Yr 9 Science Research

Sylvester So
9-19-2022

How do the responses of Australia compare to Somalia when dealing with

Cholera?

Figure 1 (vibrio cholerae, Wikipedia, 2022)

Introduction
For my Medical Science Investigation Task, I have chosen cholera as my main research target. Cholera is an
acute diarrhoeal infection caused by consuming food or water contaminated with the bacterium Vibrio
cholerae which is found in the feces and vomit of an infected person. Symptoms are usually mild or non-
existent but they can sometimes be severe. They include watery diarrhea, extreme loss of fluid and
electrolytes, and severe dehydration. People infected with cholera can die within a few hours if it is not
treated, however, It can be easily treated using an oral rehydration solution. During the 19th century, cholera
spread across the world from its original reservoir in the Ganges delta in India and up till recently, is still
endemic in many countries. Nowadays, the occurrence of cholera cases is heavily dependent on the areas’
access to safe water, sanitation, and hygiene, therefore, cholera outbreaks occur frequently in developing
countries, especially in sub Sahara Africa (World Health Organisation [WHO], 2022). With that in mind, I chose
to research and investigate how Australia is more successful in the prevention and cure of cholera than
Somalia.

Analysis
Somalia
As seen in the graph below, from December 2017 to November 2021, a total of 20 875 suspected cholera cases
including 118 related deaths (35 of them being reported from the start of 2021) were recorded from eight
regions in Somalia (WHO Regional Office for the Eastern Mediterranean [EMRO], 2022). This shows that
cholera is still endemic in Somalia with small-scale outbreaks. Cholera outbreaks usually occur when most
people in the country have limited access to safe and clean drinking water and proper hygiene. Citizens in
Somalia struggle to prevent the spread and control of cholera since only 52% of Somalia's population has
access to safely managed drinking water, and the ongoing drought is making water even more insufficient
(reliefweb, 2022). This forces citizens to use and drink unsafe water from rivers and ponds which are infested
with cholera. A total of 7796 cases of cholera, including 37 deaths, have been reported from 25 drought-
affected districts between 1 January and 10 July 2022, exceeding the total number of cases in 2021 (WHO,
2022). This huge increase in cases raised awareness of the Somali government and the World Health
Organization. Starting in 2019, Somalia participated in a campaign launched by the Global Task Force on
Cholera Control (GTFCC) for cholera control “Ending Cholera: A global roadmap to 2030”. The campaign aims
to lower cholera deaths by 90% and get rid of cholera in multiple countries by 2030 (GTFCC, 2020). The
campaign focuses on three main strategies:

1. Locating outbreak areas promptly and containing the outbreak, through strengthening the
surveillance of cholera cases, making sure healthcare systems are prepared for an outbreak, and
establishing rapid response teams. These simple measures can drastically decrease the number of
deaths caused by cholera.
2. Targeted approach towards cholera “hotspots” through measures like improved water, sanitation,
hygiene (WASH) and using oral cholera vaccines (OCV)
3. Effective technical support and partnership on both a local and global level. The GTFCC can effectively
fund, and coordinate resources countries need.

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 Figure 2 (WHO Regional Office for the Eastern Mediterranean, 2022)

Australia
As seen in the graph below, Cholera is no longer endemic in Australia. It is known to be present in some rivers
along the east coast of Australia, but being infected with cholera from Australia is very rare (Government of
South Australia, n.d.). The National Notifiable Diseases Surveillance System was implemented in 1990 with the
help and support of the Communicable Diseases Network Australia. It coordinates national surveillance and
data collection of diseases on the National Notifiable Disease List which includes cholera (Australian
Government Department of Health and Aged Care, 2022). These diseases on the list are a risk to public health
if an outbreak occurred. After the implementation of the National Notifiable Disease, all cases recorded of
cholera were imported by travellers from developing countries coming to Australia, except for 1 case of
laboratory-acquired cholera in 1996 and 3 cases in 2006 (The State of Queensland, 2015). The three cases in
2006 were caused by the consumption of infected imported food but no cases were fatal as healthcare in
Australia is both safe and affordable. Most cases in Australia nowadays occur in travellers/health aid workers
returning from developing countries. The disease is closely linked to inadequate sanitation and lack of access
to clean water, therefore the risk of an outbreak of cholera in Australia is small due to proper sewage systems,
a hygienic environment, and surplus access to clean water. Since cholera can be brought back by children and
adults travelling to cholera-endemic areas, the Australian government suggests children aged 2-6, adults and
relief/emergency workers travelling to developing countries get the oral cholera vaccine (OCV) (Health direct,
2021).

Figure 3 (Jacqueline D., Martin A., & John D, 2019, August)

Comparison
The National Notifiable Diseases Surveillance System has been a huge success in the control and surveillance of
cholera and it contributed to the elimination of the disease in Australia. Since outbreaks in Somalia occurs
severely in small areas, the Somalian government can adopt similar systems to help locate the “hotspots” and

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enforce targeted measures like providing free oral cholera vaccination, creating proper sewage systems,
introducing ways for people to obtain clean water and educating people about hygiene and prevention of the
disease. These measures if aimed toward small areas can effectively tackle and contain the occurring outbreak
and prevent the risk of future outbreaks.

Cholera can be cured easily. Most people with cholera can be treated successfully by taking an oral rehydration
solution (ORS) as soon as possible, however, some severely dehydrated patients might need antibiotic
treatment prescribed by doctors (WHO, 2022). Between 2017 and 2020, there have been 118 cholera-related
deaths in Somalia. Compared to Australia’s 0 death count since 1990, the number of deaths in Somalia is
tremendously high. This is due to most citizens not having access to basic healthcare services. There is only one
government hospital in the capital of Somalia, Mogadishu, and the majority of the population has to seek
healthcare services at private health facilities, therefore paying unreasonably high amounts for simple and
basic treatments (Office of the United Nations High Commissioner for Human Rights, 2022). Most Somali
citizens cannot afford the high prices of services and are unable to seek immediate medical attention. To solve
this problem, the Somali government can regulate the service quality and price of private health facilities. This
can better improve the access to care for citizens not living near the government hospital and hence lower the
number of deaths from cholera in Somalia. The Somali government can also create a more accessible
healthcare system by building at least one hospital in every region of the country. This provides the citizens
with an affordable option to seek immediately healthcare attention if needed.

Conclusion
Cholera is still endemic in Somalia and cases are way higher than in Australia. This is due to the majority of
Somali citizens not having access to clean drinking water and proper sewage disposal. On the other hand,
Australia has a great healthcare system and the National Notifiable Diseases Surveillance System which
effectively helps with the cure and prevention of cholera. The Somali government can adopt similar systems to
locate cholera “hotspots” and enforce target measures. They can also improve the accessibility of healthcare
through the regulation of private hospitals and the construction of more government health facilities around
the country. All in all, the Australian government is a lot more successful in the prevention and control and
cholera than Somalia. Strategies used by the Australian government can be implemented in Somalia to greatly
control the current outbreak, prevent risks of future outbreaks and lower deaths caused by cholera.

Evaluation
Since the 1800s, cholera has been eliminated by modern water and sewage systems. Therefore, finding case
numbers each year for Australia is difficult. Including graphs and data on the same year of cases in both
Australia and Somalia can more clearly display the difference in health care and sanitation between the two
countries. Analysing the trend of the graphs can also show when cholera became less common and by how
much the healthcare and sewage systems improved in both countries.

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 References
World Health Organisation. (2022, March 30). Cholera.
https://www.who.int/news-room/fact-sheets/detail/cholera

World Health Organisation Regional Office for the Eastern Mediterranean. (2022). Cholera outbreaks.
http://www.emro.who.int/health-topics/cholera-outbreak/cholera-outbreaks.html

Relief Web. (2022, July 31). Saving lives from cholera in drought-hit districts: WHO steps up vaccination
campaign using oral cholera vaccines. https://reliefweb.int/report/somalia/saving-lives-cholera-drought-hit-
districts-who-steps-vaccination-campaign-using-oral-cholera-vaccines

World Health Organisation. (2022, July 20). Cholera - Somalia. https://www.who.int/emergencies/disease-

outbreak-news/item/2022-DON398_1

Global Task Force on Cholera Control. (2020, September). Ending Cholera: A Global Roadmap To 2030.
https://www.gtfcc.org/wp-content/uploads/2020/09/ending-cholera-a-global-roadmap-to-2030.pdf

Government of South Australia. (n.d.). Cholera – including symptoms, treatment and prevention.
https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/conditions/
infectious+diseases/cholera/cholera+-+including+symptoms+treatment+and+prevention

Health Direct. (2021, April). Cholera. https://www.healthdirect.gov.au/cholera

The State of Queensland (Queensland Health). (2015, March). Cholera.

https://www.health.qld.gov.au/cdcg/index/cholera

Australian Government Department of Health and Aged Care. (2022, July 19). National Notifiable Diseases
Surveillance System (NNDSS). https://www.health.gov.au/initiatives-and-programs/nndss

Australian Immunisation Handbook. (2021, September 27). Cholera.

https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/cholera

Office of the United Nations High Commissioner for Human Rights. (2022, April 05). Somalia: UN expert warns
health care standards “dangerously low”. https://www.ohchr.org/en/press-releases/2022/04/somalia-un-
expert-warns-health-care-standards-dangerously-low

Vibrio cholerae. (2022, July 15). In Wikipedia. https://en.wikipedia.org/wiki/Vibrio_cholerae

Jacqueline D., Martin A., & John D. (2019, August). Epidemiology of cholera. ResearchGate.
https://www.researchgate.net/figure/Number-of-cholera-cases-reported-to-WHO-by-year-and-by-continent-
1989-2017_fig1_334980499

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