The Ghana Health Service has warned of a possible cholera outbreak in Accra due to the current insanitary conditions, coupled with the onset of the rains.

The management of solid waste material has been a major headache for Metropolitan, Municipal and District Assemblies across the country in recent times, as almost one-third of the total District Assemblies’ Common Fund, which could be used for development projects, are channeled into the fight against waste.

The assemblies say government’s inability to release the Common Fund has denied them the needed funds to manage waste.

Ghana has seen outbreaks of the disease since the 1970s. Cholera is a bacterial disease spread by contaminated water and food. If caught early, it can be easily treated by oral rehydration fluids. If not treated, it can kill in hours.

A total of 9,542 cholera cases with 100 deaths were reported in Ghana in 2012, but no deaths were recorded in 2013, despite some reported cases of the disease in the country.

In 2011, 10,628 cholera cases with 105 deaths were reported.

Between 1970 and 2012, Ghana recorded a total of 5,498 cholera deaths, according to data compiled by the World Health Organisation (WHO).

According to the statistics, 1,546 deaths were recorded between 1970 and 1980 while 2,258 deaths were recorded between 1981 and 1990.

Between 1991 and 199, cholera claimed 1,067 lives, and between 2000 and 2012, 627 deaths were recorded.

Cholera is an acute diarrhoeal illness caused by the bacteria Vibrio cholera, which can result in a profound and rapidly progressive dehydration and death. Humans become infected incidentally, but once infected we act as vehicles for spread. Ingestion of water and food contaminated by infected human faeces is the common means of acquiring the disease.

Signs & symptoms, diagnosis and treatment ?The main symptoms are profuse painless watery diarrhoea without fever and (often) with vomiting of clear fluid. These symptoms usually start suddenly, one to five days after ingestion of the bacteria. The diarrhoea is frequently described as "rice water" in nature and may have a fishy odour or somewhat sweet inoffensive odour.

An untreated person with cholera may produce 10-20 litres of diarrhoea a day with fatal results. If the severe diarrhoea and vomiting are not aggressively treated, it can, within hours, result in life-threatening dehydration and electrolyte imbalances.

Cholera is diagnosed by identifying the bacteria in stool. The mainstay of treatment is rapid replacement of fluids and electrolytes. Antibiotics are also given to shorten the course and duration of the symptoms, but people will recover without them if they are adequately rehydrated. Less than 1% of people who contract cholera will die from it if it is treated quickly and properly.

Cholera is easily preventable if proper sanitary practices are followed. Provision of safe water and facilities for proper disposal of faeces, and preparation and storage of food under hygienic conditions are essential in the prevention and control of cholera. Avoid eating cold meals from roadside chop bars and restaurants.

A cholera vaccine (both in injectable and oral forms) is available in some countries, but immunisation is not strongly recommended because it only provides immunity for a few months and this immunity is not very reliable.

A report published by the World Health Organisation (WHO) says by the end of 2011 a total number of 589,854 cholera cases had been reported globally, out of which 7,816 deaths were recorded.

This figure represents an increase of 85% in the number of cases reported in 2010 and a 16% increase in the number of countries. However, a total of 188,678 cases were reported from Africa only, representing an increase of 64% compared with the 2010 figure of 115,106 cases.

The rest of the total figure was taken up by Asia – 38,298; Oceania – 1,514; and Europe – 71. The Americas, however, took the largest chunk of 361,266, owing to the epidemic that hit Haiti as a result of the earthquake that struck on January 12, 2010.

Haiti alone reported 340,311 cases, which resulted in 2,869 deaths during the period.

According to the Weekly Epidemiological Record dated August 3, 2012, reported cases were from 58 countries of the world, consisting of 27 African countries (four more countries than in 2010), 15 Asian countries (an increase by one from the previous year), nine countries from the Americas (five more than 2010), five from Europe, and two from the Oceania region.

For Africa, countries that had reported cases during the period were Somalia, Nigeria, Democratic Republic of Congo, Cameroon, Niger, Angola, Benin, Burkina Faso, Ghana, and Central African Republic.

The rest were Chad, Congo, Cote d’Ivoire, Djibouti, Guinea, Kenya, Liberia, Mali, Mauritania, Malawi, Mozambique, Senegal, Somalia, Togo, Tanzania, Zambia, and Zimbabwe.

The chunk of cases recorded on the African continent was taken by five countries, with Somalia’s 77,636 reported cases, 1,130 deaths and 1.46% case fatality rate (CFR) topping the African chart.

Nigeria followed at a great distance with 23,377 reported cases, 742 deaths and a rather high CFR of 3.17%. On its heels was Cameroon with 22,433 reported cases, but with a larger number of deaths – 783 – and, not surprising, the highest CFR of 3.49% for the period.

The Democratic Republic of Congo placed fourth with 21,700 cases, 584 deaths and a CFR of 2.69% while Ghana came fifth, having reported a total of 10,628 cases by the close of 2011 and a total of 105 deaths with a CFR of 0.99%.

Four countries from Central Africa, the Great Lakes region, and the Horn of Africa accounted for 145,164 cases (Cameroon, Democratic Republic of Congo, Nigeria and Somalia), or 77% of cases reported from the continent.

There was a sharp increase in cases reported from the Horn of Africa, with 127 cases (and one death) reported from Djibouti. No cases were reported from Ethiopia, Sudan or Uganda.

A total of 2,295 cases were, however, reported from Kenya (74), Mozambique (1,279) and Tanzania (942). In southern Africa the number of reported cases declined to levels never previously reported during the current millennium, with 2,949 cases reported: Malawi (120), Mozambique (1,279), Zambia (330) and Zimbabwe (1,220).

An outbreak occurring along the Congo river and affecting four provinces in the Democratic Republic of the Congo - Ituri, North and South Kivu, Katanga and Maniema provinces had 8,088 reported cases including 436 deaths while five departments in the Congo reported 762 cases and 35 deaths in an area which had been cholera-free for about a decade.

Cases were also reported from Burundi (1,072).

But despite Nigeria’s status as the second highest in Africa, the WHO says it experienced a 47% decline compared with 2010 where it had 44,456 cases.

Conversely, both Cameroon and Chad reported a doubling in number of cases compared with 2010, with 22,433 and 17,267 reported cases respectively. Cases were also reported from the Central African Republic (117, including 15 deaths). The CFRs, however, remained high: Cameroon, 3.5%; Central African Republic, 12.8; Chad, 2.7; Niger, 2.6; and Nigeria, 3.2.

In West Africa, reported cases increased to the levels of 2006 to 2008 with a total of 16,088 cases compared with 3,074 in 2010. Ghana’s 10,628 cases accounted for 66% of cases reported from West Africa.

Increasing numbers of cases were reported from Côte d’Ivoire (1261), Mali (2220), and Niger (2324). Cases were also reported from Benin (755), Burkina Faso (20), Guinea (3), Liberia (1,146), Mauritania (46), Senegal (five), and Togo (four). The CFRs were high for Burkina Faso (10%), Mali (4.3%), and Mauritania (6.5%).