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Guinea Bissau

Cholera overview in country

Cholera was first reported in Guinea-Bissau in 1986. Since 1990, there has been a combination of outbreaks with either low numbers or very high numbers of cases, with the largest outbreaks seen in 1994, 1996, 1997, 2005 and 2008. Between 1996 and 2016, epidemiological surveillance reported 74,049 cases with 1,687 fatalities (case fatality rate ≈ 2.3%).

Guinea Bissau has been regularly hit by cholera epidemics since 1986. Previous analyses highlighted that there was no long-term trend in the occurrence of cholera epidemics in the country. On the contrary, there is a seasonal pattern of cholera: the risk of occurrence of cholera cases increases from April and is maximum in mid-September. Besides, there is a spatial pattern of cholera incidence in Guinea Bissau: the most affected areas are the capital (Bissau), Biombo region and the Bijagos Islands. Other areas highly affected are São Domingos, Nhacra in Oio, Tite in Quinara and Bedanda and Catio in Tombali.

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Description of the cholera surveillance system

Cholera surveillance system is part of the Integrated Diseases Surveillance and Response, rolled out by the national authorities. This system relies on decentralized facilities of the National Health structure. The identification of cases is done at the health centre level, and although the notification should be systematic, it was reminded that 60% of the population live more than 5km from the nearest health centre and therefore, the first detections are often greatly delayed. Community health facilities aim at compensating this situation, but the lack of willingness from their agents prevents from their proper functioning. The data collection could be often difficult to realize because cholera patients are still stigmatized, and people would then rather go to traditional medicine instead. Investigations are led at the health area level and are not systematic due to the lack of human and material resources. The latter are supported by the region and the confirmation of cases is done at the central level. All information is compiled at the central level. This communication scheme, even if it is clearly identified and respected by all stakeholders, faces transport and financial constraints.

Lessons learnt from previous emergency response

A literature review led by the London School of Hygiene and Tropical Medecine (LSHTM, 2009) aimed first, to evaluate the impact of WASH activities on the targeted population, on the political decision-makers and on the people in charge of implementing these cholera control activities. Secondly, the objective was also to estimate the impact it had in terms of access to WASH services in the area previously affected by cholera outbreaks. Based on those results, the LSHTM formulated some recommendations to improve the current cholera projects.

The activities implemented by all the stakeholders in both countries have consisted in hygiene promotion, training on WASH best practices, distribution of prevention material and on improving sanitation services.

This study has, as aforementioned, consisted in a literature review, enriched with key informant’s interviews, and field investigations at the community and household level. Based on those, the short-term recommendations were focusing on the means and ways to prevent further cholera spread to be implemented straight from the suspicion of the first cases. And the long-term strategy aimed at eliminating cholera in both countries.

However, the study highlighted that, in order to increase even more the relevance and effectiveness of these recommendations, it would still be necessary to better understand why some at-risk hygiene practices persist, or why people do not carry out prevention measures and what are the related barriers. It would be interesting to systematically realize baseline survey before any projects in order to identify the success and failures linked to its implementation and then to be able to improve the future ones. Furthermore, it is recommended to develop formative research before and during the implementation of projects to adapt the messages communicated to the targeted population.

In the short-term, the priority during the epidemic is to improve hygiene conditions and access to safe water. The long-term recommendations gather the activities to reach a sustainable improvement of the access to safe water, to sanitation facilities and to hygiene at the community level. In parallel, it is necessary to have a better understanding of the existing cholera reservoir and of the environmental context which could trigger cholera outbreaks and to have a better knowledge on the transmission pattern.

The results of these various studies above are available for download online, as well as other recommended documents in the section below.

Finally, understanding cholera epidemiology and being informed on outbreaks and dynamics is critical for the neighbouring countries. The country is affected by cross-border outbreaks, especially along its borders with Guinea/Guinée in its coastal areas.

En savoir plus : Cholera Fact Sheet - Guinea Bissau

Step 0 - Cadres stratrégiques nationaux :

Step 1 - Cholera Hotspots :

Autres ressources :

Evaluation of the cholera surveillance system in Guinea Bissau (2009)

Evaluation des activités EHA menées pour prévenir et contrôler les flambées de choléra en Guinée Conakry et Guinée Bissau (2009)

Time series analysis of cholera in Guinea-Bissau, 1996-2008 (2009)