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Zimbabwe has been affected by the outbreak of the COVID-19 pandemic like the rest of the world. In the last decade, Zimbabwe has also faced a number of disasters such typhoid, cholera and flooding. In this paper, we argue that Zimbabwe could tap into its past experiences of managing the 2018 cholera outbreak in the fight against the COVID-19 pandemic. The paper draws insights from a qualitative study that sought to understand the challenges and strategies associated with cholera disaster response that happened in 2018. We identify five strategies used by various stakeholders to combat the 2018 cholera outbreak. These strategies include; awareness campaigns, family and contact tracing, coordination meetings, food and non-food items distribution, and setting up treatment and isolation centres. The article juxtaposes the strategies used to combat cholera in 2018 with the World Health Organisation (WHO) recommended COVID-19 strategies and we come to the conclusion that the cholera management strategies could be useful in guiding Zimbabwe's COVID-19 and future pandemics' response strategies. [ABSTRACT FROM AUTHOR]

In this paper, a nonlinear deterministic model is proposed with a saturated treatment function. The expression of the basic reproduction number for the proposed model was obtained. The global dynamics of the proposed model was studied using the basic reproduction number and theory of dynamical systems. It is observed that proposed model exhibits backward bifurcation as multiple endemic equilibrium points exist when . The existence of backward bifurcation implies that making is not enough for disease eradication. This, in turn, makes it difficult to control the spread of cholera in the community. We also obtain a unique endemic equilibria when . The global stability of unique endemic equilibria is performed using the geometric approach. An extensive numerical study is performed to support our analytical results. Finally, we investigate two major cholera outbreaks, Zimbabwe (2008-09) and Haiti (2010), with the help of the present study. [ABSTRACT FROM AUTHOR]

In this paper, a cholera epidemic model with saturated recovery rate is studied. Backward bifurcation leading to bistability possibly occurs, and global dynamics are shown by compound matrices and geometric approaches. Numerical simulations are presented to illustrate the results. Our results suggest that the basic reproduction number itself is not enough to describe whether cholera will prevail or not when the resources for treatment of infectives are limited and suggest that we should pay more attention to the initial state of cholera. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper reviews and reflects on the cholera outbreak that rocked Harare, Zimbabwe, in 2008/2009. We give special attention to the root causes, impacts and debates made by key stakeholders, indicating the political and geographical responses. Based on a desktop study and documentary review, the paper highlights the inadequacy of safe and clean water in most of the suburbs, the collapse of the waste management, water supply and sanitation systems of the city as the major explanations for the scourge. Despite this, Harare remains troubled with the shortage of purification chemicals, making it quite impossible to supply clean and adequate water. The national economic crisis also had a strong bearing against the performance of the public health sector. The paper concludes that sustainable urban health initiatives involving both central and local government will provide a long-term solution to the problems highlighted.

In this paper, we conduct a dynamical analysis of the deterministic cholera model proposed in [9]. We study the stability of both the disease-free and endemic equilibria so as to explore the complex epidemic and endemic dynamics of the disease. We demonstrate a real-world application of this model by investigating the recent cholera outbreak in Zimbabwe. Meanwhile, we present numerical simulation results to verify the analytical predictions.

This paper details the phenotypic, genotypic, and antibiotic sensitivity patterns of 88 Vibrio cholerae strains from Zimbabwe. Of the 88 strains, 83 were classified as "altered El Tor" and 5 as "hybrid El Tor" strains. All of the strains were susceptible to tetracycline, doxycycline, ciprofloxacin, and azithromycin by disc diffusion, but susceptibility to tetracycline and azithromycin diminished when observed using the MIC method.

Background: Cholera is a major cause of mortality and morbidity in low-resource and humanitarian settings. It is transmitted by fecal-oral route, and the infection risk is higher to those living in and near cholera cases. Rapid identification of cholera cases and implementation of measures to prevent subsequent transmission around cases may be an efficient strategy to reduce the size and scale of cholera outbreaks. Methodology/Principle findings: We investigated implementation of cholera case-area targeted interventions (CATIs) using systematic reviews and case studies. We identified 11 peer-reviewed and eight grey literature articles documenting CATIs and completed 30 key informant interviews in case studies in Democratic Republic of Congo, Haiti, Yemen, and Zimbabwe. We documented 15 outbreaks in 11 countries where CATIs were used. The team composition and the interventions varied, with water, sanitation, and hygiene interventions implemented more commonly than those of health. Alert systems triggering interventions were diverse ranging from suspected cholera cases to culture confirmed cases. Selection of high-risk households around the case household was inconsistent and ranged from only one case to approximately 100 surrounding households with different methods of selecting them. Coordination among actors and integration between sectors were consistently reported as challenging. Delays in sharing case information impeded rapid implementation of this approach, while evaluation of the effectiveness of interventions varied. Conclusions/Significance: CATIs appear effective in reducing cholera outbreaks, but there is limited and context specific evidence of their effectiveness in reducing the incidence of cholera cases and lack of guidance for their consistent implementation. We propose to 1) use uniform cholera case definitions considering a local capacity to trigger alert; 2) evaluate the effectiveness of individual or sets of interventions to interrupt cholera, and establish a set of evidence-based interventions; 3) establish criteria to select high-risk households; and 4) improve coordination and data sharing amongst actors and facilitate integration among sectors to strengthen CATI approaches in cholera outbreaks. Author summary: Cholera transmission risk is higher in those living in and near the case household. A set of preventive interventions are implemented in and around case household to reduce cholera transmission. We investigated the implementation of cholera case-area targeted interventions (CATI) using systematic reviews (11 peer-reviewed and eight grey literature) and four case studies in the Democratic Republic of Congo, Haiti, Yemen, and Zimbabwe with 30 key informant interviewees. We found 15 outbreaks in 11 countries where CATI approaches were used. The interventions varied across outbreaks with water, sanitation, and hygiene interventions being more common than those of health. We found different alert systems to trigger interventions, inconsistent criteria to select high-risk households for CATI implementation, and varied team compositions to implement CATI approaches. Coordination and integration among actors and sectors were identified as challenging in many outbreaks, and delays in sharing case information were reported. Evaluation measures varied, few evaluated cholera transmission reduction. We recommend using uniform case definition considering country's capacity to trigger alert, evaluating effectiveness of the various interventions, establishing criteria to select high-risk households, and improving coordination among actors to facilitate integration to aid future cholera-response CATI approaches. [ABSTRACT FROM AUTHOR]

Cholera is a water-borne disease and a major threat to human society affecting about 3–5 million people annually. A considerable number of research works have already been done to understand the disease transmission route and preventive measures in spatial or non-spatial scale. However, how the control strategies are to be linked up with the human migration in different locations in a country are not well studied. The present investigation is carried out in this direction by proposing and analyzing cholera meta-population models. The basic dynamical properties including the domain basic reproduction number are studied. Several important model parameters are estimated using cholera incidence data (2008–2009) and inter-provincial migration data from Census 2012 for the five provinces in Zimbabwe. By defining some migration index, and interlinking these indices with different cholera control strategies, namely, promotion of hand-hygiene and clean water supply and treatment, we carried out an optimal cost effectiveness analysis using optimal control theory. Our analysis suggests that there is no need to provide control measures for all the five provinces, and the control measures should be provided only to those provinces where in-migration flow is moderate. We also observe that such selective control measures which are also cost effective may reduce the overall cases and deaths. [ABSTRACT FROM AUTHOR]

The annual probabilities of droughts and floods in Zimbabwe averaged at 31.6 and 57.9% between 1990 and 2014. Those disasters have accounted for 97.1% of the disaster mortalities and for 99.7% of the economic disaster losses in Zimbabwe. Occurrences of droughts and floods decrease the population's access to sufficient volumes of drinking water. In addition, provision of safe drinking water and access to improved sanitation facilities have been declining among the population in Zimbabwe in recent years, as a result of breakdown in public services. These factors have contributed to outbreaks of infectious diseases, such as cholera. Therefore, the water, sanitation and hygiene (WASH) will play a significant role in the disaster management in Zimbabwe. In the current article, the authors seek to analyse the legislation and the WASH vulnerability angle of the disaster management system in Zimbabwe. Results of the legislation analysis indicate that the disaster management system in Zimbabwe incorporates tools to deal with epidemics and WASH-related outcomes of disasters in general. The key parts of legislation include the Civil Protection Act no. 22 of 2001, the Emergency Powers Act no. 572/1979 and the Public Health Act no. 899 of 1978. Disaster management across the territory of Zimbabwe is overseen by the Directorate of Civil Protection at the national level. The coordination is also carried out by the National Civil Protection Committee. Data gathering could be facilitated by training of the NGO staff and volunteers, using the data-collection tool developed by the authors. The number of healthcare professionals who provide care to the Zimbabwean population is not the main reason for the WASH-related disaster risk. This type of disaster risk could be partially explained by the weak correlation between the socio-economic vulnerability of the Zimbabwean population and the risk from WASH-related health outcomes of disasters in the country. Further studies will have to be conducted to investigate these vulnerability results in more detail. [ABSTRACT FROM AUTHOR]

In 2008, Zimbabwe was engulfed by a devastating cholera outbreak resulting in an unprecedented 98,000 cases and over 4,000 deaths. Cholera, however, was much more than a health crisis. The disease signified the nadir of Zimbabwe's catastrophic political and economic meltdown and became the subject of significant international attention. In this article, I examine the political discourse surrounding cholera and I demonstrate the ways in which the outbreak was framed as a global 'health security' concern. I argue that the securitization of the cholera epidemic actually hampered rather than bolstered political and global health responses to the outbreak. I suggest that political science -- through theoretical and historical insights -- can help us evaluate the conceptual and normative value and limitations of the ubiquitous 'health security' frame in global health governance. [ABSTRACT FROM AUTHOR]

Introduction: Cholera, an infectious diarrheal disease, has been shown to be associated with large scale hydroclimatic processes. The sudden and sporadic occurrence of epidemic cholera is linked with high mortality rates, in part, due to uncertainty in timing and location of outbreaks. Improved understanding of the relationship between pathogenic abundance and climatic processes allows prediction of disease outbreak to be an achievable goal. In this study, we show association of large scale hydroclimatic processes with the cholera epidemic in Zimbabwe reported to have begun in Chitungwiza, a city in Mashonaland East province, in August, 2008. Principal Findings: Climatic factors in the region were found to be associated with triggering cholera outbreak and are shown to be related to anomalies of temperature and precipitation, validating the hypothesis that poor conditions of sanitation, coupled with elevated temperatures, and followed by heavy rainfall can initiate outbreaks of cholera. Spatial estimation by satellite of precipitation and global gridded air temperature captured sensitivities in hydroclimatic conditions that permitted identification of the location in the region where the disease outbreak began. Discussion: Satellite derived hydroclimatic processes can be used to capture environmental conditions related to epidemic cholera, as occurred in Zimbabwe, thereby providing an early warning system. Since cholera cannot be eradicated because the causative agent, Vibrio cholerae, is autochthonous to the aquatic environment, prediction of conditions favorable for its growth and estimation of risks of triggering the disease in a given population can be used to alert responders, potentially decreasing infection and saving lives. [ABSTRACT FROM AUTHOR]

Incidence of cholera outbreak is a serious issue in underdeveloped and developing countries. In Zimbabwe, after the massive outbreak in 2008–09, cholera cases and deaths are reported every year from some provinces. Substantial number of reported cholera cases in some provinces during and after the epidemic in 2008–09 indicates a plausible presence of seasonality in cholera incidence in those regions. We formulate a compartmental mathematical model with periodic slow-fast transmission rate to study such recurrent occurrences and fitted the model to cumulative cholera cases and deaths for different provinces of Zimbabwe from the beginning of cholera outbreak in 2008–09 to June 2011. Daily and weekly reported cholera incidence data were collected from Zimbabwe epidemiological bulletin, Zimbabwe Daily cholera updates and Office for the Coordination of Humanitarian Affairs Zimbabwe (OCHA, Zimbabwe). For each province, the basic reproduction number () in periodic environment is estimated. To the best of our knowledge, this is probably a pioneering attempt to estimate in periodic environment using real-life data set of cholera epidemic for Zimbabwe. Our estimates of agree with the previous estimate for some provinces but differ significantly for Bulawayo, Mashonaland West, Manicaland, Matabeleland South and Matabeleland North. Seasonal trend in cholera incidence is observed in Harare, Mashonaland West, Mashonaland East, Manicaland and Matabeleland South. Our result suggests that, slow transmission is a dominating factor for cholera transmission in most of these provinces. Our model projects cholera cases and cholera deaths during the end of the epidemic in 2008–09 to January 1, 2012. We also determine an optimal cost-effective control strategy among the four government undertaken interventions namely promoting hand-hygiene & clean water distribution, vaccination, treatment and sanitation for each province. [ABSTRACT FROM AUTHOR]

In November 2002, a man with ‘atypical pneumonia’ treated in Foshan hospital, Guangdong Province, in the People's Republic of China, was the first known case of Severe Acute Respiratory Syndrome (SARS). However, it was not until April 2003 that the Chinese government admitted to the full scale of ‘atypical pneumonia’ cases infected with SARS, two months after the disease had rapidly spread across the world with initial infections in Hong Kong and Vietnam sourced to Guangdong. In 2008, Zimbabwe experienced one of the biggest outbreaks of cholera ever recorded. By February 2009, the disease had spread across all of Zimbabwe's 10 provinces and to neighbouring countries—Botswana, South Africa, Zambia and Mozambique—causing thousands of infections amongst their populations. This article seeks to examine what duties the Chinese and Zimbabwe states had to protect their citizens and the international community from these outbreaks. The article refers to the findings of the International Law Commission's study into the role of states and international organisations in protecting persons in the event of a disaster to consider whether there is an international duty to protect persons from epidemics. The article concludes that both cases reveal a growing concept of protection that entails an international duty to assist individuals when an affected state proves unwilling or unable to assist its own population in the event of a disease outbreak. [ABSTRACT FROM PUBLISHER]

Background: In highly populated African urban areas where access to clean water is a challenge, water source contamination is one of the most cited risk factors in a cholera epidemic. During the rainy season, where there is either no sewage disposal or working sewer system, runoff of rains follows the slopes and gets into the lower parts of towns where shallow wells could easily become contaminated by excretes. In cholera endemic areas, spatial information about topographical elevation could help to guide preventive interventions. This study aims to analyze the association between topographic elevation and the distribution of cholera cases in Harare during the cholera epidemic in 2008 and 2009. Methods: We developed an ecological study using secondary data. First, we described attack rates by suburb and then calculated rate ratios using whole Harare as reference. We illustrated the average elevation and cholera cases by suburbs using geographical information. Finally, we estimated a generalized linear mixed model (under the assumption of a Poisson distribution) with an Empirical Bayesian approach to model the relation between the risk of cholera and the elevation in meters in Harare. We used a random intercept to allow for spatial correlation of neighboring suburbs. Results: This study identifies a spatial pattern of the distribution of cholera cases in the Harare epidemic, characterized by a lower cholera risk in the highest elevation suburbs of Harare. The generalized linear mixed model showed that for each 100 meters of increase in the topographical elevation, the cholera risk was 30% lower with a rate ratio of 0.70 (95% confidence interval=0.66-0.76). Sensitivity analysis confirmed the risk reduction with an overall estimate of the rate ratio between 20% and 40%. Conclusion: This study highlights the importance of considering topographical elevation as a geographical and environmental risk factor in order to plan cholera preventive activities linked with water and sanitation in endemic areas. Furthermore, elevation information, among other risk factors, could help to spatially orientate cholera control interventions during an epidemic. [ABSTRACT FROM AUTHOR]

Cholera remains an important global cause of morbidity and mortality, capable of causing periodic epidemic disease. Beginning in August 2008, a major cholera epidemic occurred in Zimbabwe, with 98,585 reported cases and 4,287 deaths. The dynamics of such outbreaks, particularly in nonestuarine regions, are not well understood. We explored the utility of mathematical models in understanding transmission dynamics of cholera and in assessing the magnitude of interventions necessary to control epidemic disease. Weekly data on reported cholera cases were obtained from the Zimbabwe Ministry of Health and Child Welfare (MoHCW) for the period from November 13, 2008 to July 31, 2009. A mathematical model was formulated and fitted to cumulative cholera cases to estimate the basic reproductive numbers R0 and the partial reproductive numbers from all 10 provinces for the 2008-2009 Zimbabwe cholera epidemic. Estimated basic reproductive numbers were highly heterogeneous, ranging from a low value of just above unity to 2.72. Partial reproductive numbers were also highly heterogeneous, suggesting that the transmission routes varied by province; human-to-human transmission accounted for 41-95% of all transmission. Our models suggest that the underlying patterns of cholera transmission varied widely from province to province, with a corresponding variation in the amenability of outbreaks in different provinces to control measures such as immunization. These data underscore the heterogeneity of cholera transmission dynamics, potentially linked to differences in environment, socio-economic conditions, and cultural practices. The lack of traditional estuarine reservoirs combined with these estimates of R0 suggest that mass vaccination against cholera deployed strategically in Zimbabwe and surrounding regions could prevent future cholera epidemics and eventually eliminate cholera from the region. [ABSTRACT FROM AUTHOR]

Introduction: The outbreak of cholera in Zimbabwe intensified interest in the control and prevention of cholera. While there is agreement that safe water, sanitation, and personal hygiene are ideal for the long term control of cholera, there is controversy about the role of newer approaches such as oral cholera vaccines (OCVs). In October 2009 the Strategic Advisory Group of Experts advised the World Health Organization to consider reactive vaccination campaigns in response to large cholera outbreaks. To evaluate the potential benefit of this pivotal change in WHO policy, we used existing data from cholera outbreaks to simulate the number of cholera cases preventable by reactive mass vaccination. Methods: Datasets of cholera outbreaks from three sites with varying cholera endemicity—Zimbabwe, Kolkata (India), and Zanzibar (Tanzania)—were analysed to estimate the number of cholera cases preventable under differing response times, vaccine coverage, and vaccine doses. Findings: The large cholera outbreak in Zimbabwe started in mid August 2008 and by July 2009, 98,591 cholera cases had been reported with 4,288 deaths attributed to cholera. If a rapid response had taken place and half of the population had been vaccinated once the first 400 cases had occurred, as many as 34,900 (40%) cholera cases and 1,695 deaths (40%) could have been prevented. In the sites with endemic cholera, Kolkata and Zanzibar, a significant number of cases could have been prevented but the impact would have been less dramatic. A brisk response is required for outbreaks with the majority of cases occurring during the early weeks. Even a delayed response can save a substantial number of cases and deaths in long, drawn-out outbreaks. If circumstances prevent a rapid response there are good reasons to roll out cholera mass vaccination campaigns well into the outbreak. Once a substantial proportion of a population is vaccinated, outbreaks in subsequent years may be reduced if not prevented. A single dose vaccine would be of advantage in short, small outbreaks. Conclusions: We show that reactive vaccine use can prevent cholera cases and is a rational response to cholera outbreaks in endemic and non-endemic settings. In large and long outbreaks a reactive vaccination with a two-dose vaccine can prevent a substantial proportion of cases. To make mass vaccination campaigns successful, it would be essential to agree when to implement reactive vaccination campaigns and to have a dynamic and determined response team that is familiar with the logistic challenges on standby. Most importantly, the decision makers in donor and recipient countries have to be convinced of the benefit of reactive cholera vaccinations. Author Summary: Cholera outbreaks have had catastrophic impact on societies for centuries. Despite more than half a century of advocacy for safe water, sanitation and hygiene, approximately 100,000 cholera cases and 5,000 deaths were reported in Zimbabwe between August 2008 and by July 2009. Safe and effective oral cholera vaccines have been licensed and used by affluent tourists for more than a decade to prevent cholera. We asked whether oral cholera vaccines could be used to protect high risk populations at a time of cholera. We calculated how many cholera cases could have been prevented if mass cholera vaccinations would have been implemented in reaction to past cholera outbreaks. We estimate that determined, well organized mass vaccination campaigns could have prevented 34,900 (40%) cholera cases and 1,695 deaths (40%) in Zimbabwe. In the sites with endemic cholera, Kolkata and Zanzibar, a significant number of cases could have been prevented but the impact would have been less dramatic. The barriers which currently prevent the implementation of mass vaccinations, including but not only the cost to purchase the vaccine, seem insurmountable. A concerted effort of donors and key decision makers will be needed to offer better protection to populations at risk. [ABSTRACT FROM AUTHOR]

The author reflects on the deaths of about 4,000 people from cholera in Zimbabwe in 2008 and 2009 and examines the link between water and death. The history of cholera and significant outbreaks are provided. The author explains the water situation on the planet to better understand the link between water and death, including the limited supply of fresh water, uneven distribution and the actual use. The theological meaning of cholera, water, life and death is provided.

Households in Zimbabwe are currently experiencing an ongoing series of multiple and complex shocks. In contrast with 'conventional' shocks such as droughts, which are usually singular in nature, the contemporary environment challenges households with, among other things, hyperinflation, an extreme and prolonged contraction of the economy, massive unemployment, a cholera pandemic, and politically motivated violence - all exacerbated by formidable failings in governance. In this setting, 'traditional' risk-sharing and insurance mechanisms have been taxed to their limits. In their efforts to avoid permanent loss of well-being, households have adopted, or had forced upon them, coping strategies in which mobility is a central element. This article is an exercise in empirical micro-demographics that explores patterns and consequences of population dynamics in rural Zimbabwe, beginning with the commercial farm invasions that were initiated in early 2000. [ABSTRACT FROM AUTHOR]

Zimbabwe offers the most recent example of the tragedy that befalls a country and its people when cholera strikes. The 2008–2009 outbreak rapidly spread across every province and brought rates of mortality similar to those witnessed as a consequence of cholera infections a hundred years ago. In this Review we highlight the advances that will help to unravel how interactions between the host, the bacterial pathogen and the lytic bacteriophage might propel and quench cholera outbreaks in endemic settings and in emergent epidemic regions such as Zimbabwe. [ABSTRACT FROM AUTHOR]

The article offers information on the political, economic and health problems in Zimbabwe. There is no sign yet that President Robert Mugabe will give up his control of the country despite the international pressure on him. Riot police interrupted protests in Harare on December 3, 2008 and imprisoned dozens of unionists and protesters. According to United Nations (UN), Zimbabwe's cholera outbreak claimed 1,564 lives by the end of December.

Background: Schistosomiasis primarily affects poor and neglected communities due to their lack of safe water and sanitation facilities. In an effort to improve intervention strategies, the present study investigated the association of socio-demographic characteristics of women with their existing knowledge, perceptions and practices (KPP) in five urogenital schistosomiasis endemic rural communities in Zimbabwe. Methods: In February 2016, a cross sectional study was conducted in which 426 women in rural Madziwa area, Shamva District were interviewed using a pretested structured questionnaire seeking their KPP and socio-demographic characteristics. Logistic regression analysis was performed to identify socio-demographic factors associated with the KPP variables. Results: Among the 426 participants, 93.7% knew about schistosomiasis, while 97.7 and 87.5% understood the disease transmission and methods for prevention, respectively. A significantly higher percentage of women aged ≥ 30 years compared to those < 30 years indicated that infertility is a complication of untreated chronic schistosomiasis (OR: 1.7, 95% CI: 0.9–3.0). Compared to women who had no history of infection, those who had been infected before were more likely to think that they were currently infected (OR: 3.7, 95% CI: 2.4–6.0). Bathing in unsafe water sources was more common in non-apostolic compared to apostolic followers (OR: 2.1, 95% CI: 1.2–3.7). Sole use of unsafe water for domestic purposes was significantly higher in uneducated women compared to the educated (OR: 1.8, 95% CI: 1.0–3.1). Compared to women of the Chakondora community, those in Chihuri, Nduna and Kaziro were more likely to know that dysuria is a symptom of schistosomiasis while those in Chihuri were also likely to allow young children to perform water contact activities (OR: 2.9, 95% CI: 1.5–5.5). Conclusions: Despite the high level of schistosomiasis awareness, some women had inadequate knowledge about the mode of transmission and preventive measures for schistosomiasis. Socio-demographic characteristics were associated with the KPP of women. Thus, disease control efforts should consider socio-demographic factors, which may influence the knowledge, perceptions and practices of occupants in a given setting. [ABSTRACT FROM AUTHOR]