KATHMANDU, 18 July 2007 (IRIN) - Health bodies and UN agencies in Nepal have taken emergency measures in the capital, Kathmandu, and elsewhere to control a cholera outbreak first reported last week.

Diarrhoeal diseases are endemic in the country but this monsoon season Kathmandu had a record 223 cases of cholera, a disease that worsens diarrhoea-related acute gastroenteritis (AG), according to the Epidemiology and Disease Control Division (EPCD) of the Department of Health.

AG, also known as acute watery diarrhoea, has already claimed five lives, and there are over 3,700 cases, the EPCD, a government agency charged with managing outbreaks and public health emergencies, said.

"The problem became worse this year due to severe water pollution," Manas Kumar Banerjee, director of EPCD, told IRIN on 18 July.

Banerjee said water quality in Kathmandu was very low and much of the drinking water was polluted. In April, 28 percent of the city's drinking water was unsafe to drink. By July, it had worsened to a dangerously high level of 72 percent.

According to both the EPCD and the UN World Health Organization (WHO), water became polluted due to a lack of chlorine in the mains supply.

The government's Water Supply Corporation said there was a shortage of chlorine due to a series of political strikes by pro-Madhesi groups in the Terai region of south Nepal, the country's main industrial area. This made it difficult to transport necessary amounts of chlorine on time.

"Extra cautious"

"We are now being extra cautious. There is daily active surveillance and senior government health officials are personally monitoring [the situation]," said Banerjee, who said an Emergency Health and Nutrition Working Group had been formed.

Panic about water pollution in Kathmandu dissipated after extensive water chlorination and enhanced water quality monitoring by both the government and UN agencies. With the help of WHO, a cholera outbreak committee has been established with daily meetings. Outbreak investigation teams are dispatched every day to check on water sources.

The UN Children's Agency (UNICEF) is taking a lead in disseminating key public health messages through radio, newspapers and health workers. The government has also told health officials to give daily media interviews.

In addition, the WHO and EPCD are rushing cholera and diarrhoea-related kits to health and medical workers both in Kathmandu and diarrhoea-endemic districts in a bid to mitigate outbreaks anywhere in the country, said health officials.

More steps needed

However, government officials are concerned there is still a shortage of health staff, drugs, refrigerated vehicles for the transportation of drugs and means of communication in remote districts, where a number of diarrhoea-related deaths have been reported.

In the remote Kalikot District, 700km west of the capital, over 80 villagers died during the June outbreak, according to EPCD.

UNICEF officials have called for the immediate mobilisation of village-based Female Health Care Volunteers (FCHVs) and Nepal Red Cross (NRC) volunteers who are experienced in health education and the distribution of water purifiers and oral dehydration pills.

Health officials are now also concerned about the lack of investigations into a possible outbreak in Maoist cantonment sites where all former Maoist soldiers are sheltered.

According to local human rights workers, shelter and sanitation conditions are very poor and the soldiers could be extremely vulnerable to the disease.

nn/at/cb

© IRIN. All rights reserved. More humanitarian news and analysis: http://www.irinnews.org

IRIN news