Africhol in the Democratic Republic of Congo (DRC)
Since the first cases in the country from the seventh cholera pandemic wave, the DRC has been among the five countries in the world the hardest hit by cholera. Nowadays, eastern provinces are more affected by the disease than the western ones. In 2011, four provinces are epidemic: Orientale since February, Equateur since May, and Bandundu and the city of Kinshasa during June 2011.
The Africhol site in the DRC is the city of Goma, in the North Kivu province bordering Lake Kivu, with the Cholera Treatment Centre (CTC) at the General Hospital Reference in Goma, and the UTC in the Karisimbi health area as reference health structures.
Cholera Epidemiology in the DRC
The first cases of cholera were reported in the DRC in 1974, and since the late 1990s, the DRC has been among the five countries in the world the most affected by cholera. From 2001 to 2009, 213,377 cases and 6,319 related deaths were reported in the country, with an attack rate of 36 cases per 100,000 and a lethality rate of 2.85%.
The provinces most affected by cholera are the eastern ones: South Kivu, North Kivu, Katanga, and Orientale, with 47.3 cases per 100,000 inhabitants, and a maximum of 93.1 cases per 100,000 people in South Kivu. To the west of the DRC, the incidence varies between 0.5 and 1.4 cases per 100,000 inhabitants. In the lake areas, cholera has a seasonal pattern, with the incidence peaking during the rainy season.
In 2011, when considering the number of cholera cases reported to Ministry of Health since the beginning of the year (from week 1 to week 26), seven provinces have reported 9,065 cases and 210 deaths (CFR of 2%). The epidemic began in the Province Orientale (northeast) and then spread west to the province of Bandundu, before reaching, in June, those of the Equateur and Kinshasa, bordering the Congo River. The city of Kinshasa has a case fatality rate of 15% followed by the province Equateur (8%), Bandundu and Orientale (5%).
Routine National Cholera Surveillance
In the DRC, the Ministry of Public Health is the main actor in the fight against cholera. The surveillance of cholera is conducted by the Direction de la Lutte contre la Maladie (DLM), the Institut de Recherche Biomédicale, and the provincial health inspections, health areas and their treatment centres. The coordinating structure is the Comité Intersectoriel de Lutte contre le Choléra (CILC), that brings together national and international partners involved in the fight against cholera.
According to the definitions currently used by the Ministry of Health, the cholera case definitions are the following:
- Suspected caseof cholera: a patient with severe diarrhea with dehydration or death from acute watery diarrhea
- Confirmed case of cholera: a patient for whom Vibrio cholerae serogroup O1 or O139 is isolated from a stool sample or rectal swab
- Acute diarrhea: a patient with more than six loose or watery stools within 24 hours, with a sudden onset and duration not exceeding 72 hours before the consultation in a health facility.
- Cluster cases of cholera:
In an areawith no known cases of cholera, or with only sporadic suspected cases:
- At least one confirmed case of cholera
- At leasttwo suspected cases of cholera or acute diarrhea over a period of one week, or reported by more than one health facility within the same sector or health district.
In a cholera endemic area:
- A two to three fold increase of reported suspected cholera cases compared to the number of cases reported in previous weeks.
Enhanced Surveillance Zones in the DRC
In collaboration with the MoH, the Africhol enhanced cholera surveillance zone chosen was the city of Goma, in the North Kivu province bordering Lake Kivu. The estimated total population is 554 413 inh. over an area of 491.5km2.
In this area, the main hospitals serving as reference health structures are the Cholera Treatment Centre (CTC) at the General Hospital Reference in Goma, and the UTC in the Karisimbi health area.