Imeldah Chulu resides near Matero level 1 hospital in Lusaka District, Zambia. The hospital is home to one of the six community-based cholera treatment units in the district, in addition to two larger cholera treatment centres at the National Heroes Stadium and Levy Mwanawasa University Teaching Hospital.
Chulu’s male relative recently fell ill after consuming food and drink from a shop near his home. He was quickly taken to a nearby clinic, put on a drip, and later transferred to Heroes Stadium, where severe cholera cases are treated. Fortunately, he received the necessary treatment and is recuperating. “These places are working,” says Chulu. “While we want the government to do more, we see that they are making an effort.”
Lusaka District carries the highest burden of cholera cases, accounting for 75% of all cases nationwide. As of 24 January, there were 10,720 cumulative cases and 442 deaths since 14 October 2023, with a case fatality rate (CFR) of 4%. The acceptable cholera CFR should be 1% or below, according to the World Health Organization (WHO).
As part of efforts to accelerate outbreak control measures, WHO is supporting Zambia’s Ministry of Health to conduct assessments of the six cholera treatment units (CTU) in Lusaka’s sub-districts to address gaps in the current response.
The assessment, conducted by a team of experts, is focusing on critical areas such as medical supplies, equipment, sufficient space, implementation of infection prevention measures, and the need for additional supplies and equipment to enhance operations at the treatment centres.
The results of these assessments will help identify gaps in current facilities and assess the need for additional CTUs to complement existing ones. This will help improve the quality of care and strengthen the country’s response capacity,” says Dr Kamara Rashidatu Fouad, case management officer at WHO Regional Office for Africa.
Dr Fatima Yikona, the medical superintendent at Chelstone Zonal Hospital in Lusaka, acknowledges the challenges but sees progress. “We don’t have enough space to manage our patients, but it is better now with Heroes opening. Now we don’t have patients who do not have a bed.”
Heroes, a recently opened treatment center in central Lusaka, is the largest in the country and is now helping to manage a large number of severe cases and relieve the burden from the surrounding community-based cholera treatment units. “In many of the treatment units we have observed limited space to treat clients and implement thorough infection and prevention protocols, as well as insufficient medical supplies and equipment,” says Dr Nathan Bakyaita, WHO Representative in Zambia.
Once the results of the assessments are finalized, the Ministry of Health will determine the next steps and where to focus efforts to manage the volume of cases, improve occupational and patient safety, and mobilize additional resources.
The outbreak is spreading at a fast pace. In the seven days ending on 26 January 2024, 3229 cases were reported, marking a 5.6% rise compared with the previous seven days. With the high number of cases, the outbreak is one of the worst in the country’s recent history.
A vaccination campaign is currently underway, targeting 1.5 million people, including children, health workers, and individuals at high risk of infection in the worst-affected areas. The campaign complements the ongoing measures, including provision of clean water, infection prevention and control, treatment, and improvement of hygiene services to halt the outbreak. “I encourage people to follow the health guidelines like washing hands, keeping their homes clean, where they throw rubbish, to just clean, even the toilets. They should use chlorine water according to the guidelines we give and if they don’t have that they should boil the water,” says Selestina Kabwela, a community-based volunteer.
