Abstract

Objectives: The objective of this study was to assess nurses’ knowledge on the management of cholera in Kumba District Hospital.

Method: A descriptive cross sectional study design was used to describe the knowledge by nurses in Kumba District Hospital at a single point in time, were data was collected from different individuals aimed to assess nurses knowledge on the management of cholera in Kumba District Hospital and the study was carry out for 1 month 3 weeks using nurses. A well-structured questionnaire was administered to the participants and the results analyzed.

Result: 121 eligible nurses were identified for this study of which 60 of them participated in the study, Most participants in this study had a global view on nursing process on diagnosing cholera as a majority of them 43 (71.7%) knew about nursing process and the steps involve in it. With a majority 23 (38.3%) had the nursing process in diagnosing cholera as assessment, diagnosing, planning, implementation and evaluation.

Nurses intervention for the management of cholera, 46 (76.7%) of participants administered medication on time since each drug has a half life. 23 (38.3%) agreed that treatment of cholera by fluid is the best method.

Educational words nurses give patients before discharge,19(31.7%) do not counsel patients before discharge and  41 (68.3%) counsel patients.

CHAPTER ONE

INTRODUCTION

1.0 Introduction

This chapter presents the background of the study, problem of statement, objectives, research questions, significance of the study, scope of study and operional definition of terms. Cholera is an acute intestinal infection caused by bacterium Vibro cholera leading to intestinal infection and disrrhea. It can be transmitted through  exposure to an environmental reservoir of Vibro cholera or contaminated water sources regardless of previously persons or facial contamination (food or infected person).

1.1 Background

Recent Cholera health reports show a continual vulnerability of large population to infectious diseases in relation to our environment (Ali et al, 2012) Cholera is an epidemic and infectious disease which is of global and public health significance. There is need to recognize and look for measures to address it.

Cholera is an acute intestinal infection caused by a bacterium(Vibro cholerae) leading to intestinal infection and diarrhea. Infection is mainly by intake of contaminated water and food. Transmission is due to the feacal contamination of food and water as a result of poor sanitation. The bacterium can live naturally in any environment thus it remains a global health threat especially in developing countries where access to clean and safe drinking water and sufficient sanitation cannot be guaranteed.

The disease is characterised in its most severe form by sudden onset of acute diarrhea that can lead to death by severe dehydration and kidney failure. The extremely short incubation period(two to five days) enhances the potentially explosive pattern of outbreaks, as the number of cases can rise very quickly. About 75% of people infected with cholera do not develop symptoms. However, the pathogens stay in feaces up to 5 or 7 to 14 days and are sent back into the environment, potentially infecting other individuals. It affects both children and adults. Unlike other diarrhea diseases, it can kill healthy adults within hours. Individuals with low immunity, such as malnourished children or people living with HIV, are at greater risk of death if infected by Cholera (WHO, 2014).

One hundred and fifty years ago, Snow made the historic discovery that contaminated water transmitted cholera. Koch cultured Vibro cholerae, the bacterium about which Snow could only speculate. (Haward et al,1984). They discovered the enterotoxin produced by the bacterium resulting in massive outpouring of fluid. (De SN.1959).

However discoveries, by themselves, did not save the lives of cholera’s victims; 50% of them died until intravenous hydration therapy began to be used in the early 1900s (Rogers et al, 1910). This hypertonic intravenous solution reduced the case fatality rate, but not until the late 1950s and early 1960s were consistently successful treatments implemented based on careful intake and output balance studies. (Carpenter  et al, 1965) (Watten et al, 1959).

Global spread of cholera, cholera cases and cholera deaths did not stop. In fact, the seventh pandemic,  cholera spread through Asia, then to Africa in 1970s (Goodgame et al, 1957). and then on to Latin America in the 1990s (Vugia et al, 1992) Cholera now persists in Sub-Saharan Africa leading to outbreaks which have become more frequent and more severe in recent years. (Gaffga et al, 2007).

Fortunately, the epidemic in Latin America, after spreading through most of the continent has subsided, and no cholera has been reported in recent years from South or Central America  Surprisingly, the 1991 Latin American epidemic did not spread to Haiti or the Caribbean Islands, but in October 2010 the Asian strain appeared along the Artibonite River in Haiti. ( Clemens et al, 2009). Regardless of how it arrived in Haiti, the conditions were ideal for its rapid spread to the entire country, leading to over 700000 cases, over half of whom were hospitalized, and 8000 deaths (WHO, 2011 and 2013). The devastating epidemic in Haiti, which has now spread to Cuba and recently to Mexico, dramatically demonstrated how dangerous cholera can be, and this epidemic, so close to North America, has raised cholera’s profile but has also led to a more concerted and coordinated effort to control the disease, not only in Haiti but in Africa and Asia as well (Centers for disease control and prevention, 2013).. About 2.8 million people are estimated to become ill with cholera each year, and since asymptomatic infections are common, 5 to 10 times as many are infected.

The world death toll is estimated to be over 100000 annually, (Ali et al, 2012) although only a fraction of these are reported. To deal with this global threat in Asia, Africa and the Caribbean, the strategy to control cholera has primarily focused on wash interventions (improved water, sanitation and hygiene) and ensuring proper case management with hydration and antibiotics.

These interventions are critical to the eventual control of cholera, but clearly they have not been sufficient. Populations most at risk of cholera are unlikely to have safe water and improved sanitation for many decades. Although ‘point of use’ water treatment provides protection when used properly, this has been difficult to sustain on a large scale, and drinking pure water does not negate the risk from contaminated water which may also be consumed. (Enger et al, 2013).

In Cameroon, Cholera is a severe acute watery diarrheal disease caused by toxigenic strains of Vibrio cholerae. The causative bacterium may be free-living in the environment, with environmental reservoirs well described in endemic regions in Asia (Verma et al, 2012). the microorganism can live in both fresh- (inland lakes) (Bwire et al, 2016) and salt-water (coastal, estuarine areas) environments, illness tends to occur in seasonal patterns (Baumann et al, 2016). with seasonality often associated with environmental parameters such as rainfall (WHO, 2019) and temperature (Department of Biostatistics,2017). While the environmental link is important for maintaining the microorganism long-term (including time between epidemics), once introduced into human populations Vebro cholerae rapid (epidemic) transmission is associated with poor sanitation household contamination, and contamination of food and potable water. Epidemiologic studies in Africa have clearly documented the association between environmental exposures and occurrence of illness at the same time, there are also data suggesting that a great deal of the transmission in Africa is due to direct transmission among humans (WHO, 2013). Understanding these transmission patterns is a critical element in designing interventions as part of national and global cholera control programs.Since 1817, seven cholera pandemics have spread from South and Southeast Asia to the rest of the world, and the seventh that began in 1961 in Indonesia is ongoing (Amicizia D, et al.2019). During 2014, 190,549 cholera cases and 2,231 deaths (case fatality ratio [CFR] of 1.17%) were reported to the World Health Organization (WHO) by the public health authorities of 42 countries (Griffiths et al, 2021) Yet, the actual disease burden is estimated to be much higher, in the range of 1.3 to 4.0 million cholera cases and 21,000–143,000 deaths per year worldwide (Kigen et al, 2021). Cholera is a threat to public health globally, but its burden is biased towards developing countries where poor water and sanitation provide added opportunities for transmission.

The current pandemic reached Africa in 1970, with the first cases reported in Guinea-Bissau and Guinea Conakry  Between 1980 and 2005, Africa accounted for the majority of the reported global burden of cholera.(Daso et al, 2021). From 2000 to 2014, African countries reported 2,139,424 cases of cholera, in comparison to the 186,401 from Asia; 754,694 from the Americas; 16,291 from Oceania; and the 417 from Europe.

The four countries around the Lake Chad Basin (Niger, Nigeria, Chad, and Cameroon) reported 62,762 cases in 2010; 65,401 in 2011; 6,784 in 2012; 7,215 in 2013; and 41,410 in 2014 Of these four countries, Cameroon was responsible for 22,762 cases and 786 deaths (3.5% CFR) in 2011. In 2014, Cameroon was among the four countries in Africa with a CFR >5% (WHO, 2020). far exceeding the WHO target of less-than 1%. (Mwape  et al, 2020).

Prevalence of cholera outbreak in Cameroon is on going affecting four regions Littoral, South West, South and Central Regions. As of 18 June 2020 there have been a total of 647cases and 34 deaths. Case fatality ratio 5.3 percent of the deaths a total of 23 have been in treatment centres and  in the community 44case of cholera was present in Buea Health District.(WHO,2021). Recently Cameroon has recorded 4,627 cases and 105 deaths with case fatality rate of 2.3% in March 23 to April 05, 2022, according to the Health Minister Manaouda Malachie.

1.2 Statement of the problem

Cholera is a bacteria infection  cause by  Vibro cholerae which is gotten from contaminated food and water .Verious measures have been put in place for the management of cholera such as the oral rehydration therapy but despite this measures cholera still remains a troubling health problem and global health problem especially in the management of asymptomatic carriers thereby making it difficult for early clarification and diagnosis of the disease that the carriers can be placed on trearment.It can easily or rather early be manage.

Cholera remains a global threat to public health and an indicator of inequity and lack of social development. Reseachers have estimated that every year, there are roughly 1.3-4.0 million case, and 21000 to 143000 deaths worldwide due to cholera.(WHO, 2021). About 2.8 million people are estimated to become ill with cholera each year, and since asymptomatic infections are common, 5 to 10 times as many are infected.

The world death toll is estimated to be over 100000 annually. (Ali et al, 2012).These interventions are critical to the eventual control of cholera, but clearly they have not been sufficient. In fact, the seventh pandemic, cholera spread through Asia, then to Africa in 1970s. (Goodgame et al, 1975). Cholera is a diarrheal disease that remains an important global health problem with sever hundreds of thousands of reported cases each year.

1.3 Objectives

General objective

To assess nurses’ knowledge on the management of cholera in Kumba District Hospital.

Specific objective

1. To assess the nursing process in diagnosing cholera in Kumba District Hospital.
2. To assess nursing intervention for the care and management of cholera patients in Kumba District Hospital.
3. To assess nursing education to patients with cholera in Kumba District Hospital.

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