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Typhoid, cholera and dysentery alert
Combined Harare Residents Association (CHRA)
January 24, 2012

In 2008, Zimbabwe experienced one of the most regrettable public health crises. At least 4000 people lost their lives due to cholera, typhoid and dysentery. Today, the city of Harare is failing to provide reliable and consistent water services to the residents of Harare. The city requires about 1400 megalitres of water per day yet only 600 megalitres are produced by the local authority. Of the 600 megalitres about half is lost through leakages creating a serious waters crisis for the city. CHRA has created this information sheet which has been translated into vernacular for the benefit of communities. Most diarrheal diseases share a common mode of transmission, identical signs and symptoms and similar prevention strategies. Personal and general hygienic practices, coupled with a safe portable water supply, proper sewage disposal, proper refuse management and hygienic food handling practices are key to the elimination of such deadly infections. One other common aspect is that the bacterium for diarrheal diseases either lies dormant in the ground and/or dormant in the human intestines without causing disease. CHRA encourages residents to boil water before consumption or use purification tablets and liquids available in supermarkets.

Three most important gastro-intestinal tract infections

Typhoid Fever: Typhoid fever is a systemic infection caused by bacilli Salmonella typhi. Signs and symptoms appear 8 to 14 days after infection

Symptoms: high fever, prostration, abdominal pain, and a rose-colored rash, headache, pharyngitis, constipation, anorexia, and abdominal pain and tenderness

Cholera: Cholera is an acute infection of the small bowel caused by Vibrio cholera. Signs and symptoms appear within 1 to 3 days after infection

Symptoms: mild and uncomplicated diarrhea, Abrupt, painless, watery diarrhea and vomiting are usually the initial symptoms, Stool loss in adults, severe water and electrolyte depletion leads to intense thirst, oliguria, muscle cramps, weakness, and marked loss of tissue turgor, with sunken eyes and wrinkling of skin on the fingers.

Dysentery: Shigellosis is an acute infection of the intestine caused by Shigella bacilli. Signs and symptoms appear after 1 to 4 days of infection

Symptoms: fever, nausea, vomiting, and bloody diarrhea, gripping abdominal pain, urgency to defecate, and passage of formed feces that temporarily relieves the pain. These episodes recur with increasing severity and frequency. Diarrhea becomes marked, with soft or liquid stools containing mucus, pus, and often blood

Diagnosis: Clinical judgment of Typhoid, cholera and dysentery confirmed by culture

Transmission Mode and risk factors: Fecal- Oral- Route of Transmission

• Typhoid, cholera and dysentery bacilli, are shed in stool of asymptomatic carriers and/ or in stool or urine of people with active disease
• Poor hygiene after defecation may spread bacteria to community food or water supplies
• In endemic areas where sanitary measures are generally inadequate, bacteria is transmitted more frequently by water than by food
• Flies may spread the organism from feces to food
• Transmission by direct contact (fecal-oral route) may occur in children during play and in adults during sexual practices.

Prevention:

• Patients must be reported to the local health department and prohibited from handling food until proven free of the organism
• Drinking water should be purified
• sewage should be disposed of effectively
• milk should be pasteurized
• chronic carriers should avoid handling food
• adequate patient isolation precautions should be implemented
• Travelers in endemic areas should avoid ingesting raw leafy vegetables, other foods stored or served at room temperature, and untreated water.
• Unless water is known to be safe, it should be boiled or chlorinated before drinking.
• Thorough hand washing after using toilet and before handling food

NB: use of oral rehydration fluids (SSS) is of great importance in Cholera and dysentery; these infections are curable, so please seek early treatment when you see any of these signs.

Visit the CHRA fact sheet

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