HARARE, 21 January 2010 (IRIN) - A year ago Zimbabwe was immersed in one of the continent's worst ever cholera outbreaks, and more of the same was expected in 2010, but the waterborne disease has so far kept a low profile.

The cholera epidemic that began in August 2008 and lasted for a year before it was officially declared at an end in July 2009 caused the deaths of more than 4,000 people and infected nearly 100,000 others.

The 2008-09 outbreak was attributed to dilapidated and broken sanitation and water infrastructure, much of which is still in the same state, raising the fear that the 2009-10 rainy season would bring a resurgence in cases.

Cholera, a waterborne bacterial disease, infects the gastrointestinal system, causing vomiting and diarrhoea that can lead to acute dehydration; left untreated, the disease can kill within 24 hours.

In its latest epidemiological bulletin the World Health Organisation (WHO) reported 149 cholera cases, resulting in five deaths, between September 2009 and 10 January 2010, vastly lower figures than for the same period a year previously: by January 2009, 1,912 people had died and more than 37,000 cases reported.

This season the case fatality rate has dropped from 5.1 percent to 3.4 percent - still higher than the expected average of about one percent. Ten of the country's 62 districts have been affected by the current outbreak, compared to 51 districts last year, the WHO bulletin said.

The distribution pattern of the disease in 2009-10 has also shifted, with 82 percent of cases emanating from rural areas and the balance of 18 percent from urban areas. During the 2008-09 outbreak, 66 percent of cholera cases occurred in urban areas and 34 percent in rural areas.

In 2008-09 the capital, Harare, was the epicentre of the epidemic; in the working-class suburb of Budiriro, 30 strains of cholera were detected and all water sources in the area were contaminated, but in the last few months WHO has reported only six cases in the capital, and no deaths.

The breakdown in water infrastructure and failure to collect refuse, coupled with a collapse of sewage systems that caused raw sewage to spill onto city streets, and the shallow wells dug by residents to access ground water, provided ideal conditions for the disease to breed and spread.

The threat of cholera usually recedes as the rainy season tapers off, but in 2008-09 it stubbornly continued ratcheting up its death toll, well after the rains had ended.

Harare mayor Muchadeyi Masunda told IRIN the 2008-09 outbreak had caught them by surprise, but "the cholera epidemic prepared us for another outbreak, in the sense that there are a lot of strategies and structures to combat any outbreak."

He noted that "Our health department's clinics throughout Harare are ready to deal with any cases that may arise. The residents are now more informed on how to avoid or react to reports of cholera cases."

Water disconnections

With a few months of the current rainy season still remaining, the Harare municipality has begun disconnecting water supplies to residential homes for non-payment, despite protests by some homeowners that they have been billed for services they did not receive or use.

"We are disconnecting water because we want better service delivery, and that is what we want to provide. We have done this before and we do not want a situation that would undermine the capacity of the council," the Harare municipality spokesman told a local newspaper.

"People need treated water and for us to offer them treated water, they must fully settle their bills." The disconnections contradict national government instructions that residential water supplies should not be disconnected for non-payment.

Water Resources minister Sam Sipepa Nkomo told IRIN: "We will engage the mayor of Harare and the municipality, because our position as government is that there should be no disconnections and that payment methods can be varied, like having residents pay in instalments."

Source http://www.irinnews.org