Until the traditional wedding season kicked off in July on Grand Comore, largest of the three islands that make up the Comoros archipelago, cholera was almost under control.
"This is an outbreak - we have seen over 800 cases, and 14 people have died since February," Josefa Marrato, country representative for the UN's children fund (UNICEF), told IRIN. Grand Comore, with 300,000 people, is home to almost half the Indian Ocean archipelago's total population.
Cholera is not new to the Comoros: there were epidemics in 1975, 1998 and 2000, said Abderamane Maiga, Officer in Charge at the World Health Organisation (WHO) on Grand Comore, adding that since the current outbreak started in February this year, July and August have seen a dramatic spike in new cases.
The WHO has described cholera - an intestinal infection leading to severe dehydration from chronic diarrhoea and vomiting - as "an easily treatable disease", cured with rehydration salts. However, if left untreated it can result in death within 24 hours.
Poor sanitation, crumbling sewage systems, streets filled with garbage and a lack of potable water are the root causes of the outbreak, but food served at traditional wedding parties has been blamed for spreading the disease so rapidly.
Cases have gone up due to the festivities - people get together, eat together, but are not taking the appropriate hygiene measures," said Marrato. "Cholera had been almost under control until July, when the 'Grand marriage' festivities started."
Elaborate and expensive public weddings marked by copious consumption take place throughout the islands during July and August. The timing coincides with the European holiday season when the Comoran diaspora - mainly resident in France - returns for 'Grand Marriage' - literally, 'great wedding'. The county's economy is heavily dependent on migrant remittances from the 150,000 Comorans estimated to be living abroad.
Having a 'Grand Marriage', which can cost up to US$30,000 and last from one to three weeks, is usually reserved for the wealthy but is attended by all, and the host family often feeds entire communities - "they involve the whole village and the neighbouring villages," Maiga said.
The marriage is off
In a communiqué last week, the government warned of the significance of the Grand Marriage festivities and their apparent link to the outbreak. "The government asked people not to have them [festivities] and to restrain from eating together," Marrato said.
But calling off or postponing a traditional occasion that has required years of planning and a lifetime of scrimping and saving is often not considered an option.
The sensitisation, education and communication efforts of the government, in collaboration with UNICEF, WHO and health non-governmental organisations have started to pay off. "The response has been good - the army is even helping to spread the message in communities," Marrato said.
Measures have also been taken to ensure that the disease does not spread to the other islands - Anjouan and Moheli - by informing travellers about the disease and the hygiene measures they can take to protect themselves.
"Since the weekend the amount of new cases has been going down," Maiga said. "[In prevention], the most important thing is hygiene, and we [WHO and UNICEF] are helping the government take care of people who are sick."