The annual cycle of cholera outbreaks in Ghana continues unabated. Health officials estimate close to 70 deaths this year from cholera with hospitals overwhelmed by many cases. This current outbreak has reached epidemic proportions. According to Dr. Van-Otoo, the Greater Accra Regional Director of Health, some 200 to 300 cholera cases are recorded each day in the region alone.
There have been several commentaries on how embarrassing it is for Ghana to be battling with Cholera in the 21st century (no cholera outbreak for the past 100years in the UK) whilst others rehash the causes of Cholera. Missing in the narrative is the need for prompt use of Oral rehydration salts(ORS) to reduce deaths . According to WHO ORS can successfully treat 80% of cholera patients, both adults and children.
ORS can dramatically reduce the number of death, particularly during an epidemic and when given early when symptoms arise.
Indeed, in the last 30 years, O.R.S. has saved an estimated 50 million lives worldwide, particularly children who are most vulnerable to diarrhea-related dehydration. In 1978 the British medical journal The Lancet called the humble solution “potentially the most important medical advance of the 20th century.”
ORS is a solution we must thus promote in this Cholera outbreak.
Cholera is characterized by a sudden onset of acute watery diarrhoea that can rapidly lead to death by severe dehydration. The disease is acquired by ingestion of water or food contaminated by Vibrio cholerae and has a short incubation period of two hours to five days. Cholera is an extremely virulent disease that affects both children and adults. Unlike other diarrhoeal diseases, it can kill healthy adults within hours. All cases of cholera should be treated immediately. If treatment is delayed or inadequate, death from dehydration and circulatory collapse may follow very shortly. Individuals with lower immunity, such as malnourished children or people living with AIDS, are at greater risk of death if infected by cholera. Among people developing symptoms, 80% present with mild to moderate acute watery diarrhoea, while the other 20% develop rapidly severe dehydration leading to deaths
Effective and timely case management contributes to reducing mortality to less than 1%. It consists of prompt rehydration of patients. Mild and moderate cases can be successfully treated with oral rehydration salts (ORS) only. The remaining 20% of severe cases will need rehydration with intravenous fluids. Antibiotics are not paramount to successfully treat patients, but they can reduce the duration of disease, diminish the volume of rehydration fluids needed, as well as shorten duration of shedding of the germ.
In these times that our facilities are overwhelmed, patients should be encouraged to early and liberally take the ORS whilst waiting to be seen by health professionals.
ORS is a sodium and glucose solution which is prepared by diluting 1 sachet of ORS in 1 litre of safe water. In case ORS packets are not available, homemade solutions consisting of either half a small spoon of salt and six level small spoons of sugar dissolved in one litre of safe water, or lightly salted rice water or even plain water may be given to PREVENT or DELAY the onset of dehydration on the way to the health facility. However, these solutions are inadequate for TREATING dehydration caused by acute diarrhoea, particularly cholera, in which the stool loss and risk of shock are often high. To avoid dehydration, intravenous fluids should be given as soon as possible. All oral fluids, including ORS solution, should be prepared with the best available drinking water and stored safely. Continuous provision of nutritious food is essential and breastfeeding of infants and young children should continue.
Promoting ORS must go hand in hand with promoting good hand washing practices, eating our foods hot and been mindful of the water we drink.
Cholera remains a disease of poor countries, cholera deaths are largely preventable. We need to take water and sanitation seriously. In the medium to long term Government policy on the provision of safe water and sanitation must be one of priority to help reduce the impact of cholera and other waterborne diseases.
