MAPUTO, 10 February 2009 (IRIN) - Cholera has spread to all but two of Mozambique's 10 provinces, but that does not deter hundreds of vendors and buyers from crowding the waterlogged, garbage strewn Xiquelene market on the eastern outskirts of the capital, Maputo.

Outbreaks of cholera are common during the rainy season and there are still two months to go, so health authorities remain on high alert.

"When it rains there is mud and water everywhere, but if I stay at home I will have nothing to eat with my family," said Rosina Nhone, a single mother of three, as she spread her tomatoes, onions and other vegetables on plastic sheets on the ground next to the other traders.

Three major roads meet at Xiquelene, making it the main shopping area for more than a dozen impoverished districts in Maputo, whether it rains or not.

The World Health Organisation (WHO) has noted that cholera "remains a challenge to countries where access to safe drinking water and adequate sanitation cannot be guaranteed ... typical at-risk areas include peri-urban slums."

Cholera is a waterborne intestinal infection that causes severe diarrhoea and vomiting, leading to rapid dehydration. Left untreated, it can bring death within 24 hours but the WHO describes it as "an easily treatable disease", cured with rehydration salts to replace lost fluids.

Real risk

The numbers show the risk is real: according to the Ministry of Health, 2,655 cases and 21 deaths were recorded in Mozambique during the month of January alone. Since the outbreak began in October 2008, there have been 4,132 cholera cases and 52 cholera-related deaths.

The good news is that the mortality rate has dropped significantly. "The number of cholera infection cases normally increases during the rainy season but for this period [January] we are happy to say the mortality rate as a percentage of the cases treated is less than one percent," the secretary-general of the Mozambican Red Cross, Fernanda Teixeira, told IRIN.

The latest cholera update by the UN Office for the Coordination of Humanitarian Affairs noted that the case fatality rate since the outbreak began was 1.3 percent but had dropped to 0.56 percent in January.

Only the two southern provinces of Gaza and Inhambane have not record cholera-related fatalities; the highest fatality rates were recorded in Mozambique's northern and central provinces of Nampula, Cabo Del Gado, Manica and Tete.

"More than 50 percent of the population does not have access to safe and clean drinking water, and that is a major cause for the spread of the disease," Teixeira said.

"Our prevention strategy is aimed at teaching people about improved hygienic standards, such as washing hands after eating, and properly washing vegetables to reduce chances of their contamination during irrigation [before being harvested]."

gn/tdm/he

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