Cholera has been reported in Kenya from the early 1970's. The two largest epidemics in the country were in 1997, with more than 33,000 reported cases, and in 2009, with 11,769 cases.
Africhol collaborates with the Kenya Ministry of Public Health and Sanitation to strengthen cholera routine surveillance system within the country, and to identify enhanced surveillance zones for cholera.
The enhanced surveillance zone sites will include Homa Bay and Suba districts in Nyanza Province as well as two informal settlements in the capital near Nairobi.
Cholera Epidemiology in Kenya
Since 1971, Kenya has suffered several cholera epidemics and has reported cases every year from 1974 to 1989. The largest epidemic started in 1997 and lasted until 1999, with more than 33,400 reported cases. The 1997 outbreak started in June along the Lake Victoria, and spread to Kenya's third largest city (Kisumu) in mid-October, to join the Siaya District, northwest, by early November. From 2000 to 2006, cases were reported each year ranging from 1,157 to 816 except for 2002, with 291 cases. Cholera outbreaks affected 4 provinces in 2007: Rift Valley, Coast, North Eastern and Nyanza, with 625 cases and a case fatality rate of 5.6%; and 4 provinces in 2008: Nyanza, North Eastern, Western and Rift Valley, with a cumulative number of cases nationwide of 1,243 and 67 deaths. In 2009, Kenya reported 11,769 cases including 274 deaths, which is the largest number of cases in the last 10 years. By January 2010, outbreaks had affected 31 districts nationwide, causing a total of 3,024 cases and 53 deaths.
In Kenya as well, outbreaks of cholera are related to poor access to drinking water and effective sanitation systems, whose factors are directly linked to high poverty levels, ignorance of prevention measures, low latrine coverage and inappropriate traditional beliefs (Disaster Relief Emergency Fund (DREF), Operation report n°03, 2009). Refugee camps located in North Eastern Province of Kenya are also a source of cholera outbreaks.
Routine cholera surveillance is conducted as part of the Integrated Disease Surveillance and Response (IDSR) system and is overseen by the Department of Disease Prevention and Control in the Ministry of Public Health and Sanitation. The Disease Outbreak Management Unit is responsible for monitoring cholera activity and responding to outbreaks. The Kenya's International Emerging Infections Program (IEIP-Kenya program) is based at the Kenyan Medical Research Institute (KEMRI) in Nairobi and Kisumu, and national, provincial and district health offices actively participate in program operations.
A national system for routine disease surveillance is established in Kenya, and includes regular reporting for cholera. Cases are detected through daily and weekly reporting. When a case occurs, it is reported to the health facility or laboratory to the District Surveillance Officer, and then, to the regional and national level. The National Public Health Laboratory (NPHL) and/or KEMRI are involved with confirmation of specimens. These data are entered into a database and a weekly epidemiological bulletin is produced and disseminated to persons on the e-mail distribution list.
Enhanced Surveillance Zones in Kenya
The enhanced surveillance zone sites, identified in collaboration with the Ministry of Health, will include Homa Bay and Suba districts in Nyanza Province, as well as two informal settlements in the capital near Nairobi.