Imeldah Chulu lives near Matero level 1 hospital in Lusaka District, Zambia. The hospital houses one of the six community-based cholera treatment units in the district, adding to the two bigger cholera treatment centres at the National Heroes Stadium and Levy Mwanawasa University Teaching Hospital. 

One of Chulu’s male relatives recently fell ill after purchasing food and drink from a shop near his home. He was rushed to a nearby clinic, put on a drip and later transferred to Heroes Stadium, which treats severe cholera cases. He received the treatment he needed and is back on his feet. “These places are working,” says Chulu. “While we want government to do even more, we see that they are trying.” 

Lusaka District has the highest burden of cholera cases, accounting for 75% of all cases nationwide. As of 24 January, there were 10 720 cumulative cases and 442 deaths since 14  October 2023, with the case fatality rate (CFR) of 4%. The acceptable cholera CFR should be 1% or below, according to World Health Organization (WHO).

As part of efforts to accelerate outbreak control measures, WHO is supporting Zambia’s Ministry of Health to conduct assessments of the six cholera treatment units (CTU) in Lusaka’s sub-districts to address gaps in the current response. 

The assessment by team of experts is looking into critical areas ranging from medical supplies, equipment, sufficient space, implementation of infection prevention and control measures and what additional supplies and equipment are needed to bolster operations at the treatment centres.

The results of these assessments will help to identify the gaps at current facilities and assess the need for additional CTUs to complement what already exists. “This will help to improve quality of care and strengthen the response capacity of the country,” says Dr Kamara Rashidatu Fouad, case management officer at WHO Regional Office for Africa, and one of the assessment team members. 

“We’ve had challenges, but I can see it moving in a positive direction,” says Dr Fatima Yikona, the medical superintendent at Chelstone Zonal Hospital in Lusaka. “We don’t have enough space to manage our patients, but it is better now with Heroes opening. Now we don’t have patients who do not have a bed.”

Heroes, a treatment centre which opened recently in central Lusaka, is the biggest in the country and is now helping to manage a large number of severe cases and relieve the burden from the surrounding community-based cholera treatment units. 

“In many of the treatments units we have observed limited space to treat clients and implement thorough infection and prevention protocols, as well as insufficient medical supplies and equipment,” says Dr Nathan Bakyaita, WHO Representative in Zambia. “This assessment is really going to help to identify where WHO can support to make the biggest impact for optimal infection and prevention control, speedy treatment and ultimately avoid more deaths,” he says. 

Once the results of the assessments are finalized, the Ministry of Health will determine the next steps and where to focus efforts to manage the volume of cases, improve occupational and patient safety and mobilize additional resources. 

The outbreak is spreading fast. In the seven days ending on 26 January 2024, 3229 cases were reported, marking a 5.6% rise compared with the previous seven days. With the high number of cases, the outbreak is one of the worst in the country’s recent history. 

A vaccination campaign is currently underway, targeting 1.5 million people, including children, health workers and people at high risk of infection in the worst affected areas. The campaign complements the ongoing measures, including provision of clean water, infection prevention and control, treatment and improvement of hygiene services to halt the outbreak.

“I encourage people to follow the health guidelines like washing hands, keeping their homes clean, where they throw rubbish, to just clean, even the toilets. They should use chlorine water according to the guidelines we give and if they don’t have that they should boil the water,” says Selestina Kabwela, a community-based volunteer.