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Cholera remains a threat to the global public health and a clear indicator of the presence of inequality and absence of the social development. Cholera is an acute bacterial infection that occurs due to the intake or consumption of water and food that is contaminated with bacterium Vibrio cholera. The bacterium Vibrio cholera multiplies and survives in the environment outside the human body and spreads quickly where the survival requirements are crowded together, that is where there is no waste disposal management and where the water sources are not protected. These conditions are present in the refugee's camps and low-income countries. For example in 1994, there was a cholera outbreak in the democratic republic of Congo in a refugee camp in Goma where 80000 cases were reported (Ali et al. 2012).
Cholera is mainly spread to people through contaminated drinking water and food, and also through person to person contact by the fecal-oral route, therefore, observing good sanitary condition in our surrounding is of utmost importance in controlling its spread. The signs and symptoms of the disease include vomiting, severe watery diarrhea that may lead to severe dehydration in the body, increased heart rate and if not treated it may lead to death within hours. People who show these symptoms require urgent hydration to prevent the symptoms from getting worse since dehydration may lead to the development of severe cholera. Once the vibrio cholera bacteria gets into the human body, the signs and symptoms develop quickly in most cases within hours. Some people are at greater risk of acquiring the disease this includes, the malnourished individuals or those with low body immunity and children aged between two to 4years are highly susceptible as compared to older children. Research has also proven that the people with blood type o have higher chances of developing cholera as compared to others.
The global burden of the disease
The world health organization keeps a public record of the past cholera cases and gives the outbreak updates. WHO indicates that the number of official cholera reported cases represent 5 to 10% of the original number of cases that occur annually. It is estimated that around 1.4 million to 4.3 million people are infected with cholera globally with around 28,000 to 142,000 deaths occurring annually (Ali et al. 2012). According to lunate et al. (2009), approximately 11 million cases of cholera occur worldwide annually among the children below the age of 5 years. However, the older children and adults can also get infected thus mortality can increase among all the age groups. Cholera cases have been reported in many parts of the world, for example between the year 2005 to 2006, cholera cases were reported in Cuba and in African countries such as Kenya, South Sudan, and Tanzania where 216 deaths were reported. 121 people in Iraq were also diagnosed with cholera, which was their first outbreak since 2012 (Ali et al. 2012). Most of the industrialized countries globally have not reported any cases of cholera for a long period, and this is due to their improved sewage and water treatment infrastructure.
The burden of cholera in Haiti.
Cholera outbreak in Haiti was first reported 2002, which was the first incidence in the country in over a century. The outbreak occurred after the huge earthquake in Haiti that displaced more than 1 million individuals and killed more than 200000 people (Pfrimmer, 2012). The outbreak was the worst in the present history whereby 665000 cases of cholera have been reported and 8183 deaths (Pfrimmer, 2012). The disease has spread all over Haiti since 2010 to 2017, and it is linked to political, poor sanitary conditions and the post-earthquake conditions. Before the occurrence of the outbreak, the country had poor sanitation and public health infrastructures, in 2008 37% of the population in the country had limited access to clean drinking water while 83% lacked improved sanitary facilities (Pfrimmer, 2012). This challenge made the nation to be at risk of the outbreak. According to the statistics by the countries ministry of public health approximately 36045 cases and 322 cases were reported in 2005 from January to December (Barzilay et al. 2013). Despite the financial constraint and inadequate infrastructure, the international and concerned Haitians efforts have gained success in minimizing the number of cholera cases from the peak of above 350 000 cases in 2011 to 21916 cases in 2014 (Pfrimmer, 2012).
Common medication and other forms of treatment used in cholera prevention.
Various organizations such as the United Nations, World Bank, and other nongovernmental organizations are working are collaborating with the Haiti government through the implementation of the national cholera elimination plan to eliminate cholera, various methods have been employed in control, this includes,
Oral Vaccination against cholera.
Oral vaccination against cholera is a crucial prevention measure while initiated against the clean water sanitation intervention. The oral cholera vaccines are acceptable, safe and effective and act as an additional method for control of cholera to the other priority control methods. Adults aged 18 to 64 who intend to travel to areas with the cholera outbreak use it (Tuite et al. 2011). The vaccine is given orally in at least three ounces of fluid, and it is approximately 80% effective to people affected by the cholera bacteria at least three months after the initial vaccination (Barzilay et al. 2013). The oral vaccine is given ten days before traveling to the cholera-affected regions. According to the world health organization, the guidelines on cholera vaccines include. First, the oral cholera vaccines should be used in instances of a cholera outbreak, in areas experiencing endemic cholera and during the humanitarian situations which are at high risk of cholera. Secondly, the oral vaccine should not hinder the delivery of other key priority health measures in the control of cholera outbreaks. Over 15 million cholera vaccines have been used in Haiti in the areas with the high cholera outbreaks to help minimize the spread of the disease (Piarroux et al. 2011).
Water and sanitation intervention.
The long-time strategy in the control and prevention of cholera is in the access to clean drinking water and proper sanitation. The effective way to achieve this is through the implementation of the water, sanitation, and hygiene guidelines to help in good sanitation practices, use of clean and safe drinking water and use of good hygiene practices among the people at risk of the cholera outbreak. This interventions need long time funding and continued persistence to ensure the elimination of the epidemic. The introduction of the global hand-washing day also led to the introduction of the intersectoral strategic plan in Haiti whose aim was to create a conducive environment for ensuring proper hygiene and sanitation practices through facilitating information coordination and education on hygiene (Piarroux et al. 2011).
Cholera surveillance is crucial in the integrated disease surveillance system; this involves sharing information at the global level and obtaining feedback at the local level. Cholera is first identified through the clinical test in patients who present the symptoms of severe watery diarrhea. The detection is facilitated by the implementation of rapid diagnostic tests whereby several positive samples lead to cholera alert. The ability to diagnose and monitor cholera incidences is crucial to the surveillance process and strategizing on the control measures. The countries at high risk of cholera should be keen in diseases surveillance to enable the detection and response to the cholera outbreaks.
The United Nations have encouraged increased awareness campaigns on the hygiene measures and the cholera prevention strategies. With the efforts in all the Haiti government departments based at the community level, the united nation is currently meeting its target of ensuring that at least 80% of the Haiti population is aware of the basic hygiene and cholera prevention methods (Barzilay et al. 2013). During cholera outbreak, the united nations in collaboration with the health agents to initiate focus groups and mass sensitization campaigns in the affected areas for example in 2014 approximately 96000 individuals living in Haiti camps were the beneficiaries of cholera sensitization campaigns on the importance of hygiene (Kirk et al. 2015). The health education campaigns should promote various hygiene practices that include safe storage and preparation of food, proper disposal of human waste and hand washing with soap. Funerals of the cholera victims should be adapted to avoid infection among those attending. Awareness campaigns should also be carried out during outbreaks, on the signs symptoms of the disease, the precautions to take, and where to get assistance in case the symptoms appear.
Administration of the oral rehydration solution can treat cholera cases; therefore, oral rehydration should be easily accessible in the community facilities as it is the case for large facilities that provide twenty-four hours care. The cholera patients are also given antibiotics to help in reducing the period of diarrhea and minimize the capacity of rehydration fluid needed. Quick access to treatment is vital during an outbreak since early treatment helps reduce the cases of death. Efforts are in place to integrate the cholera treatment facilities into health structures. The world health organization visited the health centers all over Haiti assessing their working conditions, for example, the number of patients, health staffs present and the services provided. During the first half of 2014, most of the centers were using the national protocol of cholera control. However incidences of cholera increased congesting most of the facilities thus reduction in the quality of care; therefore, there is need to assess the situation to fill the gap (Kirk et al. 2015).
The Barriers to Cholera Treatment and Prevention
The treatment of the cholera patients was hindered by various things this include, first, the withdrawal of the medical partners in the field. This was due to lack of funding that resulted in the closure of the treatment centers in Haiti. The removal of the medical personnel in the treatment centers hinders the response of the disease and acts as contributing factor to the increased transmission of the conditions due to the lack of medication and early detection of the disease.
Secondly, the available diagnostic tests in the health facilities in Haiti are not used in the right manner, and the challenge is experienced in confirmation of cholera cases in the laboratory culture. The transportation of the laboratory samples to the public health national laboratories needs to be more organized; the world health organization is trying to ensure that the WASH and other health actors are contributing to the transportation and collection of the laboratory samples.
Thirdly, the minimal national water and sanitation systems are also contributing to the diahorrea outbreak which was the situation even before the initial cholera outbreak. Therefore, the government of Haiti needs to improve the nation's water and sanitation system to facilitate the prevention of cholera.
The role of the primary care provider.
The primary care provider usually makes the initial diagnosis of cholera. The role of the primary care provider includes, first, noting the history of the patient, such as the age, gender, and the day of the symptoms occur. The caregiver also identifies the characteristic of rice water diarrhea in case a cholera outbreak has been identified in th...
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