Zimbabwe - High priority areas / Hotspots

SUMMARY OF KEY FINDINGS

Cholera Burden

• Cholera reported almost every year since 1998
• 2008-2009 outbreak represent the largest part of the caseload (84% of all cases)
• Only sporadic cases have been reported since 2012
• 5 most affected provinces Mashonaland West, Central, East, Manicaland and Masvingo 

Cholera Seasonality

• Cholera outbreaks tend to start between November-December
• Cholera risk increases with the start of the rainy season and decreases with the start of the dry season

Cholera Hotspots

• 2/3 of the cholera caseload reported by 1/5 of the districts
• 21 identified hotspots (districts) responsible for 67.9% of all cases
• Only 13 high priority hotspots (T1+T2) responsible for 36,1% of all cases

Risk factors

• Lack of adequate access to safe water & sanitation and access to healthcare
• Unreliable water services (quantity; service interruptions, quality)
• Contaminated environment (open defecation; Sewer bursts & blockages in urban/periurban areas)
• Rainy season
• High population density / population density per borehole
• Low elevation in high-density neighborhoods
• Presence / number of markets / bus stations in the neighborhood
• Individual risk factors: low cholera immunity, weakened immune systems due to HIV and AIDS, and poor nutritional status
• Children under five and women of childbearing age
• Rural populations (AR in rural areas > in urban areas in 2008)
• Mobile working population (age 15-44) in urban areas
• Refugees / displaced people in camps

High-risk practices & aggravating factors

• Open defecation (44% in rural areas – MICS 2014)
• Use of unprotected water sources
• Body transportation & preparation during burials, consumption of food at funeral feasts
• Belonging to a religious sect that discourages seeking medical attention
• Low cholera awareness
• Limited access to oral rehydration solutions at community level increase the severity of dehydration – and risk of mortality
• Inadequate surveillance / access to healthcare (61.4% of all reported deaths took place in the community in 2008-2009)