of its low efficacy and risk of adverse events.)

Map showing spread of cholera in Zimbabwe as of December 6, 2008, from Wikipedia.

bmartin (1127 Posts)

A native East Tennessean, Barbara Martin is a formerly practicing, board-certified neurologist who received her BS (psychology, summa cum laude) and MD from Duke University before completing her postgraduate training (internship, residency, fellowship) at the Hospital of the University of Pennsylvania in Philadelphia. She has worked in academia, private practice, medical publishing, drug market research, and continuing medical education (CME). For the last 3 years, she has worked in a freelance capacity as a medical writer, analyst, and consultant. Follow Dr. Barbara Martin on and Twitter.