Simiyu Region, January 2016 - Simiyu is among the 22 regions in Tanzania which have been hard hit by the cholera outbreak in the country. The region started reporting cholera on 24th December 2015. By 20th January, 2016 a total of 153 cases had been reported out of which 115 occurred in the previous 14 days.

A total of 10 deaths had also been reported. Most of these cases are reported from Bariadi and Busega districts with cases coming mainly from villages along the banks of the river Duma which separates the two districts.

The close proximity of these districts and movement of people has made it easy for cholera to spread in the two districts. The people living in villages along the banks of the river use unprotected wells and also rely on the river for their water supply. The river Duma is considered to be a source of the cholera infection due to unfavorable human activities. Access to sanitation is also a challenge in the villages, where despite the ongoing sanitation campaign, a number of households do not have toilets.

Since the commencement of the outbreak in the region, the communities have been actively engaged in the prevention and control efforts. Village health workers and community change agents have been conducting health education in all the hamlets on prevention methods with particular emphasis on cholera, hand washing, household water treatment and use of toilets. Community meetings have also been conducted to sensitise the communities and discuss solutions to the problem.

However, the spread of cholera in villages has been perpetuated by poor access to clean and safe drinking water and poor sanitation, community deaths and unsafe burials, communal gatherings, particularly open markets and movement of people across the two districts. Currently, there has been an increase in the number of cholera cases and deaths from Mwamondi, Imalamate and Jiseesa villages.

In order to address the situation, the Regional Commissioner for Simiyu Region convened a consultative meeting between Bariadi and Busega districts in order to find solutions to stop cholera transmission. The meeting was held at Dutwa secondary school in Bariadi. The MOH and WHO cholera outbreak Rapid Response Team was also present in Bariadi and participated in moderating the deliberations and adoption of recommendations for both districts.

The participants were from the district, ward and village levels and constituted members from Primary Health Care, Disaster and Security committees. The meeting was chaired by a representative of the Regional Commissioner for Bariadi, Mr. Albert Rutaihwa, the District Administrative Secretary for Bariadi and the acting Regional Medical Officer, Dr. Maeka Magune.

In attendance were officials from Ministry of Health, regional and district offices, District Medical Officers; District Executive Officers; Ward Executive Officers; District Commanding Officers; District Security Officers; Police Officers; Religious Leaders; Representatives of the Primary Health Care Committees; Political parties and Village Executive Officers.

The CHMT representatives from Bariadi and Busega briefed the meeting about the cholera situation in the two districts and the interventions which were put in place to address the problem. The community leaders and representatives from various institutions raised serious concerns about cholera in the two districts.

Notably, were concerns about poor access to clean and safe water, long distances to the Cholera treatment centres, treatment of water from wells; limited health education and sensitization in communities, misconceptions about cholera and harmful beliefs and practices, limited involvement of community leaders; political interference in enforcement of public health laws; harassment of non-uniformed police officers by villagers during enforcement of Public Health bylaws, late care seeking and the need for decontamination of the patients discharged from the cholera treatment centres.

The meeting resolved unanimously that cholera prevention should rest in the hands of the community and that they should remain accountable for their actions. The key resolutions included:

• formation of committees at hamlet level to be in charge and present daily reports about the situation;
• to promote household water treatment particularly boiling of drinking water and treatment with aquatabs;
• to aggressively promote the construction of toilets and ensure their use; to promote environmental sanitation;
• to control gatherings in the community,
• to ensure proper enforcement of public health regulations and ensuring that the police are uniformed to avoid harassment of officers;
• to intensify  sensitization and health education in places such as churches, schools and markets; to ensure proper use of the river;
• to remove political interference and protection of those who break laws and to address the misconceptions on cholera at the community level.

The cholera outbreak rapid response multi disciplinary team from MOH and WHO which visited Simiyu region from 5th to 15th January worked with the regional  and district officials to strengthen the key aspects of outbreak management particularly coordination of the response through engagement of various sectors, strengthening surveillance and laboratory functions, providing standards and guidance on cholera case management, educating and engaging communities in the fight against cholera and promoting WASH interventions.

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Below:

01 Engaging communities along the Duma river

02 The Ministry of Health /WHO Cholera Rapid Response Team with officials from Bariadi District Council takes a tour of Duma river, an unprotected water source used by surrounding communities.

03 WHO staff participate in the orientation of Village Health Workers and teachers using the Cholera flip chart at Mwamondi village in Bariadi district