Open access peer-reviewed chapter

# Outbreak of Cholera Due to Cyclone Idai in Central Mozambique (2019)

By Edson Mongo, Edgar Cambaza, Robina Nhambire, Jacinto Singo and Edsone Machava

Submitted: July 31st 2019Reviewed: August 26th 2019Published: March 11th 2020

DOI: 10.5772/intechopen.89358

## Abstract

Idai was a strong tropical cyclone in Central Mozambique, causing over 1000 deaths, destroying schools, hospitals, roads, and more than 239,731 houses, displacing thousands of people to 136 accommodation sites, and leaving people in need for assistance. The resulting precarious hygienic conditions caused outbreaks of diseases such as malaria and cholera. This communication summarizes the onset of cholera outbreak in Sofala province and its response. It was declared on 27 March, and the number of cases raised up to 6766 and 8 confirmed deaths, with the highest incidence in the city of Beira. The government and partners made integrated efforts to control the disease, establishing treatment centers and units and improving sanitation and hygiene and surveillance. Furthermore, 800,000 people were immunized, and the results seemed satisfactory considering the response. Although cyclones are rare, Mozambique has a very limited capacity to handle their impact, and this urges the country to keep a contingency fund for future disasters.

### Keywords

• cholera
• Cyclone Idai
• Sofala
• Center of Mozambique
• outbreak

## 1. Introduction

In mid-March 2019, Tropical Cyclone Idai from category 4 hit Mozambique, devastating the port city of Beira and surrounding areas, following torrential rains and strong winds, causing massive flooding and leaving entire communities submerged [1, 2, 3]. It has damaged supplies, cut off clean water and sanitary facilities, and destroyed different infrastructures including schools, hospitals, houses (239,731), roads, rails, disrupting regional trade, and supplies of fuel, wheat, medicines, and other goods, even from neighbor countries such as Zimbabwe and Malawi [3, 4, 5].

Thousands of displaced people were sheltering in 136 accommodation sites, including schools, across Sofala, Manica, Zambezia, and Tete, as reported by the National Institute of Disaster Management (INGC) [4, 6, 7].

Idai caused a range of public health consequences, including mortality (598 confirmed deaths until 02 April 2019), injury, and infections [8, 9] due to waterborne and vector-borne diseases including cholera, malaria, and measles, and more than half of affected people are children [2, 10, 11]. Two weeks after Cyclone Idai’s landfall, the index of cholera was confirmed in Mozambique with the death of five people. After the Ministry of Health declared a cholera outbreak on 27 March, 4979 cases and six deaths were confirmed [1, 3, 5, 8, 12].

Cholera is an acute, secretory diarrhea caused by strains of the Gram-negative bacterium Vibrio choleraethat occurs in both endemic and epidemic patterns, presenting symptoms like watery diarrhea, rice-water stools, fishy odor to stools, vomiting, rapid heart rate, loss of skin elasticity, dry mucous membranes, and low blood pressure. This bacterium is usually found in food or water contaminated by stools from a person with the infection, and, if untreated, the fatality rate can be as high as 30–50%, but with rehydration and electrolyte replacement, the death rate decrease to 1% [8, 13].

Environmental factors play an important role in the epidemiology of cholera. The flooding and displacement of people has increased the risk of cholera because many of them spent days without accessing safe water supplies, resorting to drink the floodwaters. There are some videos of children playing with the same water that unfortunately were strewn bodies of humans and animals. Beyond that, menstruated women are also susceptible to waterborne diseases due to the use of unsafe water to wash their clothes, during the bath or while collecting water to prepare food [1, 8, 14, 15, 16].

Idai survivors received supplies to purify their drinking water, food supplies, and items such as soap, nappies, towels, and blankets, to stop spreading cholera. The Mozambican Ministry of Health (MISAU), World Health Organization (WHO), Cooperative for Assistance and Relief Everywhere (CARE), and other NGOs worked in setting up treatment centers and clinics, as well as helping to run a massive campaign, where 800,000 doses of oral cholera vaccines were distributed and dispensed [2, 4, 10]. This paper aims to summarize the status of the outbreak of cholera in Mozambique due to the deadliest storm Cyclone Idai.

## 2. Sources and documentary analysis

This short communication was based on simple reviews of the most relevant literature related to the cholera outbreak as a result of Cyclone Idai. The documentary analysis was performed through ATLAS.ti (ATLAS.ti GmbH, Berlin, Germany) and partly in Microsoft Excel™ (Microsoft, Redmond, Washington, USA) and mainly based on flash updates by the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), WHO, UNICEF, OXFAM, Health Cluster of Mozambique, and other agencies.

## 3. Overview of Cyclone Idai

Due to the damages caused by Cyclone Idai, it is important to know that different humanitarian helps were given, coming from national and international entities, both to the outbreak of cholera and to other diseases, in order to reduce the impact caused to the cyclone victims.

The central region of Mozambique was affected by heavy rains since 6 March 2019. It was a system formed in the Mozambican channel, which evolved from tropical depression to moderate tropical storm called Idai that took more than 800 lives and displaced thousands of individuals [17].

The house’s destruction, roads, hospitals, clean water, and sanitary facilities also puts the traveler’s health at risk, so they should always take the basic prevention, such as drinking and using safe water, washing hands often with soap, avoiding bug bites and direct contact with contaminated floodwater, or avoiding travels to dangerous areas [18, 19].

Idai was one of the worst tropical cyclones on record to affect Africa and the southern hemisphere and caused catastrophic flooding, landslides, and large numbers of causalities in Mozambique, Zimbabwe, and Malawi, affecting more than 3 million people, but the most affected area was Beira, Mozambique’s second largest port city, where the cyclone’s landfall was on 14 March [17]. The heavy rains, strong winds, and severe flooding caused problems with water and food supplies, sanitation, electricity, transportation, shelter, communication, security, medical care, and mosquito control, creating opportunities for outbreak diseases, such as cholera. Due to the disasters caused by Idai, 6766 cholera and 43,556 malaria cases were registered [1, 19, 20, 21].

Idai affected 1,85M people (more than half were children), displacing 90,000 to 136 accommodation sites, mostly schools and churches. The sheltered people were sleeping in open spaces, increasing the risks of gender-based violence [11].

## 5. Epidemiological accounts

According to the Health Cluster of Mozambique, there were a total of 6735 cumulative cholera cases, as of 6 May 2019. Until 31 May 2019, the number increased to 6766 cases, identified in emergency clinics, according to the National Situation Report [21].

The Figure 2 shows that the number of cases of the present outbreak is lower than 7073 cholera cases observed in 2015, even though Cyclone Idai caused a much higher destruction of infrastructure [3, 28]. The Ministry of Health of Mozambique declared a cholera outbreak on 27 March after the epidemiological conclusions made in areas affected by Idai, and more than 4000 cases were recorded in the city of Beira [1, 29]. Figure 2 shows how the number of confirmed cases of cholera increased from the day it was announced as an outbreak, up to 31 May.

As the capital of Sofala and because it is the most populous city in the province, Beira registered 4745 cases, followed by Dondo with 1094 cases, Nhamatanda with 793 cases, and Buzi with 134 cases of cholera [20, 21, 29, 30, 31].

The Mozambican government, with the help of international entities, reacted to this happening with the supply of vaccines and water purification supplies, and, according to some reports, the daily reporting number of cholera cases reduced [1], but they do not show the numbers or percentages.

Cholera is just a part of the disasters; there were other concerns such as malaria, measles, respiratory infections, mental disorders, and the material damages. Restoration of the damages is still ongoing, and there are more people waiting for help; in some areas, people are already living in chronic poverty and now face huge challenges to survive.

## 6. Conclusions

Cyclone Idai hit the center of Mozambique in mid-March 2019 causing thousands of deaths. The destruction of infrastructures contributed to the epidemiology of cholera, and the Ministry of Health declared a cholera outbreak on 27 March, after identifying more than 4000 cases, number that increased to 6766 until 31 May; eight deaths in emergency clinics created to reduce the impact of diseases in that area. Flooding and overcrowding in accommodation places increased the risk of spreading cholera; however, considering the magnitude of the disasters caused by Idai, the outbreak of cholera was well managed with the efforts of the Mozambican government and partners, such as the WHO and CARE. Mozambique has already faced other outbreaks, which helped the country to create ways to confront the recent outbreak, due to Cyclone Idai.

Many infrastructures were destroyed, including roads, hospitals, schools, and houses, and only 17% of the money required had been provided. However, food, water, and medicine supplies arrived to the affected areas through planes, helicopters, and boats. The outbreak was controlled certainly due to the setting up of treatment centers and clinics, where more than 800,000 people were immunized with doses of oral cholera vaccines. They also provided supplies to purify the drinking water and campaigns to spread the information about treatment of water and food, resulting in a decrease of the daily reporting number of cholera cases. It is important to know that even with all of this help, there are people who still need help.

## Funding

This research received no external funding.

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Edson Mongo, Edgar Cambaza, Robina Nhambire, Jacinto Singo and Edsone Machava (March 11th 2020). Outbreak of Cholera Due to Cyclone Idai in Central Mozambique (2019), Evaluation of Health Services, Sandeep Reddy and Aida Isabel Tavares, IntechOpen, DOI: 10.5772/intechopen.89358. Available from:

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