| Uganda |
Use of contaminated river water mainly from River Lhubiriha. Poor sanitation resulting from wide spread open defecation. Poor food handling, storage and cooking practices especially eating of cold food. Bathing in water sources mainly rivers (Lhubiriha). Bad personal hygiene in particular not washing hands with soap. Rampant migration along the country borders with DRC and vise versa. Bad handling of the dead bodies involving opening and touching of the corpse. |
Chlorination of water for household use especially for drinking and food preparation. Promotion of eating of hot foods, safe food preparation and boiling of drinking water. Sanitation, safe water chain and hygiene promotion. Inspection and enforcement of hygiene in the community and in the public places (schools, markets, hotels, etc). Health education on cholera prevention and treatment. Disease surveillance with emphasis on early detection and reporting of suspected cases and deaths. Treatment of the sick in the Cholera treatment centres and in Oral rehydration centres. Medical supervision of the suspected cholera burials to limit community contact with the corpse. Restriction of feasting and promotion of infection control through hand washing, disinfection, good sanitation and hygiene practices. |
The outbreak was protracted for over 3 months which disrupted other routine services by withdrawing resources (human, logistics and infrastructure). Lack of information sharing between the two neighboring countries (Uganda and DRC). Inadequate risk factor assessment since some patients originated across the border in DRC where the Ugandan health workers could not easily access. Poor communication between the patients and the health workers due to language barrier; the official communication language for the health workers in Uganda was English while that in DRC was French. Lack of collaboration between the two sister governments (cholera actors) in implementation of the cholera response. Rampant movement of the patients and communities across the border which complicated the follow up for risk assessment and exacerbated the spread of the infection. Lack of accurate population data for response planning especially for quantification of supplies for water chlorination, and hygiene. During the 18th and 24th calendar weeks, the outbreak along Uganda-DRC border spread to two different localities in the interior within the same border district leading to 102 cholera cases with no deaths. These outbreaks in the interior were quickly detected and controlled within two weeks of confirmation for each affected location. |
| Malawi |
Floods leading to contamination of the water sources. Poor sanitation and hygiene. Use of contaminated water sources. Migration across the Malawi-Mozambique border and vise-versa. |
Similar interventions as those implemented in Uganda plus use the of OCV to complement the WASH interventions. A total of 160,000 doses of OCV were imported for vaccination campaign and used for cholera control in Malawi. |
Similar challenges as those documented in Uganda were noted in Malawi except the following: the border was Malawi-Mozambique and the official language of communication for the health workers in Mozambique (replacement for DRC) was Portuguese not French. Implementation of OCV required accurate data which was not available since the population in Mozambique which also benefited could not be accurately estimated. The recommended vaccine dose for OCV by WHO is two doses given 14 days apart. However, some clients mainly those from Mozambique received only one dose and could not be located to receive the second dose. The outbreak later spread to other districts in Malawi namely; Blantyre and Ntcheu leading to 60 cases and 3 deaths with high CFR of 5%. |
