**3. History of cholera in Zimbabwe**

The first recorded cholera case in Zimbabwe was in Mashonaland East Province (Mudzi district) in 1972. In the same year another outbreak was reported in Mashonaland Central (Mt Darwin district) [16]. Thereafter outbreaks occurred every 10 years until 1992. More frequent outbreaks occurred in the late 1990s, with the largest being recorded in 1999 when 4081 cases were reported in low lying border areas covering six provinces. Since the year 2000, cholera outbreaks were reported on an annual basis, with unprecedented outbreaks occurring in 2008/2009, when 60 of the 62 districts in the country were affected, and by the time the outbreak was declared over in May 2009, 98,592 cases and 4288 deaths had been reported [17]. The 2008/2009 cholera outbreak tested the strength of the Zimbabwe emergency preparedness and response at a time when the country was ill prepared for emergencies. Smaller outbreaks occurred in 2010 and 2011 each covering four districts and recording 1022 and 1140 cases respectively but these were controlled in reasonable time given the built response capacity from the 2008/2009 outbreak. After 2011, the country continued reporting cholera outbreaks


1 Source: National Health information and surveillance, Ministry of Health and Child Care, Zimbabwe.

**Table 2.** Cholera cases and deaths in Zimbabwe between 2008 and March 20181 .

on an annual basis to date with varying magnitudes. Remarkably, from 2012, all the outbreaks have been controlled at source without further spread to other districts. Chiredzi and Chipinge districts remained as hot spots with cases coming from these two districts for most years. **Table 2** shows cholera cases and deaths in Zimbabwe from 2008 to March 2018.

Since 2008, most of the cholera outbreaks in Zimbabwe were in urban settlements where the main drivers of cholera included the overloaded and dilapidated water and sanitation infrastructure which has been deteriorating over the years, inadequate water, contaminated water sources and poor water storage [18, 19]. In addition, cultural practices such as unsafe handling of corpses during burials add to the list of risk factors. In most of the reported outbreaks a great number of cases had been associated with deaths and reported to have attended a funeral [17].
