MSF has set up treatment centers in Cameroon, Chad, Niger and Nigeria after an outbreak of cholera occurred in a number of places in the whole region.

In early summer, a cholera outbreak appeared in four neighboring countries in western Africa. Although cholera is endemic in the region, there have been far more cases than usual.

Cholera is a bacterial infection that leads to severe watery diarrhea and vomiting. Treatment is simple: the loss of fluids is compensated with a salt and sugar based rehydration therapy, administered either orally or by infusion.  “Due to rapid dehydration, cholera can lead to death within hours. It needs to be treated fast”, explains Issiaka ABOU, MSF-Head of Mission for Chad.

With the number of cases rising significantly in the last few weeks, MSF has implemented several medical interventions in all four countries:

Chad
The first cases of cholera in Chad appeared at the end of June 2010 and since then the epidemic spread in 12 districts. As of September, 1836 cases have been reported with a mortality rate of 5.2 percent (96 deaths).    

The capital city of N’djamena registered the first cholera case at the beginning of September, and two districts (south and east) are now affected by the epidemic. MSF is supporting the Ministry of Health’s 40-bed cholera treatment centre (CTC) at Liberté Hospital since September 8th and already treated 138 patients. MSF also set up oral rehydration points in basic health units and provided an ambulance for severe cases to transfer to the hospital. In the district of South Ndjamena, MSF teams are supporting a 40-bed CTC at Samaritan Hospital and a 20-bed cholera treatment unit (CTU) at Union Hospital and established 3 oral rehydration points.     

In mid-September MSF teams arrived in the town of Bol, Lac region, from where a total of 673 cases and 47 deaths were reported. A cholera treatment unit was set-up in Bol, the team is now expanding the activities to Kaygaand and Tchokoutalia where most cases are coming from.

In addition, there are 130 cholera cases and three reported deaths in Bokoro, where MSF has set up a nutrition intervention in May. A cholera treatment center has been set up with the Ministry of Health and the MSF team is providing technical support as well as water and sanitation assistance. An MSF team is providing support to the Ministry of Health in Fianga, at the Cameroonian border, where a small outbreak has been confirmed and continues to monitor the situation in that area.

Cameroon
In Cameroon, the first cases were reported in early May, and started to increase in July. Until September 12, 6119 cholera-cases were registered in Cameroon’s “Extrême Nord” (Extreme north) region, of which 410 people have died.

MSF set-up and manages two cholera treatment units in Marua and Mokolo towns. In Kolofata and Mogode, teams are supporting the units already in place by providing hygiene management and case management. MSF is also donating water and sanitation supplies and medical material.

“In Cameroon, we believe that the epidemic has peaked now but we have to be prudent about forecasts”, says Dr. Phil Humphris. Therefore MSF continues to assess locations in the region “Extrême Nord”.

Niger
By September 17th, 567 cases of cholera had been detected in South Niger, of which 39 people died.  Since early July, several small outbreaks started in the regions closest to Chad and Nigerian borders, including the regions of Diffa, Zinder and Maradi. An epidemic has not been officially declared in the country so far.

MSF supports the local health authorities in the areas where its nutritional programs are ongoing. In Maradi and Zinder region, MSF and its Niger partner organization “Forsani” thus provided human resources and medical material to set-up cholera treatment units in Sae Saboua, Tibiri, Safo, N’Yelma, Dan Issa , Mazada Abdou, Maradi hospital and Hamdara. MSF teams are also involved in household disinfection and community sensitization.

Overall, the cholera situation in Niger remains localized, unlike the malaria epidemics and the malnutrition crisis. Nearly 200,000 severely malnourished children and 1.2 million malaria cases have been notified in the country since January 2010. More than 85,000 children with severe malnutrition were admitted since the beginning of the year. Food supplements are distributed to 143,000 others that remain vulnerable.

Nigeria
In the State of Borno, MSF is supporting the Ministry of Health’s 116-bed cholera treatment centre in Maïdiguri, the district most affected by the epidemic. The teams already treated more than 300 patients, of which 7 died, in one week of activity. The data collection monitoring and the exploration of others district are still going on. Oral rehydration points will also be set up to take care of simplest cases of cholera in other districts in Borno State.

In the State of Bauchi, MSF teams are treating patients in the 200-bed cholera treatment centre inside the central hospital. As well, 31 oral rehydration points have been set up and outreach activities (water chlorination, hygiene promotion and education) are ongoing to prevent the spread of the disease among communities. Since mid-July, more than 3,300 cases have been treated by MSF teams and Ministry of Health staff.

In Northwestern Nigeria, specifically in Zamfara state, 8 local-government areas out of 14 have declared over 1000 cases of suspected cholera, and more than 100 deaths.  MSF is supporting, through its mobile teams, the Ministry of health clinics by providing supplies, information, education and communication, training and infection control. A cholera treatment unit has also been constructed in Anka town.  Additional international and national staff has been employed by MSF to support the Ministry of Health in its response. MSF will also set up two cholera treatment units in two adjacent districts, and oral rehydration points will be established to take care of simplest cases of cholera in other districts of the same State.
 
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