Africhol in Guinea
According to data from the Ministry of Health of Guinea, about 60 000 cases and 2,276 deaths from cholera have been reported since 1970. The frequency of cholera outbreaks has increased in Guinea-Conakry over the last two decades. These epidemics spread from coastal zones which serve as reservoirs.
In collaboration with the Department for Disease Control and the National Public Health Institute, Africhol supports cholera surveillance activities within the country and establish an enhanced surveillance zone in the health district of Ratoma in the city of Conakry.
Cholera epidemiology in Guinea:
According to the World Health Organization (WHO), Guinea reported 19,257 cases and 880 deaths between 1999 and 2009.
Guinea has experienced cholera epidemics since 1970, with outbreaksoccurringmore and more frequently, until reaching a yearly occurrence between 2003 and 2007. The major 1994 cholera outbreak accounted for 31,415 cases and 671 deaths, within the city Conakry alone. From 1998 to 2009, the annual number of cholera cases in Guinea varied from 6 cases (2003) to 8,500 cases (2007). Vibrio cholerae serogroup O1 biotype El Tor was the causative agent of all these outbreaks.
Before 1994, outbreaks in the country remained limited to the coastal strip and the capital. The first cases appeared in people living in the coastal lagoon near the border with Sierra Leone. Starting with the Conakry 1994 epidemic, cholera spread to even the most remote prefectures in the country.
Cholera lethality ranged from 3.6% in 2007 to 8.6% in 2006. In 2008, Guinea reported 32 deaths over the 513 cholera cases, leading to a CFR of 6.24% which was the fourth highest CFR reported by countries worldwide that year.
A study on data from 2003-2007 (UNICEF, 2009) described a link between the rainy season and the resurgence of cholera outbreaks, with a seasonal increased risk from April to June.
Routine national cholera surveillance
In Guinea, cholera surveillanceis part of the “Surveillance Intégrée de la Maladies et la Riposte” (SIMR), and is an ongoing and systematic collection, analysis and data interpretation of morbidity and mortality of disease. Data are collected in health facilities and sent weekly to cholera surveillance focal points in eight administrative regions comprising 38 health districts. The Prefectural Health Directorate (DPS) compiles the data and then forwards it to the Regional Health Directorate (DRS) which summarizes and transmits it to the “Direction de la Lutte contre la Maladie” (DLM) at the Ministry of Health (MoH). In case of an outbreak, anational crisis committee, chaired by the Minister of Health, meets once a week for an update on the epidemiological situation.
Within the guidelines of the SIMR, the following case definitions for cholera are applied:
- Suspected case of cholera:
During an epidemic:a patient over one year of age suffering from watery diarrhea with or without vomiting.
Outside of an epidemic: a patient over one year of age suffering from severe watery diarrhea with severe dehydration or resulting in death.
- Confirmed case of cholera: a suspected case with laboratory confirmation of of Vibrio cholerae O1/O139 in the stool.
- Clustered cholera cases:
In an area with no known cases of cholera, or with only sporadic suspected cases:
- At least one confirmed case of cholera
- At least two suspected cases of cholera and severe diarrhea over a period of one week, or reported by more than one health facility within the same sector or same DPS.
Enhanced surveillance zones in Guinea
In collaboration with the Ministry of Health, Africhol has established its enhanced surveillance zone in the sanitary district of Ratoma in Conakry city, with the Cholera Treatment Centre (CTC) at Donka National Hospital as a base for cholera surveillance activities.
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