Cholera - Probably a Future Epidemic In Pakistan By Shiraz Mehboob

The word ‘cholera’ appeared first in the Hippocratic corpus (or Hippocratic Collection, is a collection of around 60 early Ancient Greek medical works strongly associated with the physician Hippocrates and his teachings) (460– 377 BC) and was referred to as a sporadic diarrheal disease. Cholera is a rapidly lethal dehydrating diarrheal disease had killed millions of people in the nineteenth century. Here I would like to demonstrate that Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae.Most people exposed to the cholera bacterium (Vibrio cholerae) don't become ill and never know they've been infected. Yet because they shed cholera bacteria in their stool for seven to 14 days, they can still infect others through contaminated water. Most symptomatic cases of cholera cause mild or moderate diarrhea that's often hard to distinguish from diarrhea caused by other problems. In this article I will provide my utmost attention on Cholera Cases in Pakistan. 

At the time of partition of Indo-Pakistan subcontinent in 1947, due to mass migration of refugees across the border and breakdown of sanitary conditions, 6333 deaths occurred due to cholera in West Pakistan, while many more cases were reported from East Pakistan during this period.  

However in later years situation improved in West Pakistan where no cases of cholera were reported between 1950-1957, but East Pakistan continued to be an endemic area and several cases were diagnosed between 1947-1969, out of which 0.27 million died.

According to a press release issued by the Pakistan Fisherfolk Forum on Wednesday, 155 patients of diarrhea were reported from June 14 to 21, of which 20 were declared as suffering from Vibro Cholera Ogawa at Karachi.68 of the patients were males and 87 females. One hundred and thirty-four of the patients were less than 15 years of age.

25 October 2010 - On 12 October 2010, the Ministry of Health in Pakistan reported laboratory confirmation of 99 cases of Vibrio cholera 01 in the country. These cases were laboratory-confirmed by the National Institute of Health since the beginning of the flood until 30 September 2010. These cases have been reported sporadically from a wide geographical area in the flood-affected provinces of Sindh, Punjab and Khyber Pakhtunkhwa. 

Coming back to US, after 19^th century water supply sanitation was improved however in Pakistan authorities are unable to tackle this situation. Example include women fetching water from a canal in a small village in Sindh’s coastal district Thatta. The residents of Noor Muhammad Thaheen Village have no official water supply. It has been observed that women’s are washing plates from sand. Women spend most of the time collecting water and the exercise is tiresome.

According to Express Tribune Newspaper issued on July 15^th 2017 approximately 90% of water supplied in Karachi (City of Pakistan) is unfit for human consumption due to the presence of bacterial contamination & during observation several locations of the city has been found in dirty condition and local shopkeepers usually through waste outside their shop. Withal unavailability of proper waste skips has been found in Karachi city at several locations. This condition has the potential to cause Cholera cases in future at Karachi City. Therefore, don’t drink tap water in Karachi or even you come as a visitor in another cities of Pakistan. It is beneficial to purchase water from shop to prevent adverse ill-health effects to your body.

In February 2017, 200 garbage-lifting machines among other equipment imported from China has been used for waste disposal. But still, waste management is not improvement in Karachi which is a threat for cholera outbreak in Future. 

Reasons for Lack of Reporting & Lack of Cholera Prevention in Pakistan: 

• Lack of Surveillance or limitations in surveillance system or no active case-based surveillance.
•  Fear of Trade and Travel Sanctions.
• Lack of Systematic studies.
• Report of NGO’s working in disaster situations.
• Lack of Tap Water Inspections conducted & provision of inadequate water supply. 
• Lack of Cholera Awareness among population.
• Presence of illegal immigrants in Pakistan (According to Express Tribune Newspaper of Pakistan it is mentioned that in 2012 five million illegal immigrants are in Pakistan living in different cities of Pakistan) or increased population movement from another country to Pakistan
• Sale on rotten fruits (occasionally)
• Hard to reach areas in some of the geographical remote areas.
• Poor Infrastructure & limited access to healthcare.
• Inadequate sewerage system such as in Karachi (City of Pakistan).
• Corruption
• Poor Sanitation and Hygiene Practice especially in villages in Pakistan.