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Eradicating Cholera

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On 7 October 2017, an editorial in the Lancet spoke of eradicating cholera, one of the most dreadful diseases faced by humanity. In this context, we would like to draw attention to the recent outbreak of cholera cases in Kerala. It reverses the achievements of the health services in Kerala, which had been heralded as a low-cost model of healthcare.

Kerala recently witnessed a massive outbreak of epidemic fevers. Available data from the Kerala legislative proceedings show that between January and ­July 2017, there were 19,56,198 cases in the state, which could be considered an extraordinary epidemic situation. The actual situation could, in fact, be much more alarming, as many private institutions may have been excluded from the data. Yet, even this data reflects the seriousness of the epidemic. The maximum case load occurred in Malappuram (2,95,440 cases), which is one of the least developed districts, and in Thiruvananthapuram (2,52,493 cases), one of the most well-developed districts of Kerala. In most districts, the morbidity was above one lakh cases. The morta­lity from various types of fevers during the same period was extremely high. It was revealed that the maximum number of deaths ­occurred due to dengue, suspected (177) and confirmed (24); ­followed by fever (71); H1N1 (69); and leptospirosis (45).

It is against such a profile of infectious diseases that we need to address the ­issue of cholera, and move towards its eradication, beyond mapping “Broad Street” or profiling East African slums. That the eight suspected cases of cholera, and one death, occurred among migrant workers needs to be further investigated, as it demonstrates that conditions for the causative agent to multiply exist even in sanitised environments like that of Kerala. Water, sanitation and hygiene (WASH) may be a recognised ­solution, but global strategy cannot be one homogenised approach. There is a need to understand contextual factors, as well as establish a multi-sectoral monitoring mechanism, in order to ­prevent the state from regressing 50 years backwards.

K Rajasekharan Nayar

Thiruvananthapuram

Sunitha B Nair

Kannur

Updated On : 12th Jan, 2018

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