By Tendai Mscngezi The third in a series on health in southern Africa.
The Muloshi family sits in a circle outside their home in Lusaka the, Zambia capital. Inside the circle lie two coffins. One contains the body of a mother, while the other contains her 22-year-old son.

They are just two of the many victims of the cholera epidemic which has broken out in the southern African countries of Zambia, Tanzania, Mozambique and Angola. Apart from cholera, dysentery, malaria and tuberculosis also claim many lives–all of which are diseases of poverty, malnutrition and lack of resources for basic sanitation.

Since the beginning of 1991, cholera has killed more than 11,000 people in Africa and the hardest hit nation is Zambia. The country has reported about 12,000 cases with more than a thousand deaths in the last 18 months. The numbers are rising steadily – an alarming situation which led one Zambian health worker to comment: “If more attention is not given towards eradicating this disease, then we can be sure that many more of our people will die.”

Cholera is an acute intestinal infection characterized by severe diarrhoea, dehydration and cramps. It is caused by ingesting water or food that is contaminated with a virulent.

The worst affected areas are the northern Copper belt, the capital Lusaka, Luapula town and the Northern, Eastern and Central provinces. Some hospitals, including Kitwe Central hospital, in the Copper belt, have been forced to closed out-patient wards and dental clinics to create room for the ever-increasing number of patients. Some of the patients can be seen writhing with pain and vomiting on the floor.

Zambia’s cholera problem, like other affected countries, is a direct result of overcrowding, poor sanitation and drinking contaminated water. The country’s ailing economy and falling standards of Jiving mean that the situation will remain the same until the government can afford to generate more money for a disease that is preventable.

The same problem of overcrowding and lack of proper sanitary facilities confronts Angola and Mozambique. Large numbers of people have been displaced by war in both countries and fled to
“relatively secure” areas in cities worsening already crowded conditions. One example is that of the squatter camps in Angola’s capital, Luanda. Sanitary conditions are so bad and overcrowding so dense that all communicable diseases spread quickly.

Health infrastructure in these countries have also been crippled by long running wars of destabilization.

The National Public Health Directorate in Angola began reporting an increase in cholera cases in 1987, particularly in Benguela, Luanda, Namibe and Bengo. The disease was worsened by seasonal heavy rains and high temperatures, exacerbated by a shortage of fresh water and poor sanitation.

From 1987 to the beginning of 1991, more than 3,000 cases of cholera, with 200 deaths, had been confirmed by the health ministry in Mozambique. The worst hit areas were in Maputo, Tete and
Zambezi provinces, because of dirty water from the Zambezi River.

Dysentery which, like cholera, can kill within days, has also broken out in many parts of Zambia, particularly in the northern provinces.

The region’s worst affected arc Mbala and its sub-centre of Mpulungu, where more than 1,300 cases have been reported, with several fatalities. There are fears that the disease could be spreading rapidly in Kingstone. Kalabo, Lukulu and in some rural areas surrounding Lusaka. Medical experts predict that without international assistance Zambia could become overwhelmed since cholera and other diseases have already reached epidemic levels. Many children of school-going age in Mbala and lsoka, in the Northern province can be seen playing football and other games in streets instead of attending classes because their schools have been closed.

Malaria is also another disease that has made a dramatic recent resurgence in southern Africa. The reasons given by the World Health Organization (WHO) are the waning in international efforts to eradicate it; drug resistance and the growing immunity of malaria-bearing mosquitoes to insecticides.

The spread of malaria particularly among expectant mothers is worrying many doctors.

“This has concerned us very much and usually, these arc women pregnant for the first time,” said Dr Nsama Sikwaze, a consultant gynaecologist in Zambia.

In Zimbabwe, malaria appears to be under control. However, in 1988, a drug-resistant malaria was discovered in some areas around the Zambezi Valley, the eastern Highlands and Gokwe kiJling more than 220 people. According to Dr. Chad Tarumbwa, a Zimbabwean medical practitioner. The disease originated from East Africa and parts of Mozambique.

In an effort to combat tuberculosis and leprosy, the Tanzanian government set up a Tuberculosis and Leprosy Unit within the Ministry of Health in 1977 to contain the diseases. However, with the emergence of the Acquired Immunity Deficiency Syndrome (AIDS), tuberculosis, a highly infectious disease, seems to be getting out of control again. One of the main reasons for this is that educational programmes and publicity campaigns in the local media have not been especially in rural areas.

According to Dr Petra Graf, a senior medical officer in the Tuberculosis and Leprosy Unit, cases of the tuberculosis have been increasing at an alarming rate countrywide, particularly in large towns including the capital, Dar es Salaam.

“The urban centres have fallen prey to the disease largely because of overcrowding, poor housing,
poverty and malnutrition.” says Dr Graf.

The main contagious diseases in the region are spread through poor sanitary conditions and lack of adequate accommodation. There is a need to improve people’s living standards so as to reduce deaths from these contagious diseases. Medical facilities are also often not within easy reach for many people, particularly in the rural areas resulting in the death of many people who could otherwise have been saved.

The problem of communicable diseases that faces southern African governments is one of poverty. The majority of those affected by these diseases are the underprivileged. As long as regional economies remain in a week state, then diseases will continue to claim more lives. Poor housing and sanitation have compounded the situation and unless serious efforts are made to remedy it, health for all by the year 2000 will almost certainly never be achieved. (SARDC)
The last of the series will deal with AIDS.

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SANF is produced by the Southern African Research and Documentation Centre (SARDC), which has monitored regional developments since 1985.      Email: sanf@sardc.net     

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