Maputo — The cholera outbreak in the northern Mozambican province of Cabo Delgado has spread to a fourth district, Namuno.

The spokesperson for the Ministry of Health, Leonardo Chavane, told reporters on Friday that three cases of cholera have been diagnosed in Namuno.

The other districts affected by the outbreak are Montepuez, Ancuabe and Mocimboa da Praia. Between them the four districts have registered 408 cases. The worst hit district is Montepuez, with 291 cases.

To date, six people have died in the outbreak, three in Montepuez and three in Ancuabe.

In Ancuabe, rumours spread that health workers were causing cholera, not curing it. This led to a mob attack on a cholera treatment centre in the village of Muaja a fortnight ago, in which four people died when the police opened fire, and six others were arrested.

Attacks on health workers have occurred repeatedly in northern Mozambique, and it is sometimes speculated that the root of the problem lies in confusion between the words "cholera" and "chlorine" ("cloro" in Portuguese). Health workers use chlorine to disinfect wells, and are then accused of putting cholera in the water.

Chavane denied that the Health Ministry had failed in its task of health education. "It doesn't seem that there's anything going wrong in the Ministry", he said. "Rather, it seems that there are some people within the communities with obscure intentions. It is incomprehensible that, in a situation where we have health problems and staff are trying to deal with these problems, people emerge in the communities vandalizing the treatment centres".

The Ministry fears that the cholera situation will worsen at the height of the rainy season in January and February. "We are permanently on the alert to control new outbreaks", said Chavane.

From the beginning of the year up until now 19,310 cases of cholera have been diagnosed in the entire country. Of these people, 154 have died.

Chavane also announced that in the past two weeks there have been no further cases of swine flu reported in the country. To date there are just 57 confirmed cases, and 130 suspected cases of this type of flu (influenza A, sub-type H1N1, to give it its scientific name).