A cholera outbreak in the capital of Guinea Bissau has killed at least four people and infected hundreds more. Health experts say the dismal sanitary conditions and infrastructure in the country make such outbreaks common and persistent. Brent Latham has more from our West Africa bureau in Dakar.

Health experts in Guinea Bissau warned that a full-scale cholera outbreak has reached the capital city, Bissau. In addition to the four confirmed deaths, hundreds of people have been treated in recent days at the central hospital.

This is the second cholera outbreak in Guinea Bissau in the last two months, following a string of infections in the southern region of Tomboli in late May. That outbreak has been mostly contained, according to the WHO. Experts said they do not know if they are dealing with one outbreak or two separate ones.

Mawo Fall, a physician who has worked with several NGOs in the country, emphasized the seriousness of the toll in the capital thus far.

"When we talk about cholera, just one case of cholera is an outbreak," he said. "Actually there are 272 cases in Guinea Bissau, and nine deaths. So I want to remind you that one case is an outbreak. We don't have to wait for 10 or 50 cases."

Fall lists a number of factors which contribute to the severity and frequency of cholera outbreaks in Guinea Bissau. He says that poor health and sanitation infrastructure and lack of human resources in health services are compounding the health problems that Bissau Guineans face.

Fall recommends a multi-step plan for dealing with the situation.

"There are many interventions to prevent cholera in Guinea Bissau," he explained. "The first is to focus on sanitation - sanitation in the schools, sanitation in the markets, sanitation wherever it is possible to contract cholera. We also have a campaign of mobilization to explain what cholera is, to explain what complications cholera can bring, and to explain how we treat cholera."

Fall says the government's Ministry of Health has formed partnerships with NGOs to work towards that plan.

Fall added that the public health system consists of just 107 health centers, of which only 14 have what he described as an "adequate level of service." He says the system reaches only 40 percent of the estimated 1.5 million Bissau Guineans.

Alpha Jallow, a representative for the Red Cross in Guinea Bissau, says investment in basic water and sewage systems would go a long way towards resolving the country's health problems.

Jallow says cholera outbreaks have occurred year after year in Guinea Bissau.

Guinea Bissau has had a history of political upheaval since winning independence from Portugal in 1973. A civil war that ended in 1998 was followed by two coup attempts in the last decade, leaving most of the country's already sparse infrastructure in shambles.

In a report last week, Brussels-based International Crisis Group said there is a risk of Guinea Bissau becoming "a narco-state and political no-man's land of interest to Maghreb criminal and terrorist networks." Archipelago-like geography and the unstable political environment have made it a haven in recent years for South American drug traffic headed to Europe.