Alarm as more in Nairobi die from deadly cholera wave

Two people succumbed to cholera at Mama Lucy Kibaki Hospital on Sunday, bringing to five the number of those who have died in Nairobi County alone.

This suggests there is an increase in local transmission in Kenya.

Five people were admitted to Mama Lucy and two died at Mbagathi Hospital, with three more patients admitted, an insider told the Nation.

As of Saturday, about eight patients were screened and admitted to Mama Lucy.

“Two wards at Mama Lucy were fully occupied by cholera patients and the numbers are increasing. If we are not keen on this, then our hospitals are going to be overwhelmed,” said a Nairobi County public health officer, who sought anonymity because he was not authorised to talk to the media.

As of Saturday, Nairobi had reported 84 cases – 43 males, 41 females – and three deaths, said a situational report for the county. Some 29 of the cases had attended a wedding (28 in Limuru and one in Karen).

More males than females have been affected by cholera, with 21-30-year-olds the most affected, followed by those in the 51-60 age bracket.

About 25 cases of cholera were admitted to hospitals in Nairobi.

The county has closed down areas considered to be the source. A bar and restaurant in Mutindwa, Umoja II, were closed down because it sits next to an open sewer and people were cooking and eating there.

This comes a month after the Ministry of Health declared a cholera outbreak in Kenya, confirming 61 cases in six counties following a wedding celebration held in Kiambu County where 31 cases were reported.

The National Public Health Microbiology Laboratory isolated Vibrio cholera-01-Ogawa as the responsible serotype.

Serogroup O1, which is responsible for the seventh cholera pandemic, is divided into three serotypes – Inaba, Ogawa and Hikojima (a variant of the Ogawa serotype).

Symptoms in the early stages of infection include profuse watery diarrhoea, vomiting, rapid heart rate, loss of skin elasticity, dry mucous membranes, low blood pressure, thirst, muscle cramps and restlessness or irritability.

The infection is often mild or without symptoms, but can sometimes be severe and life-threatening.

The ongoing drought could have worsened the situation, said Dr Patrick Amoth, the acting director-general for health, who urged counties to step up weekly reporting of cases.

"Counties are required to improve laboratory capacity for specimen collection and shipment,” Dr Amoth said.

“The Ministry of Health has placed all counties on high alert for possible cholera outbreaks.”

He said health workers should be conversant with the case definition and sensitised on potential cholera outbreaks.

Cholera is enabled and transmitted through the ingestion of contaminated water.

Vibrio cholera, the bacteria that causes cholera, is transmitted mostly by faecal matter from an infected person. It is severe during rainy seasons when surface runoffs find their way into water bodies.

Many in rural areas also do not use toilets. The term “flying toilets”, whereby human waste is put in plastic bags and tossed into the night, was made popular in the Kibera slums. Lack of toilets, poor hygiene and unsafe drinking water have been blamed for cholera outbreaks. Slum dwellers are particularly vulnerable.

Families and eateries are advised to ensure food is properly cooked.

Water vendors in Kenyan towns, including Nairobi, can help spread the disease. Burst sewer pipes are also a danger.

“The cholera-causing bacteria can be easily controlled through boiling water meant for human use, especially if it comes from suspect sources, and the use of proper sanitation and hygiene,” Mr David Kigo said.

The prevailing water shortage in most counties, Nairobi included, and insufficient sanitation facilities might be the main reason for the recent cholera outbreak in Kiambu.

“The national and county governments have to prioritise sanitation through the provision of adequate sewer systems and ensuring a sufficient supply of clean water for drinking and other domestic uses, and construction of toilets, even pit latrines,” Mr Kigo said.

Restaurants must prioritise safety, said Eric Kibe, programme director at SafiServe, a company that trains food handlers on safety and hygiene.

“They have a moral and ethical duty to ensure meals are fit for consumption,” he said.

Cholera patients are advised to take large quantities of an oral rehydration solution containing sugar and salt and drink a lot of clean water.

The disease can be prevented. One is advised to eat food that is cooked and served hot and to drink beverages from sealed bottles or cans.

Careful hand hygiene should be observed. Food handlers must wash their hands with soap and clean water after using the bathroom.

Counties are already training and sensitising healthcare workers on the disease while holding community dialogues and barazas on market days.

In Kenya, diseases such as cholera, bilharzia, typhoid and other enteric fevers can be traced to contaminated water bodies, commonly through human activity.

On prevention, Nairobi County is advising people to treat their drinking water by distributing chlorine tablets, inspecting eateries and water points and treating water storage containers.