8 March 2002 the Limpopo Province reported its first case of cholera. These patients were from villages at Mokopane (previously known as Potgietersrus). This region was previously affected by the outbreak closed in July 2001.
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The villages received various interventions at the time such as: home-to-home health education, the provision of bleach and purified water and the set up of a rehydration school in the village.
Surveillance of the area and water resources played an important role in keeping track of the disease. Microbial water quality testing helped in identifying water sources that were infected by the cholera virus.
The Limpopo province hosts the annual Moria Easter Conference. Over 3 million Zion church members visit the churches in Moria. The chances of transmission are increased by overcrowding. It is also the church’s tradition to baptize new converts in streams. Furthermore unplanned sanitation can also contribute to the spread of cholera.
Interventions
An assessment was done on Moria water and sanitation facilities and a report sent to the church elders. With regards to water and sanitation it was recommended that the baptismal bath be purified.
In the Sekonye community teams were deployed to implement interventions in the village with regards to funerals.
Water and sanitation facilities were provided for the Moria conference. Water tanks were placed at strategic locations on the church ground. Toilet facilities were found to be satisfactory.
The Sekonye community obtains water from borehole and a community-cemented tank, which supply most of the taps. However, at the time it was found that not all the taps were working but water supply was not a problem.
Water samples tested proved negative for E. coli, faecal coliform and total coliform and the cholera bacteria.
Health education. Important messages were relayed to Moria elders and it was requested that announcements be made from a central stage. Educational materials such as posters and pamphlets were distributed to the Evelyn Lekganye clinic, which provides healthcare to all members. An onsite emergency centre with volunteer doctors, paramedics and nurses who were all church members was set up.
In the Sekonye community teams of health workers were deployed. House to house education on the prevention and control of cholera was done. Although the community members both young and old were well informed not much behaviour change took place as there was no decrease in the number of cases since 26 March. Posters and pamphlets were distributed to promote awareness.
Health workers did presentation on the proper handling of food and toilet use at funerals. The drinking of ritualistic and purificatory water was discouraged. Members of the community were encouraged to visit the clinic or oral rehydration school as soon as they showed any cholera signs and symptoms.
Case control
At Moria all diarrhoea and vomiting cases were referred to the Evelyn Lekganye clinic. Critical cases were further referred to Mankweng Hospital. Some of the cases of diarrhoea seen at the onsite centre were suspected to be the result of food poisoning as church members did not have proper food storage facilities. These cases were referred to Evelyn Lekganye where they were treated for rehydration and then discharged.
At the Sekonye community rehydration centre cases were managed through oral rehydration as well as intravenously. Antibiotics were used on a few cases at the beginning of the outbreak.
At both Moria and Sekonye community constant surveillance was done.
Outbreak in Rapetse, Knobel
30 March 2002 seven cases of diarrhoea were reported from Knobel Hospital in Rapetese village.
The principle case was a female that dressed and cleaned a deceased person in Sekonye. These villages are 100 km apart. Antibiotics were used on 5 patients however, it was emphasized that oral rehydration be given except in severe cases. Rectal swabs were taken and based on laboratory tests a cholera outbreak was confirmed.
In Sekonye the source of infection was hard to identify. Personal and environmental hygiene seemed to be the contributing factor especially in affected families. It was further discovered that there were squatters in a nearby village. The area did not have adequate water and sanitation facilities.
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