Preventing a cholera outbreak in Guinea-Bissau

From IRIN, a look at the steps taken to prevent a cholera outbreak in Guinea-Bissau.

Staff from NGOs and the health authorities are going house-to-house to distribute thousands of bottles of bleach to residents in the Bafata area of central Guinea-Bissau, to prevent another cholera outbreak. An epidemic in 2008 claimed at least 225 lives and infected more than 13,000 people.

"We're doing everything possible to prevent a cholera outbreak this year. The joint effort of communities and local authorities has prevented many cases of cholera in the past and efforts have once again been stepped up," said Ingrid Kuhfeldt, Country Director of Plan International, which works to alleviate child poverty.

Cholera is a waterborne disease that usually occurs during the rainy season and spreads quickly in rural areas like the Bafata region, where most people fetch their water from wells that are easily contaminated, and it is not always stored in hygienic conditions.

This year the first rains fell in early June, but so far no cholera cases have been recorded anywhere in Guinea-Bissau. Kuhfeldt told IRIN this was partly the result of careful planning by the government and aid agencies – a repetition of the strategy implemented in 2009, when Bafata had no confirmed cases.

Plan International's cholera prevention methods include distributing medical and cleaning supplies, like bleach and oral rehydration sachets, sinking wells and building toilets.

The UN Children's Fund (UNICEF), backed by the European Commission's humanitarian aid department (ECHO), has been running a hand-washing campaign and distributing water purification kits in case there is an outbreak.

Kuhfeldt told IRIN that a cholera prevention project in which children and young adults were taught to diagnose hygiene problems and apply the solutions in their communities was so successful that it is being rolled out in Bafata and Gabu, 200km northeast of the capital, Bissau.

Children put up posters encouraging people to wash their hands more often, and run house-cleaning competitions every two weeks, with the national flag hoisted in front of the winner's home. Residents in the targeted communities said fewer people had been sick since the project began.

"Before we started the project in my community it used to be very dirty," said Malam Dola Cassama, 17, who was elected president of the project in Gantauda, a village 15km from Bafata town.

"There used to be lots of sickness during the rainy season; these days the community is much cleaner. If we see rotting food, we dig a hole and bury it, and we know not to drink from the same cup as someone who is vomiting or has diarrhoea," he told IRIN.

To be effective, anti-cholera actions must take place long before an epidemic breaks out, so that practicing new behaviour becomes established habit, said Jeroen Ensink of the London School of Hygiene and Tropical Medicine (LSHTM).

In the nearby village of Buntunsum, health worker Amadou Djao said he has seen a dramatic drop in the incidence of infectious disease. "Since the young people started encouraging everyone to place such emphasis on cleanliness, not only has cholera decreased, but also other illnesses spread by contaminated food and water."

As rainfall across the country becomes heavier, Guinea-Bissau's Ministry of Health is implementing a series of recommendations made by Plan International, other NGOs, UNICEF, the World Health Organization, and ECHO. These include stockpiling bleach, and running campaigns to dispel myths, such as that the sun can kill the bacteria that cause cholera.

An epidemic in 2005 infected 25,000 people, followed by an epidemic in 2008, which prompted the Ministry of Health to swiftly order laboratory tests for suspected cases of cholera this month, but they proved negative.

"There's an alertness [to cholera] that has been maintained by the Ministry of Health," said Geoff Wiffin, UNICEF's Representative in Guinea-Bissau. "This analysis of suspected cases is an example of action leading to results."