Angolan cholera epidemic could have been prevented

ANGOLA

An epidemic of cholera that has infected more than 35 000 people in Angola in the past three months and killed more than 1300 could have been prevented by investment in basic services, the charity Médecins Sans Frontières said last week.

The agency says the outbreak is an example of how Africa is being crippled by preventable diseases due to poverty and lack of infrastructure, pointing out that the epidemic first started in the crowded shanty towns around the capital, Luanda, in mid-February.

The population of Luanda has doubled in the past decade, and most of this growth is concentrated in slums, where “there has been virtually no investment in terms of water, sanitation, drainage, and waste disposal,” says the agency. Half of the cases have occurred in the capital, where 90% of its estimated 5.5 million population live in overcrowded shantytowns, known as musseques.

Four years after the end of Africa’s longest civil war, conditions for most people in Angola have scarcely improved, the agency claims in a report issued last week.

“Despite impressive revenues from oil and diamonds, there has been virtually no investment in basic services since the 1970s.” Without clean water, and given the lack of proper drainage and rubbish collection, “disease is rampant” in the vast slums. “This disastrous water and sanitation situation makes it virtually impossible to contain the rapid spread of the outbreak.”

The situation has been worsened by heavy rains that last month inundated the slums.

The outbreak has now spread to other parts of the country, with cases reported in 11 of Angola’s 18 provinces. Its spread in some of the provincial towns has been “extremely rapid and marked by very high mortality,” with over 15% case fatality in some places.

The agency, which has established 10 new treatment centres around the capital, is concerned by the “very limited means” dedicated to containing the outbreak. Without sufficient quantities of water, it is impossible to ensure minimum hygienic measures. “Telling people that they must wash their hands is not going to work if they barely have enough water to drink.”

“Cholera is right in its element in the shanty towns of Luanda,” said David Noguera, the charity’s emergency coordinator in Angola. “Concurrent to our efforts to provide treatment, preventive measures such as a massive emergency intervention to provide free of charge water in the affected areas are needed.”

He said this must be done immediately to prevent many more people from becoming infected, warning, “If nothing is done to improve water supply and sanitation, this outbreak could continue on this scale for months to come.”

 
UPDATE
2006
By the end of 2006, the outbreak reached 16 provinces out of 18. Angola recorded 67257 cases and 2722 deaths, representing a huge fatality rate of 4.5%. Angola was the most affected country in the world in number of reported cases. Africa registered 99% of all the cases in the world.
2007
A total of 16320 cases and 419 deaths have been reported in 16 out of the 18 provinces, from 01st January to Aug 12 2007.
The case fatality rate is 3%.
Mado reporting from Luanda, Angola.
 
1 British Medical Journal, 27 may 2006 http://www.bmj.com/cgi/content/full/332/7552/1234-b 
Report. Murky waters: Murky Waters: Why the Cholera Epidemic In Luanda (Angola) Was a Disaster Waiting to Happen http://www.msf.org/source/countries/africa/angola/2006/cholera_briefpaper.doc
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