Nearly 300 people have died in a cholera epidemic in West Africa, and thousands of others have been infected.  Naomi Schwarz reports from Dakar, international health experts say if steps to improve West Africa's sanitation, water, and public hygiene are not taken, next year could be worse.

Senegalese wade through flood water in Thiaroye in the suburbs of Dakar after unseasonal rains in Dakar, Senegal, 26 Aug. 2005 (file photo)

Outbreaks this year have left more than 250 dead in Guinea and 30 dead in Sierra Leone.  In Senegal, more than 2,000 cases of cholera have been reported, says Red Cross Health Manager for West and Central Africa Aissa Fall Gueye.

This is a very high infection rate, she says, but not exceptional for the West African country.

Only 12 cases have been fatal.  She says Senegal has done a good job of responding to this year's crisis.

But she says the disease will continue to plague the region if international donors and governments do not shift their focus from disaster relief to long-term prevention.

Cholera is a water-borne disease that can cause severe diarrhea and vomiting and leave patients severely dehydrated.  Outbreaks peak during the rainy season in West Africa, but cases are reported year-round.  The disease is spread through contaminated water and food, and thrives in places that lack proper sewage and garbage disposal.

It can also pass from person to person, which becomes a serious problem as people move around the country.  For example, in Senegal, this year's first major outbreak was reported in Touba, after rains caused the sewers to overflow.  One week later, there was an outbreak hundreds of kilometers away in Saint Louis, after a religious gathering that was attended by many from Touba.

Gueye says health organizations and ministries need to stop acting like firefighters, who wait to respond until the situation is already in crisis.

She says they need to be more proactive and they need donor support to help them focus more strongly on prevention.

The Red Cross is stepping up their efforts to educate communities about proper hygiene and to distribute anti-microbial soap and chlorine to disinfect drinking water.

But community level action is not enough, says Belgium's Doctors Without Borders West Africa Operational Coordinator Sebastien Roy.

"The biggest increase of cases is probably linked to structural reasons.  Bad sanitation conditions, problems with the water supply for the population, and with wide urbanization of the city," he noted.

He says to prevent further outbreaks, real infrastructure improvements need to be made.

"We have to invest in water distribution and sanitation conditions if we want to avoid cholera in the next year," he added.  "To improve these conditions we need to join the different efforts between the states and the NGOs and the different organizations."

In 2005, more than 1,200 died in a massive outbreak that infected more than 75,000 across West Africa.