Dakar — More than 700 people have been sickened by cholera in Guinea-Bissau, the highest number of cases so far this year in West Africa, which has nonetheless seen a significant drop in cases this year compared to 2012.
Isolated health centres, insufficient medical personnel and detrimental traditional beliefs have contributed to the prevalence, explained Inàcio Alvarenga, an epidemiologist with World Health Organization (WHO).
Guinea-Bissau's southern Tombali region is the worst hit, with 225 cases and 21 deaths as of late July, said Nicolau Almeida, a health ministry director.
"Tombali is the poorest region [in the country] in terms of human resources. There is only one nurse per health centre. The health system cannot properly cater for patients. This is in addition to superstitions by people who don't believe the scientific explanation of cholera," Alvarenga told IRIN.
As of 22 July - when the latest data was available - the UN Children's Fund (UNICEF) reported 742 cases in Guinea-Bissau, 416 in Niger and 368 in Sierra Leone. The outbreak in Guinea-Bissau is a continuation of the 2012 epidemic, when 3,359 people contracted cholera.
"To confirm a new epidemic, the 2012 outbreak should have been declared over" by demonstrating the absence of vibrio cholera in diarrhoea, said Alvarenga.
"For reasons I'm not aware of, the government did not test cases in the first weeks of the year. These cases did not disappear but got spread around," he continued. "I don't think we will hit the 2008 level [when 14,204 people were infected and 225 killed], but the disease risks will be lingering for several months like in 1996-1998."
Most cases have so far been reported in Catungo and Mato Foroba localities in the country's south. "These are rice-growing areas where vibrio cholera can easily reproduce," Alvarenga said.
Other cases have been reported in Catio area and in Quinara region - all in the south. Almeida said that the cases in Catio town indicated that the disease was spreading. Two cases have been confirmed in the capital, Bissau, said hospital sources.
"Residents of the city's old town district are very concerned," Alvarenga said. The water and electricity company has been unable to supply water to the capital in the past weeks due to financial difficulties, although it recently resumed partial service. "People are seeking all possible means to get water. It's not rare to see water transporters on the streets."
Need for medical personnel, drugs
Almeida, from the health ministry, said the government's priority was to contain the disease in Tombali, where a medical team - comprising an epidemiologist, two doctors, two nurses and a community outreach specialist - has been sent.
"We, however, need to boost the medical team with three more nurses and five doctors to better guide the health sector in the region. We need to set up different teams in the different areas. There is also a huge requirement for medicines," he said.
In neighbouring Guinea, cholera has infected 146 people and killed 10 since March, according to aid group Action Contre la Faim (ACF). In Sierra Leone, where around 300 died of cholera in 2012, 369 people have been infected so far this year, mainly in Kambia area, near the border with Guinea.
"Fish is often a factor of cholera infection in this region," said Jérôme Pfaffmann, a health expert with UNICEF; fishermen criss-cross between the islets off the Guinean coast. The movement of people across the borders of Guinea, Guinea-Bissau and Sierra Leone are also factors in transmission, said ACF's Jainil Didaraly.
Guinea is conducting a vaccination campaign targeting 4,679 people.
Africa - and West Africa in particular - is the only part of the world where cholera cases are steadily increasing.