The current cholera outbreaks in Zambia and Malawi are a reminder of challenges posed by infectious diseases in urban and rural communities.
Cholera is caused by bacteria, vibrio cholera, which goes into the body through consumption of food or water contaminated with faeces.
Poor sanitation increases the likelihood of taking contaminated food and water.
Where there is open defaecation, run-off collects wash away faecal matter and deposits it in unprotected wells, rivers and lakes.
Drinking water not treated with chlorine or boiling puts people at risk of contracting cholera.
For people living close to rivers and lakes, defaecating in water perpetuates cholera outbreaks.
This scenario is mostly common in rural areas where access to treated piped water is limited.
But why are cholera outbreaks still occurring in urban and semi-urban areas—including Lilongwe and Lusaka?
There had been deadly cholera outbreaks in London. The outbreak near Broad Street in 1854 killed over 600 people and physician John Snow discovered that contaminated water was the source of the outbreak. Soho District, where the outbreak occurred, was experiencing similar problems that developing countries experience today: influx of people into cities and lack of sanitary services to support the increasing population.
Overcrowding in cities has resulted in poorly designed settlements with poor sanitation facilities.
Poor waste disposal, lack of clean toilets and unsafe drinking water have contributed to the spread of cholera. Flies from filthy toilets carry germs and contaminate foodstuffs that are not covered. Those who consume contaminated food may contract cholera.
In most informal settlements food business is rampant. People on the move grab mangoes, boiled cassava, boiled maize and home-made drinks packaged in reused bottles rinsed by the vendor.
The challenge is what sort of water was used to clean the utensils, the food or the hands of the person serving the food?
The food vending business is also common in city markets where waste is lying everywhere and flies swarm these places. Poor sanitation in marketplaces could be a source of cholera.
Identifying the actual source of the disease is a huge task. This could explain why Zambia banned gatherings and food vending in Lusaka.
While reducing the risk of the spread of cholera, this ban has affected the livelihoods of many who survive on selling food products.
A ban like the one imposed in Lusaka does not only prevent people from getting their daily snack from the street or market, but also deprives the food vendors of the needed income to sustain their households.
The cost of the outbreak to government and the whole population should never be underestimated.
Cholera management, prevention and control require a lot of resources both human and monetary. These hidden costs may never be visible to the public and the affected communities.
For the cholera camp to run, the medicine and all necessary chemicals to treat and disinfect all contaminated areas, equipment used by the medical personnel, fuel and other transportation costs to transfer cholera patients to the camp, the list is endless.
On the community level, deaths of cholera patients result in loss of livelihood, breadwinners, human capital, skills and loss of labour. People are unable to tend to their farms and other businesses to take care of the sick.
Balancing the need to control and prevent cholera and how this affects livelihoods for small-scale business owners and communities is no simple matter.
The cost of prevention is cheaper than the cost of curing a disease.
Preventing cholera outbreaks in our communities begins with every individual, observing proper hygiene in our households, drinking and using safe water, keeping our surroundings clean and ensuring there is a clean toilet.