Africhol in Togo
In Togo, cholera occurs in an endemo-epidemic pattern, with the capital, Lomé city, accounting for more than 2/3 of total cases during the last 5 years. The first epidemic was described in Togo in 1971 and accounted for 335 cases; the latest 2005 outbreak accounted for 1320 reported cases and caused 15 deaths.
Under the guidance of the National Hygiene Institute (INH), and with the support of the Togolese Ministry of Health, Africhol has established two enhanced surveillance zones in Lomé city and in the Lakes district in the Maritime region.
Cholera epidemiology in Togo
In Togo, cholera occurs in an endemo-epidemic pattern. A first epidemic was described in Togo in 1971, with 335 reported cases, and between 1970 and 2009, a total number of 15,870 cholera cases has been reported to the World Health Organization (WHO). Since 2005, 3,234 cases of cholera were reported by the Togolese Ministry of Health, with 48 related deaths.
The last cholera outbreak occurred in Lomé in 2010 and lasted from October to November, corresponding to a period of major flooding in the region. The monthly attack rate during October was 3.6 cases per 100,000. Previously, the city monthly incidence rate reached 25 cases per 100,000 during January 2006.
During the last five years, most of cholera cases (2/3 of total cases) occurred in Lomé city, the remaining cases spreading over the Maritime and Plateaux regions.
The case fatality rate oscillates between years, from 0.5% in 2009 to 4.0% in 2010. In Lomé, cholera rarely causes death, due to appropriate free medical care.
Routine national cholera surveillance
The case definitionsof cholera used by the Togolese Ministry of Health, under the guidance of the Surveillance Intégrée de la Maladie et de la Riposte (SIMR), are the following:
- Suspected case of cholera: patient with severe diarrhea with dehydration or death from acute watery diarrhea
- Confirmed cased of cholera: patient for whom Vibrio cholerae serogroup O1 or O139 is isolated from a stool sample or rectal swab
- Clustered cholera cases:
In an areawith no known cases of cholera, or with only sporadic suspected cases:
- At least one confirmed case of cholera
- At least five 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.
In a cholera endemic area:
- A 2 to 3 fold increase of reported suspected cholera cases compared to cases reported in previous weeks
Enhanced surveillance zones in Togo
In collaboration with the National Hygiene Institute, and with the support of the Togolese Ministry of Health, Africhol has established two enhanced surveillance zones:
- Lomé commune (districts I to V), with an approximate 1,058,813 inh. in 2010
- The lakes district in the Maritime region, with an approximate 251,784 inh. in 2010
These two areas were selected on the basis of the following criteria:
- Areaswith high incidences of cholera, including annual reporting of cases of cholera in 2007, 2008 and 2009 and the occurrence of epidemics in those years
- Existence of hospitals and/or CTC for hospitalization that host the majority of patients with cholera
- Existence of laboratories engaged in, or having the ability to perform stool culture, especially in the diagnosis of cholera
- Consistency with the administrative division of Togo by health districts at the regional level
Within these areas, the Africhol-linked laboratories are found in the health structures below:
- Centre Hospitalier Universitaire of Tokoin, in Lomé district V
- Bé Hospital, in Lomé district III
- Public Hospital of Aného, in Aného Lakes district