Cholera case management in Harare City, 2018: are we doing the right things right?

Abstract

Introduction: On September 6, 2018, a cholera outbreak was declared in Harare City. By September 17,31 deaths out of 3564 cases had occurred with a case fatality rate of 0.9%. Despite having sensitised staff on cholera case management, resources and a rapid response team being in place, 20 of 31 deaths (65%) occurred within cholera treatment centers. A September 12 situation report revealed that the cholera strain was resistant to ceftriaxone and ciprofloxacin and sensitive to azithromycin and imipinem. We assessed the quality of cholera case management. Methods: We carried out a descriptive cross-sectional study of records and observations for case management. Using a data extraction form, we extracted and reviewed 264 records of clients who were treated at major health facility in Harare City. Observations of patient triaging and treatment were done and case management was compared to Zimbabwe Cholera Control Guidelines standards. Data were entered into Epi info 7TM to calculate frequencies, means and proportions. Results: Antibiotic prescribing, fluid management and laboratory investigations were the quality indicators assessed. Intravenous (IV) fluids and oral rehydration solution (ORS) were documented for 73/264 (28%) and 78/264 (29%) of cases respectively. Out of 252 who had prescribed fluids, only 17/252 (7%) of the cases received adequate amount of fluids as prescribed. Ciprofloxacin was prescribed for 166/264 (63%) of cases with only 9/264 (3%) receiving azithromycin. The majority 93/95 (98%) and 69/95 (64%) of cholera case strains were resistant to ceftrioxone and ciprofloxacin respectively. Conclusion: There was over prescription of antibiotics. Fluid management was not according to hydration status and weight as stipulated in the cholera treatment guidelines. The results were shared with Harare City Health department. We recommended strengthening of record documentation, continuous mentorship on case management and use of guidelines to ensure rational drug use.