Angola - High priority areas / Hotspots

SUMMARY OF KEY FINDINGS

Cholera burden and dynamics

• Often affected areas were located in Luanda, northern provinces bordering DRC, especially Uíge and Zaire, as well as provinces in the southwest, such as Cunene, Huíla, and Benguela.
• Luanda Province reported 29% of all cases over the course of nine outbreaks, most outbreaks in Luanda occurred between 2006 and 2013. 
• Uíge, Zaire, and Cabinda reported 99% of all cases reported from 2015 to 2018. Cholera case numbers increased between October and December, which corresponds to the early months of the rainy season (starting in September). 
• Cross-border transmission appears to play a major role in cholera outbreaks in Angola due to porous national borders between Angola and DRC and poor water and sanitation conditions in cross-border zones

Localization of cholera hotspots

• Urban province of Luanda
• Northern provinces, many of which share a border with DRC: Uíge, Zaire, Cabinda, Lunda Norte, Malanje, and Kwanza Norte
• Southwestern provinces: Cunene, Huíla, Benguela and Namibe

Risk factors

• Limited access to safe drinking water

23% of rural populations and 63% of urban population have access to at least basic drinking water sources (estimates not markedly improved since 2000 - 24% and 67%, respectively)

• Cunene (2013-2014): drought forced people to resort to drinking unsafe chimpaka water
• Soyo, Zaire (2016-2017): affected communities largely consumed untreated river water or water cacimbas located in close proximity to latrines
• Cabinda (2016-2017): affected communities obtained drinking water from unprotected cacimbas, water trucks, and untreated river water
• Uíge (2017-2018): 21% of cases reported using river water, and 63% reported using untreated water from cacimbas

• Limited access to basic sanitation and hygiene facilities

            21% of rural populations and 62% of urban populations have access to at least basic sanitation

            Limited access to sanitation facilities was a risk factor during recent cholera outbreaks in Cunene, Zaire, Cabinda and Uíge

            73% of rural populations and 50% urban populations have no handwashing facility on premises

• High-risk practices

           Approximately 56% of rural populations and 3% of urban populations resort to open defecation in Angola.1

           Approximately one third of the population practices handwashing at critical times

• Environmental factors: heavy rains, flooding and drought

          –Overall cholera case numbers increased between October and December, which corresponds to early months of the rainy season (starting in September)

        –An extended drought that started in late 2011, followed by the onset of the rainy season in southern Angola triggered a sharp in cholera cases during the 2012-2013 period, mainly concentrated in Cunene Province.