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Zimbabwe - High priority areas / Hotspots



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)