Revisiting Cholera Outbreak in Jajarkot, Nepal, 2009

In 2009, it took around two months before the health authorities and public knew the acute watery diarrhea (AWD) outbreak in hilly districts of Mid Western region of Nepal as cholera. That year, > 15,000 people were affected and > 200 people lost their life. There were joint Government of Nepal (GON), UNICEF and other organizations for implementation of medical and behavioral control activities. This incident demands acute need for enhanced surveillance, hygiene and sanitation promotion and selective vaccination in a high risk, remote area of the country.
 
Risk factors: In general, illiteracy and poverty are risk factors for cholera, as any other infectious diseases outbreaks in remote areas. We can add, this is further compounded by combination of following reasons:

1.     Poor or difficult access to source of drinking water

2.     Water and food contamination during monsoon due to sanitation runoff and flooding disrupting everyday life exposing community to all possible infectious diseases

3.     Poor hygiene practices like hand washing after cleaning of dirt or waste / working in the field or defecation. This may be due to poor knowledge on disease causation or simply no supplies (e.g. soap)

4.     No latrines / open defaecation – this is general picture in hard to reach areas of the country.

5.     Poor access to health care, which is geographically remote from most people. Even if there is health centre in the vicinity, there can be a situation when there is lack of health personnel and medicines.

Challenges:

1.     Geography - remote with little road access and probably limited or no electricity there. These challenges make it an important to be innovative, but it is not impossible carry out preventive measures provided we have combination of dedicated staffs / leadership with adequate resources. 

2.     Carry out effective as well as put sustainable surveillance system in place throughout country with focus to reach hard to reach areas. This demands trained health staffs and budget, which is greater challenge for low income countries.