Understanding Cholera: Symptoms, Treatment, and Public Health Strategies

As a public health nurse, I have seen firsthand how cholera affects communities, especially in underserved areas with limited access to clean water and sanitation. One case I recall from my experience involved a girl of approximately 16 years who was brought to our clinic.

The girl had severe diarrhea and dehydration, and the mother, unaware of cholera dangers, kept her at home. By the time they arrived, her condition was critical. We immediately started oral rehydration therapy (ORT) and intravenous (IV) fluids, but unfortunately, the girl died.

What is Cholera?

Cholera is an infection of the small intestines by some strains of the bacterium Vibrio cholerae, which spreads through contaminated food and water, poor sanitation, inadequate sewage disposal, and consumption of raw and undercooked seafood.

Once ingested, the bacteria produce a toxin that causes the intestines to release a large amount of water, leading to severe dehydration. In some cases, death within hours can occur if not treated.

According to the World Health Organization (WHO), there are 1.3 to 4 million cases of cholera every year, and about 143,000 deaths. It remains endemic in parts of Africa, such as Zambia, which is my country, as well as in Asia and the Americas, due to poor sanitation and disasters that lead to a lack of access to clean water.

Cholera Symptoms and Diagnosis

Cholera symptoms range from mild to severe and usually appear within hours after infection. The most common ones are:

• Profuse watery diarrhea (rice-water stool).
• Dry mouth, sunken eyes, and rapid respirations (severe dehydration).
• Vomiting and muscle cramps due to electrolyte loss.
• In severe cases, extreme fatigue, confusion, and low blood pressure.

Diagnosis

1. Rapid diagnostic test (RDT) for cholera.
2. Stool for culture and sensitivity, which is a confirmatory test for Vibrio cholerae.

As a public health nurse, I always emphasize that early detection is critical, so once symptoms begin, dehydration can progress rapidly.

Cholera Treatment and Management

Rapid rehydration is vital in cholera treatment. A patient can lose about one liter of fluids in an hour, which can cause dehydration and death.

Key Treatment Methods

1. ORT, a simple sugar-salt solution, helps restore lost fluids and electrolytes.
2. IV fluids are used for patients with severe dehydration who cannot tolerate oral fluids.
3. Antibiotics: Even if they are not always necessary, they can shorten illness duration in severe cases. Doxycycline, azithromycin, or ciprofloxacin are commonly used.
4. Zinc supplements can also be given.

During my practice, I have seen many patients recover fully within a few days when treated early. Those who are delayed in care increase the risk of shock, kidney failure, and death.

Cholera Prevention and Public Health Measures

Prevention efforts focus on improving sanitation, hygiene, and public awareness because cholera spreads through contaminated water and food.

Effective Prevention Strategies

Access to clean water:

• Boiling or chlorinating water before drinking.
• Using safe water sources for cooking and washing food.

Sanitation and hygiene:

• Proper handwashing with running water and soap, after using the toilet, and before eating.
• The community should be advised to use latrines and avoid open defecation.

Food safety:

• The community should be encouraged to cook food thoroughly, especially seafood, to prevent foodborne illnesses.
• Cover leftover food to prevent contamination.

Cholera vaccination:

• According to the WHO, people should be given cholera vaccines (OCV), especially for high-risk areas.
• Vaccines must be combined with sanitation efforts because they provide short-term immunity.

In public health nursing, education is key and a very important tool. I have been conducting community health talks to educate communities about safe water practices, recognizing early symptoms, and proper hygiene. Communities do not know that boiling drinking water daily can prevent a deadly disease.

The Role of Healthcare Professionals

Personnel such as nurses, primary care providers, and public health workers play a vital role in controlling cholera. Our responsibilities include:

Early detection and rapid response

• Identifying cases quickly to prevent the spread of cholera.
• Setting up emergency treatment centers in outbreak zones (e.g., an urban clinic in Solwezi, northwestern Zambia, where I am currently working)
• Ensuring IV fluids and ORT are always in stock.

Community Education

• Giving information, education, and counseling on hygiene and water safety in communities.
• Distributing ORT packets and showing the community how to prepare them.
• Talking about myths on cholera, for example, in my community, they say cholera can be treated using herbal medicines.

Strengthening Healthcare Systems

• We typically advocate for improved water quality and access to good sanitation.
• Supporting the vaccination campaign, especially in high-risk areas.
• We also partner with local leaders, including politicians, church leaders, and schools, to enhance our response to outbreaks.

The most rewarding experiences I had were working with rural health teams, like community-based volunteers, to distribute ORT and educate communities on how to recognize the early signs of dehydration. Many families told me they had no idea that diarrhea can be so dangerous. This explains how simple community counseling can save lives.

Conclusion

Despite being easily preventable, cholera continues to be a threat to millions of lives worldwide. As public health nurses and other public health professionals, we play a critical role in prevention, early detection, and treatment. By improving access to clean water, sanitation, and education, we can significantly reduce the impact of cholera.

About the Author:

Sharon Kaunda is a dedicated Public Health Nurse and Nursing Tutor with a passion for health education and community outreach. With over a decade of experience in both clinical practice and nursing education, she is committed to empowering future nurses and promoting disease prevention through accessible, evidence-based health information.

Sharon is an independent contributor to CEUfast's Nursing Blog Program. Please note that the views, thoughts, and opinions expressed in this blog post are solely those of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your healthcare provider for any health-related questions or concerns.

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