Abstract
Incidence of cholera outbreak is a serious issue in underdeveloped and developing countries. In Zimbabwe, after the massive outbreak in 2008–09, cholera cases and deaths are reported every year from some provinces. Substantial number of reported cholera cases in some provinces during and after the epidemic in 2008–09 indicates a plausible presence of seasonality in cholera incidence in those regions. We formulate a compartmental mathematical model with periodic slow-fast transmission rate to study such recurrent occurrences and fitted the model to cumulative cholera cases and deaths for different provinces of Zimbabwe from the beginning of cholera outbreak in 2008–09 to June 2011. Daily and weekly reported cholera incidence data were collected from Zimbabwe epidemiological bulletin, Zimbabwe Daily cholera updates and Office for the Coordination of Humanitarian Affairs Zimbabwe (OCHA, Zimbabwe). For each province, the basic reproduction number () in periodic environment is estimated. To the best of our knowledge, this is probably a pioneering attempt to estimate in periodic environment using real-life data set of cholera epidemic for Zimbabwe. Our estimates of agree with the previous estimate for some provinces but differ significantly for Bulawayo, Mashonaland West, Manicaland, Matabeleland South and Matabeleland North. Seasonal trend in cholera incidence is observed in Harare, Mashonaland West, Mashonaland East, Manicaland and Matabeleland South. Our result suggests that, slow transmission is a dominating factor for cholera transmission in most of these provinces. Our model projects cholera cases and cholera deaths during the end of the epidemic in 2008–09 to January 1, 2012. We also determine an optimal cost-effective control strategy among the four government undertaken interventions namely promoting hand-hygiene & clean water distribution, vaccination, treatment and sanitation for each province.
Highlights
Cholera is still a burning problem in underdeveloped and developing countries causing morbidity and mortality
In Zimbabwe, one of the most severe cholera outbreaks occurred in 2008–2009, that had been attributed as the worst African outbreaks in terms of its high case fatality rate (CFR) and shorttime extensive spread in some provinces
Our estimated values of R0, Rl and Rh are in good agreement with the previous estimates given by Mukandavire et al [14], for the provinces Harare, Mashonaland East, Mashonaland Central, Midlands and Masvingo but significantly differ in Bulawayo, Mashonaland West, Manicaland, Matabeleland South and Matabeleland North
Summary
Cholera is still a burning problem in underdeveloped and developing countries causing morbidity and mortality. In Zimbabwe, one of the most severe cholera outbreaks occurred in 2008–2009, that had been attributed as the worst African outbreaks in terms of its high case fatality rate (CFR) and shorttime extensive spread in some provinces. The outbreak, beginning in Chitungwiza, had duration from August 2008 to July 2009, ended with 98,592 reported cases and 4,288 reported deaths [1]. These massive outbreaks happened mainly due to Zimbabwe’s poor health care system, shortage of good-quality food and clean drinking water [2]. The provinces of Zimbabwe experienced a total of 2101 cholera cases over the period, 17th October, 2009 to 30th June, 2011 [4,5]. The substantial number of cholera cases in some provinces, e.g. Manicaland, Mashonaland West, Masvingo, Midlands, etc., both during and after the epidemic in 2008–09, indicate a plausible presence of seasonal forcing in cholera incidence in some of the provinces
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