LOBAMBA, Swaziland — A national outbreak of diarrhea attributed to rotavirus has killed at least 36 children in Swaziland. Globally, rotavirus kills approximately 527,000 young children per year, but 85 percent of these deaths occur in developing countries. This highlights the need for better sanitation and clean water among the affected regions, as well as the inclusion of a rotavirus vaccine in Swaziland’s national immunization program.
At a press conference on July 30 attended by most of the Swaziland Government’s Cabinet, Prime Minister Sibusiso Dlamini reported that over 3,000 cases had been recorded in the country. Most were dealt with at the outpatient stage, and of approximately 500 children admitted to hospitals, the majority were successfully treated and released. Yet the 36 children who died during treatment served as a tragic wake up call to health officials.
“The link between poor water quality and child mortality is not a theoretical matter,” said Thab’sile Ndlovu, a government social welfare officer. “We can see in the admissions rooms of hospitals how widespread the problem is.”
Although children in Swaziland die each year from rotavirus, the reasons behind this particularly deadly outbreak remain unclear. One prominent theory is that Swaziland’s worsening poverty could be a factor.
“The economy is getting worse, and less money means lower standards of living,” said Andrew Mkhonta, a medical consultant researching the rotavirus outbreak for a social welfare NGO. “The population of informal settlements is growing around the towns and there is no sanitation there at all. We spoke with some of the patients’ families and many are from these settlements or have children in poor schools where there is no running water or toilets.”
A team from the World Health Organization (WHO) has been deployed to help contain and mitigate the outbreak, and the Swaziland Health Ministry has been broadcasting bulletins to update citizens and provide information about proper hygiene.
“We urge the public to practice thorough hand-washing using soap and safe running water after using the toilet, changing nap pies and before preparing and consuming food. We encourage the public to observe good sanitation practices, as well as drinking water that is known to be safe, or water that is boiled before use,” said the premier.
But for those without proper sanitation capabilities or water infrastructure, these guidelines can be impossible to follow. Nearly one third of Swaziland’s population must make do without access to clean drinking water. The majority of rural communities rely on communal water taps, rivers and wells. Also, most of the rural population must relieve themselves in either pit latrines or out in the bush with no access to running water.
In lieu of drastic infrastructure improvements, an effective method of preventing diarrhea outbreaks is a widespread vaccination program. WHO has recommended a rotavirus vaccine be included in all immunization campaigns, and 21 African countries have complied thus far. Swaziland health officials reported that a rotavirus immunization campaign was scheduled for July 2015, but that given the current state of events, the government would expedite the launch of the campaign.
Given the apparent availability of the vaccine, there has been widespread backlash against the Swaziland government. A local medical doctor said, “Parents are now being blamed for failing to practice hygienic standards and taking too long to bring their children to hospital after exhibiting signs of diarrhea… [The government] never took the WHO advice seriously. The vaccine is widely available but Swaziland chose not to vaccinate the children.” His words are echoed by many parents who have watched their children suffer or die from the virus.
The deaths caused by this outbreak were not due to one factor alone. But at this point in time, vaccination seems the clearest cut way to control the outbreak. Hopefully, the vaccines will be introduced rapidly enough to diminish the outbreak and prevent future deaths.
– Mari LeGagnoux