Cholera Outbreaks in Zimbabwe: An In-Depth Analysis of Drivers, Constraints and Reimagining the Use of Medicinal Plants

Abstract

Cholera, an intestinal infection caused by Vibrio cholerae, poses a severe threat to public health, particularly in developing countries. This narrative review discusses drivers for cholera outbreaks, challenges and viable alternatives, in Zimbabwe. A literature search was conducted using electronic databases notably ScienceDirect, Google Scholar and PubMed, as well as thesis and conference papers. Evidence indicates that the epidemiology, as well as risk factors, includes (1) extreme droughts; (2) political meddling in health issues and water supply; (3) natural disasters; (4) migration; (5) problems with water and sanitation; and (6) the endemic nature of the causative agent as well as its development of drug resistance. Reliable supply of clean water and proper sanitation and hygiene as the main key to prevention is emphasised. The use of antibiotics and vaccines for therapy, as well as the use of medicinal plants in traditional medicine, is discussed. Kirkia acuminata and Ziziphus mucronata root and stem bark infusions or decoctions were revealed to be the most common folklore treatments for cholera in rural communities. The potential of medicinal plants as anti-Vibrio cholerae remedies based on their positive antibacterial assays, and mechanism of action is also presented. Finally, the development of innovative anti-Vibrio cholerae therapeutics based on natural leads and compounds and adapted for use in resource-constrained cholera-prone areas is viewed as a potential option, to complement cholera prevention and treatment, particularly in resource-limited endemic areas.

Keywords: Vibrio cholerae; cholera control challenges; cholera outbreaks; epidemiology; medicinal plants; potential treatment options.

Figure 1

An overview of typical drivers for the repeated occurrences of cholera outbreaks in Zimbabwe (map of Zimbabwe adapted from BBC News [13]).

Figure 2

Cholera outbreaks in Zimbabwe, with complete statistics missing for 1972.

Figure 3

Villagers fetching water for drinking in the river in Mbire District (adapted from Médecins Sans Frontières [8]). Photographer: MSF/GRACE MAVHEZHA.

Figure 4

Strategies to inhibit drug efflux (adapted from Shriram et al. [120]).