Mwanza, 10 February 2016 —The on-going cholera outbreak in Tanzania has affected more than 15,000 people and claimed over 230 lives from 23 Regions. Seven out of the 23 affected Regions from the Lake Zone namely: Mwanza, Mara, Kagera, Kigoma, Geita, Tabora and Shinyanga, have contributed 51% of the reported cases and 62% of the reported deaths.

Despite the Cholera control interventions set up, the outbreak persists in the Lake zone, with the fishermen communities being the hardest hit. WHO has geared up its emergency response to support Tanzania’s Ministry of Health to curb the on-going Cholera transmission in the six (6) Regions.

WHO Representative, Dr. Rufaro Chatora, participated in a meeting convened in Mwanza Region by the Chief Medical Officer, Professor Mohammed Bakari Kambi; gathering RMOs and Medical Officers in charge from the six (6) Regions.

The meeting was attended by Director of Preventive Services, Dr. Neema Rusibamayila; Director of Health Quality Assurance; Assistant Director of Emergency Preparedness and Response Section; Chief Pharmacist; Representatives from the Regional Administration and Local Government (PMORALG), Ministry of Water and Medical Stores Department; members from the deployed Mwanza RRT, staff from WHO and CDC. 

During the meeting, the WHO Representative was given an opportunity to provide an overview of the outbreak in the country; highlighting the persisting issues of concern and propose recommended solutions including:

1. Intensifying surveillance to ensure all cases are reported timely and accurately using the standard line list format as per standard case definition
2. Ensuring access to safe water, regular water quality checks and discouraging chlorination of shallow wells
3. Promoting latrine construction and use by individual households
4. Enforcing Public Health by-laws through public information and regular inspections
5. Engaging key stakeholders to address myths and beliefs
6. Ensuring all health workers uphold ethical conduct

The meeting then received reports from the Regions highlighting the status of the outbreak, on-going interventions and challenges in their Regions. Main challenges highlighted include: Geographical and logistical barriers(fuel, incentives) to reaching affected communities in the remote Islands; Myths and Beliefs related to cause of Cholera, use of boiled/treated water, use of shared latrines; and Political interference hampering reporting of cases, enforcement of public health by-laws.

Plenary discussions were held and the following were some of proposed next steps to be implemented by the Regions:

• Each Region to ensure the recent National guidelines for prevention and control of Cholera and Cholera treatment wall charts are distributed and used in the CTCs and ensure CHMT members are conversant with the tools for effective supportive supervision. Regions to also ensure CTCs have proper triage stations
• Regional and District health teams were reminded to maintain ethical conduct in their practice regardless of indirect interference from political leaders and that daily and timely reporting of cases must go hand in hand with submission of the line list.
• To address myths and misconceptions, Regions to identify and engage local change agents (traditional healers, religious leaders, political/influential leaders, Beach Management Units, Heads of fishing camps) to influence behaviour change. An example was shared to invite the identified key persons in the Regional PHC meetings.
• For fishing communities in the hard to reach areas, Regions need to estimate Aqua tab requirements and plan for targeted distribution, social mobilization and other WASH interventions (e.g. the National Sanitation Campaign) guided by surveillance data. Regions to also explore with PSI possibilities of ensuring availability of Aqua tabs in shops for continued household water treatment. Water authorities to work with Regions to identify the requirements for ensuring regular water quality monitoring.
• Regions were encouraged to use PHC meetings to discuss operationalization of the PH by laws-emphasizing on educating the food vendors and supporting them to implement food hygiene and safety
• Regions to develop Response Plans with realistic budgets to guide implementation of interventions including estimates of resources required for response teams to access remote Islands. Cross-border Regional planning, sharing of best practices was also encouraged.

WHO Representative assured meeting participants and the government of continued partner’s support to end the countrywide Cholera outbreak.

WHO Representative also had an opportunity to visit Igoma CTC in Nyamagana District and later on met with the Regional Administrative Secretary, C.P Clodwig Mathew Mtweve, where he reiterated the persisting challenges facing the Lake Zone Region in containing the outbreak and appealed for his leadership and commitment to address the critical issues to curb the outbreak. WHO Representative plans to visit the Mara Region and also participate in the WHO supported Regional PHC meeting to be held on Friday in Mwanza Region.

______________________________

Below:

Director of Health Quality Assuarance encouraging use of the Cholera treatment wall charts in the CTCs for correct management of patients

WHO Representative visiting a patient admitted in Igoma CTC in Nyamagana District