# Amai da Gudawa

| Amai da Gudawa |
| --- |
|  |
| Description (en)  |
| Iri |
intestinal infectious disease (en) , waterborne disease (en) , primary bacterial infectious disease (en) , anthroponotic disease (en) , vibrio infectious disease (en) , cuta pandemic and epidemic-prone diseases (en)  |
| Field of study (en)  |
infectious diseases (en)  emergency medicine (en)  |
| Sanadi |
Vibrio cholerae (mul)  |
| Symptoms and signs (en)  |
diarrhea, amai, dehydration (en) , hypovolemia (en) , spasm (en) , discomfort (en) , hypotension (en) , oliguria (en) , cyanosis (en) , terminal dehydration (en) , thirst (en)  muscle cramp (en)  |
| Effect (en)  |
third cholera pandemic (en) , 1854 Broad Street cholera outbreak (en) , first cholera pandemic (en) , second cholera pandemic (en) , fifth cholera pandemic (en) , fourth cholera pandemic (en) , sixth cholera pandemic (en)  Cutar kwalara ta bakwai |
| Disease transmission process (en)  |
food-borne transmission (en) , fecal–oral route (en)  water-borne transmission (en)  |
| Physical examination (en)  |
physical examination (en) , microbiological culture (en) , complete blood count (en) , rapid diagnostic test (en)  polymerase chain reaction (en)  |
| Identifier (en)  |
| ICD-10-CM |
A00, A00.0, A00.9 da A00.1 |
| ICD-9-CM |
001.0, 001 da 001.9 |
| ICD-9 |
001 |
| OMIM |
166600 |
| DiseasesDB |
29089 |
| MedlinePlus |
000303 |
| eMedicine |
000303 |
| MeSH |
D002771 |
| Disease Ontology ID |
DOID:1498 |

**Kwalara** / / ˈkɒlərə / ) kamuwa ce ta ƙaramin hanji ta wasu nau'ikan ƙwayoyin cuta na *Vibrio cholerae* . Alamomin na iya bambanta daga babu, zuwa mai sauƙi, zuwa mai tsanani. Alamar da aka saba gani ita ce yawan gudawa mai ruwa-ruwa wanda ke ɗaukar kwanaki kaɗan. Amai da ciwon tsoka suma na iya faruwa. Gudawa na iya zama mai tsanani har ya kai ga rashin ruwa mai yawa da rashin daidaiton electrolyte cikin awanni. Wannan na iya haifar da faɗuwar idanu, sanyi ko cyanotic fata, raguwar laushin fata, kurkura hannuwa da ƙafafu, kuma, a cikin mawuyacin hali, mutuwa. Alamomin suna farawa awanni biyu zuwa kwana biyar bayan kamuwa da cutar.

Kwalara tana faruwa ne sakamakon nau'ikan *Vibrio cholerae* da dama, wasu nau'ikan kuma suna haifar da cututtuka masu tsanani fiye da wasu. Ana yaɗa ta galibi ta hanyar ruwa mara kyau da abinci mara kyau wanda aka gurbata da najasar ɗan adam mai ɗauke da ƙwayoyin cuta. Kifin da ba a dafa shi yadda ya kamata ba abu ne da aka saba gani. Mutane ne kawai aka sani suna ɗauke da ƙwayoyin cuta . Abubuwan da ke haifar da cutar sun haɗa da rashin tsafta, rashin isasshen ruwan sha mai tsafta, da talauci . Ana iya gano cutar kwalara ta hanyar gwajin bayan gida, ko gwajin dipstick mai sauri, kodayake gwajin dipstick bai yi daidai ba.

Hanyoyin rigakafi kan cutar kwalara sun haɗa da inganta tsafta da kuma samun ruwa mai tsafta . Allurar rigakafin kwalara da ake bayarwa ta baki tana ba da kariya mai kyau na tsawon watanni shida, kuma tana ba da ƙarin fa'ida na kariya daga wani nau'in gudawa da *E.<span typeof="mw:Entity" id="mwuw">&nbsp;</span>coli* . A shekarar 2017, Hukumar Abinci da Magunguna ta Amurka (FDA) ta amince da allurar rigakafin cutar kwalara mai rai da aka sha sau ɗaya, wacce ake kira Vaxchora ga manya 'yan shekara 18-64 waɗanda ke tafiya zuwa yankin da cutar kwalara ke yaduwa. Tana ba da kariya mai iyaka ga yara ƙanana. Mutanen da suka tsira daga cutar kwalara suna da garkuwar jiki mai ɗorewa na tsawon shekaru akalla uku (lokacin da aka gwada).

Babban maganin da ake bayarwa ga mutanen da abin ya shafa shine gishirin sake shakar ruwa ta baki (ORS), maye gurbin ruwa da electrolytes ta hanyar amfani da ruwan 'ya'yan itace masu zaki da gishiri. Ana fifita ruwan 'ya'yan itace da aka yi da shinkafa. A cikin yara, an gano cewa ƙarin zinc yana inganta sakamako. A cikin mawuyacin hali, ana iya buƙatar ruwan jijiya, kamar Ringer's lactate, kuma maganin rigakafi na iya zama da amfani. Zaɓar maganin rigakafi yana taimakawa ta hanyar gwajin jin daɗin maganin rigakafi .

Kwalara ta ci gaba da shafar kimanin mutane 3-5 mutane miliyan daya a duk duniya kuma yana haifar da 28,800–130,000 mace-mace a shekara. Zuwa yanzu, annoba guda bakwai na kwalara sun faru, inda aka fara kwanan nan a shekarar 1961, kuma har yanzu yana ci gaba. Cutar ba kasafai take faruwa a ƙasashe masu kuɗi mai yawa ba, kuma tana shafar yara sosai. Kwalara tana faruwa ne a lokacin barkewar cutar da kuma a wasu yankuna . Yankunan da ke da haɗarin kamuwa da cuta sun haɗa da Afirka da Kudu maso Gabashin Asiya . Haɗarin mutuwa tsakanin waɗanda abin ya shafa yawanci ƙasa da 5% ne, idan aka yi la'akari da ingantaccen magani, amma yana iya kaiwa 50% ba tare da samun irin wannan damar samun magani ba. Ana samun bayanin kwalara tun farkon ƙarni na 5 KZ a cikin adabin Sanskrit . A Turai, kwalara kalma ce da aka fara amfani da ita don bayyana kowace irin cutar gastroenteritis, kuma ba a yi amfani da ita don wannan cutar ba har zuwa farkon ƙarni na 19. Binciken cutar kwalara a Ingila da John Snow ya yi tsakanin 1849 da 1854 ya haifar da ci gaba mai yawa a fannin ilimin cututtuka saboda fahimtarsa game da yaduwar cutar ta hanyar gurbataccen ruwa, kuma taswirar irin wannan ita ce ta farko da aka rubuta ta hanyar bin diddigin cututtuka.

Takaitaccen bayani game da bidiyo tare da VideoWiki ( rubutu )
## Alamomi da Siffofin

Gudawar cholera da ke kama da "ruwan shinkafa"
Babban alamomin cholera su ne yawan gudawa da amai na ruwa mai tsabta. Wadannan alamomi yawanci suna fara ne kwatsam, daga rabin rana zuwa kwanaki biyar bayan shigar kwayar cutar. Gudawar ana yawan bayyana ta da "ruwan shinkafa" kuma tana iya yin wari kamar kifi. Mutum da ba a yi wa magani ba na iya fitar da gudawa lita 10 zuwa 20 a rana. Cholera mai tsanani, ba tare da magani ba, tana kashe kusan rabin wadanda abin ya shafa. Idan ba a yi wa gudawa mai tsanani magani ba, tana iya haifar da rashin ruwa mai tsanani da rashin daidaiton sinadarai a jiki. Kimantawa na nuna cewa daga kowane mutum 3 zuwa 100 na iya kamuwa ba tare da alamomi ba. Cholera ta samu lakabi da "mutuwar shuɗi" saboda fata na iya zama shuɗi-ashen daga asarar ruwa mai tsanani.

Zazzabi ba kasafai yake faruwa ba, kuma idan ya bayyana yana iya nuna wata cuta ta biyu. Marasa lafiya na iya zama masu kasala kuma suna iya samun idanu da suka nutse, baki bushe, fata mai sanyi da zufa, ko hannaye da ƙafafu masu runtsi. Kussmaul breathing, numfashi mai zurfi da wahala, na iya faruwa saboda acidosis daga asarar bicarbonate a cikin bayan gida da kuma lactic acidosis da ke da alaƙa da rashin isar jini. Matsin jini yana raguwa saboda rashin ruwa, bugun jini na gefe yana sauri kuma ba shi da ƙarfi, kuma fitar fitsari yana raguwa da lokaci. Tsokoki na iya yin kakkarwa da rauni, hankalin mutum na iya rikicewa, kamuwa da farfaɗiya, ko ma suma saboda rashin daidaiton sinadarai a jiki, musamman ga yara.

## Musabbabi

Hoton *Vibrio cholerae* da aka ɗauka ta na'urar hangen nesa ta lantarki (Scanning Electron Microscope)
*Vibrio cholerae*, ƙwayar cutar da ke haddasa kwalara
### Yaɗuwa

Yaɗuwar cutar yawanci tana faruwa ne ta hanyar cin abinci ko shan ruwa da ya gurɓace da bayan gida saboda rashin tsafta. Yawancin lokutan kwalara a ƙasashen da suka ci gaba sakamakon abinci ne, yayin da a ƙasashe masu tasowa ruwa ne mafi yawan hanyar yaɗuwar cutar. An gano ƙwayoyin kwalara a cikin dabbobin teku masu harsashi da kuma plankton. Yaɗuwar cutar ta hanyar abinci na iya faruwa idan mutane sun kama abincin teku kamar oysters daga ruwan da najasa ta gurɓata, domin *Vibrio cholerae* tana taruwa a cikin ƙananan halittun ruwa na crustaceans da ke rayuwa tare da plankton, sannan oysters suna cin zooplankton. Barkewar kwalara na ƙaruwa wajen yawaita faruwa, bazuwa da tsanani sakamakon sauyin yanayi.

Mutanen da suka kamu da kwalara sukan yi gudawa sosai, kuma yaɗuwar cutar na iya faruwa idan wannan bayan gida mai ruwa ƙwarai, wanda ake kira "ruwan shinkafa", ya gurɓata ruwan da wasu mutane ke amfani da shi. Sau ɗaya kacal mutum ya yi irin wannan gudawa na iya ƙara yawan *V. cholerae* a muhalli har sau miliyan ɗaya. Asalin gurɓatar yawanci daga wasu masu fama da kwalara ne idan ba a kula da bayan gidansu yadda ya kamata ba kuma ya shiga koguna, ruwan ƙasa ko hanyoyin samar da ruwan sha. Shan gurɓataccen ruwa ko cin abincin da aka wanke da irin wannan ruwa, da kuma dabbobin teku masu harsashi da ke rayuwa a wuraren da ruwa ya gurɓata, na iya sa mutum ya kamu da cutar. Kwalara ba kasafai take yaɗuwa kai tsaye daga mutum zuwa mutum ba.

*V. cholerae* tana rayuwa a wajen jikin ɗan Adam a cikin hanyoyin ruwa na halitta, ko dai ita kaɗai ko kuma ta hanyar hulɗa da phytoplankton, zooplankton, ragowar halittu masu rai da marasa rai. Shan irin wannan ruwa na iya haddasa cutar ko da ba a sami gurɓataccen bayan gida ba. Sai dai akwai matsin zaɓin muhalli a cikin ruwa wanda kan rage ƙarfin cutarwa na *V. cholerae*. Musamman, binciken dabbobi ya nuna cewa tsarin karanta ƙwayoyin halittar ƙwayar cutar yana canzawa yayin da take shirin shiga muhalli na ruwa. Wannan canjin yana rage ikon *V. cholerae* na girma a cikin kafofin gwaji na yau da kullum, abin da ake kira "mai rai amma ba za a iya noma shi a dakin gwaje-gwaje ba" (VBNC), ko kuma "mai aiki amma ba za a iya noma shi ba" (ABNC). Wani bincike ya nuna cewa ikon girman *V. cholerae* yana raguwa da kashi 90% cikin sa'o'i 24 bayan shiga ruwa, kuma wannan raguwar tana da alaƙa da raguwar ƙarfin haddasa cuta.

Akwai nau'ikan ƙwayoyin da ke da guba da kuma waɗanda ba su da guba. Waɗanda ba su da guba na iya samun ikon haddasa cuta ta hanyar wani bacteriophage mai matsakaicin yanayin rayuwa.

### Sauƙin kamuwa

Yawanci ana buƙatar mutum ya haɗiye kusan ƙwayoyin cuta miliyan 100 kafin kwalara ta kama lafiyayyen baligi. Amma wannan adadin yana raguwa ga mutanen da acid ɗin cikinsu ya yi ƙasa, kamar masu amfani da proton pump inhibitors. Yara ma sun fi saurin kamuwa, musamman masu shekaru biyu zuwa huɗu. Hakanan nau'in jinin mutum yana tasiri wajen yiwuwar kamuwa da kwalara, inda masu jinin nau'in O suka fi saurin kamuwa. Mutanen da garkuwar jikinsu ta yi rauni, kamar masu AIDS ko yara masu fama da rashin abinci mai gina jiki, sun fi yiwuwar kamuwa da mummunar kwalara idan suka kamu da cutar. Kowanne mutum, har ma da lafiyayyen baligi mai matsakaicin shekaru, na iya fuskantar mummunar cutar, kuma ya kamata a tantance kowanne hali bisa yawan ruwan da aka rasa daga jiki, tare da shawarar ƙwararren ma'aikacin lafiya idan zai yiwu.Samfuri:Medical citation needed
Canjin gado da ake kira delta-F508 wanda ke da alaƙa da cutar cystic fibrosis a cikin mutane, an ce yana ba masu ɗauke da kwafin guda ɗaya na wannan canji kariya daga kamuwa da *V. cholerae*.
A wannan samfurin, raunin da ke cikin sunadaran tashar cystic fibrosis transmembrane conductance regulator yana hana ƙwayoyin cutar manne wa rufin hanji, wanda hakan ke rage tasirin kamuwa da cutar.

## Tsarin Aiki

Rawar biofilm a mamayar hanji da *Vibrio cholerae* ke yi
Lokacin da aka haɗiye ƙwayoyin cutar, yawancinsu ba sa rayuwa saboda yanayin acid mai ƙarfi na cikin ɗan adam. Ƙalilan da suka tsira suna adana ƙarfinsu da abubuwan gina jiki da suka tara yayin wucewa cikin ciki ta hanyar dakatar da samar da sunadarai (protein). Lokacin da waɗannan ƙwayoyin da suka tsira suka fita daga ciki suka isa ƙaramin hanji, dole ne su yi amfani da motsinsu wajen ratsawa ta cikin kaurin majinar da ke rufe ƙaramin hanji domin isa bangon hanjin inda za su manne kuma su rayu cikin nasara.

Da zarar ƙwayoyin cutar kwalara sun isa bangon hanji, ba sa buƙatar flagella domin motsi. Ƙwayoyin cutar suna daina samar da sunadarin flagellin domin adana kuzari da abubuwan gina jiki ta hanyar canza irin sunadaran da suke samarwa sakamakon sabon yanayin sinadarai da suka samu. Bayan sun isa bangon hanji, *V. cholerae* na fara samar da sunadarai masu guba (toxins) waɗanda ke haifar da gudawa mai ruwa ga wanda ya kamu da cutar. Wannan gudawar tana fitar da sababbin ƙwayoyin *V. cholerae* masu yawaita zuwa ruwan sha na wanda zai kamu na gaba idan ba a samar da ingantaccen tsafta ba.

Gubar kwalara (CTX ko CT) wani hadadden tsarin sunadarai ne da ya ƙunshi ƙananan sassa shida na sunadari: kwafi ɗaya na sashin A (part A) da kwafi biyar na sashin B (part B), waɗanda ke haɗe da juna ta hanyar disulfide bond. Sassan B guda biyar suna samar da zobe mai sassa biyar wanda ke manne wa gangliosides na GM1 da ke saman ƙwayoyin epithelium na hanji. Sashin A1 na sashin A wani enzyme ne da ke yin ADP-ribosylation ga G proteins, yayin da sarkar A2 ke shiga tsakiyar ramin zoben sashin B. Bayan manne wa ƙwayar halitta, hadadden tsarin yana shiga cikin ƙwayar ta hanyar receptor-mediated endocytosis. Da zarar ya shiga cikin ƙwayar, ana karya disulfide bond ɗin, kuma sashin A1 yana 'yantuwa domin haɗuwa da wani sunadarin ɗan adam mai suna ADP-ribosylation factor 6 (Arf6). Wannan haɗuwar tana bayyana wurin aikinsa, wanda ke ba shi damar yin ribosylation na dindindin ga Gs alpha subunit na heterotrimeric G protein. Wannan yana haifar da ci gaba da samar da cAMP, wanda ke sa ruwa, sodium, potassium da bicarbonate su rika zubowa cikin lumen na ƙaramin hanji, lamarin da ke haddasa saurin rashin ruwa a jiki. An shigar da kwayar halittar da ke ɗauke da umarnin samar da gubar kwalara cikin *V. cholerae* ta hanyar horizontal gene transfer. Nau'ikan *V. cholerae* masu tsanani suna ɗauke da wani nau'in bacteriophage mai suna CTXφ.

Masana ilimin ƙwayoyin cuta sun yi nazarin hanyoyin ƙwayoyin halitta da *V. cholerae* ke amfani da su wajen kashe samar da wasu sunadarai da kuma kunna samar da wasu yayin da take amsa yanayin sinadarai daban-daban da take fuskanta yayin wucewa cikin ciki, ta cikin majinar ƙaramin hanji da kuma zuwa bangon hanji.
Musamman, an mayar da hankali kan hanyoyin ƙwayoyin halittar da ke kunna samar da gubobi waɗanda ke mu'amala da tsarin ƙwayoyin jikin mai masaukin cutar domin tura ions na chloride zuwa cikin ƙaramin hanji. Wannan yana haifar da matsin lamba na ions wanda ke hana ions na sodium shiga cikin ƙwayar. Ions na chloride da sodium suna samar da yanayin ruwa mai gishiri a cikin ƙaramin hanji wanda ta hanyar osmosis zai iya jawo har zuwa lita shida na ruwa a rana su ratsa cikin ƙwayoyin hanji, lamarin da ke haifar da matsananciyar gudawa. Mai kamuwa da cutar na iya rasa ruwa cikin sauri idan ba a yi masa magani yadda ya kamata ba.

Ta hanyar saka sassa daban-daban na DNA na *V. cholerae* cikin DNA na wasu ƙwayoyin cuta kamar *E. coli*, waɗanda ba sa samar da waɗannan gubobi a dabi'ance, masu bincike sun yi nazarin yadda *V. cholerae* ke amsawa ga canjin yanayin sinadarai na ciki, majinar hanji da bangon hanji. Masu bincike sun gano cewa wani hadadden tsarin sunadarai masu sarrafawa ne ke kula da bayyanar halayen tsananin cutar (virulence determinants) na *V. cholerae*. A lokacin amsawa ga yanayin sinadarai da ke bangon hanji, ƙwayoyin *V. cholerae* suna samar da sunadaran TcpP/TcpH, waɗanda tare da sunadaran ToxR/ToxS ke kunna samar da sunadarin sarrafawa na ToxT. Daga nan ToxT kai tsaye yana kunna bayyanar kwayoyin halittar virulence waɗanda ke samar da gubobi, suna haddasa gudawa ga wanda ya kamu da cutar kuma suna ba ƙwayoyin damar mamaye hanji. Bincike na yanzu yana neman gano "siginar da ke sa ƙwayoyin kwalara su daina iyo kuma su fara mamaye (wato manne wa ƙwayoyin) ƙaramin hanji".

### Tsarin Kwayoyin Halitta

Binciken DNA ta hanyar Amplified Fragment Length Polymorphism (AFLP) na nau'ikan *V. cholerae* da suka haddasa annoba ya nuna bambance-bambance a tsarin kwayoyin halittarsu. An gano rukuni biyu: Rukuni na I da Rukuni na II. A mafi yawan lokuta, Rukuni na I ya ƙunshi nau'ikan shekarun 1960 da 1970, yayin da Rukuni na II ya fi ƙunsar nau'ikan shekarun 1980 da 1990, bisa sauye-sauyen tsarin clone. Wannan rarrabuwa ta fi bayyana a cikin nau'ikan da aka samu daga nahiyar Afirka.

### Juriya ga Magungunan Rigakafin Ƙwayoyin Cuta

A yankuna da dama na duniya, juriya ga magungunan rigakafin ƙwayoyin cuta na ƙaruwa a cikin ƙwayoyin kwalara. A Bangladesh, alal misali, mafi yawan lokuta suna nuna juriya ga tetracycline, trimethoprim-sulfamethoxazole da erythromycin. Akwai hanyoyin gwaji masu sauri domin gano lokutan da ke da juriya ga magunguna da dama. An kuma gano sabbin magungunan kashe ƙwayoyin cuta waɗanda suka nuna inganci a kan ƙwayoyin kwalara a gwaje-gwajen dakin bincike (*in vitro*).

## Ganewar Asibiti

Ana samun gwajin dipstick mai sauri don gano kasancewar V. cholerae. Idan sakamakon ya nuna akwai cutar, ya kamata a yi ƙarin gwaje-gwaje don gano juriya ga maganin rigakafi. A lokacin annoba, ana iya yin ganewar asibiti ta hanyar tarihin marar lafiya da bincike mai sauƙi. Ana iya fara magani ta hanyar shayar da ruwa da magungunan ruwa na kasuwa kafin ko ba tare da tabbatarwa daga dakin gwaje-gwaje ba, musamman inda kwalara ta zama matsala.

Samfurin bayan gida da swab da aka tattara a lokacin farkon cutar, kafin a fara maganin rigakafi, su ne mafi amfani wajen gano cutar. Idan ana zargin annoba ta kwalara, mafi yawan sanadin cutar shi ne V. cholerae O1. Idan ba a gano O1 ba, sai a binciki V. cholerae O139. Idan babu ɗayansu, dole ne a aika samfurin bayan gida zuwa dakin gwaje-gwaje na musamman.

Cutar da V. cholerae O139 ke haifarwa ya kamata a bayar da rahoto da kuma kula da ita kamar yadda ake yi da V. cholerae O1. Ciwon gudawa da ke da alaƙa da ita ya kamata a kira da kwalara kuma dole ne a bayar da rahoto a Amurka.

## Rigakafi

Allurar rigakafin kwalara a shekarar 1966
Hukumar Lafiya ta Duniya (WHO) tana ba da shawarar mayar da hankali kan rigakafi, shiri, da martani domin yaƙar yaɗuwar kwalara. Haka kuma tana jaddada muhimmancin ingantaccen tsarin sa ido da bibiyar cuta. Gwamnatoci na iya taka muhimmiyar rawa a duk waɗannan fannoni.

### Ruwa, tsaftar muhalli da tsaftar jiki

Samfuri:Further

Ko da yake kwalara na iya zama cuta mai barazana ga rayuwa, rigakafinta yawanci abu ne mai sauƙi idan ana bin ƙa'idodin tsafta yadda ya kamata. A ƙasashe masu ci gaba, saboda kusan kowa na samun ingantaccen tsarin kula da ruwa da tsaftar muhalli, kwalara ba ta cika faruwa ba. Alal misali, annobar kwalara ta ƙarshe mai girma a Amurka ta faru ne tsakanin shekarun 1910 zuwa 1911. Kwalara ta fi zama barazana a ƙasashe masu tasowa, musamman a wuraren da har yanzu hanyoyin samar da ruwa mai tsafta, tsaftar muhalli da tsaftar jiki (WASH) ba su wadatar ba.

Ingantattun hanyoyin tsaftar muhalli, idan an aiwatar da su kuma aka bi su a kan lokaci, yawanci suna isa su dakatar da annoba. Akwai wurare da dama a cikin hanyar yaɗuwar kwalara inda za a iya dakatar da yaɗuwarta:

* **Kashe ƙwayoyin cuta (Sterilization):** Zubarwa da kula da duk wani abu da ya taɓa bayan-gidan mutanen da suka kamu da kwalara (misali tufafi, shimfiɗa da makamantansu) yadda ya kamata yana da matuƙar muhimmanci. Ya kamata a tsabtace su ta hanyar wanke su da ruwan zafi, tare da amfani da sinadarin chlorine bleach idan akwai. Hannayen da suka taɓa marasa lafiya ko tufafinsu da kayan kwanciyarsu ya kamata a wanke su sosai kuma a kashe ƙwayoyin cuta da ruwan chlorine ko wasu sinadarai masu kashe ƙwayoyin cuta.

* **Gudanar da najasa da datti na bayan-gida:** A yankunan da kwalara ta shafa, dole ne a kula da najasa da datti na bayan-gida yadda ya kamata domin hana yaɗuwar cutar ta hanyar bayan-gidan ɗan adam. Samar da tsaftar muhalli da tsaftar jiki muhimmiyar hanyar rigakafi ce. Dole ne a hana yin bayan-gida a fili, sakin najasa ba tare da magani ba, ko zubar da datti daga rijiyoyin bayan-gida ko tankunan septic cikin muhalli. A yawancin yankunan da kwalara ta fi yawaita, matakin kula da najasa yana da ƙasa. Saboda haka, amfani da busassun bayan-gida (dry toilets) waɗanda ba sa gurɓata ruwa na iya zama wata hanya mai amfani maimakon bayan-gidan ruwa (flush toilets).
* **Tushen ruwa:** Ya kamata a sanya gargadi a wuraren ruwan da ake zargin sun gurɓace da kwalara tare da bayanin yadda za a tsarkake ruwan (ta hanyar tafasa shi, amfani da chlorine da sauransu) kafin amfani.

* **Tsarkake ruwa:** Duk ruwan da za a sha, a yi amfani da shi wajen dafa abinci ko wanke-wanke ya kamata a tsarkake shi ta hanyar tafasawa, chlorination, amfani da ozone, hasken ultraviolet (misali ta hanyar tsarkake ruwa da hasken rana), ko tacewa da na'urorin kashe ƙwayoyin cuta a duk yankin da ake zargin akwai kwalara. Chlorination da tafasawa su ne hanyoyin da suka fi sauƙi da rahusa wajen dakatar da yaɗuwar cutar. Tace ruwa da zane ko sari filtration, duk da kasancewarsu hanyoyi masu sauƙi, sun rage yawan kamuwa da kwalara sosai a ƙauyukan Bangladesh da ke amfani da ruwan sama ko na saman ƙasa ba tare da magani ba. Ingantattun matatun ruwa masu kashe ƙwayoyin cuta su ne mafi inganci. Wayar da kan jama'a kan lafiyar jama'a da bin ƙa'idodin tsafta suna da muhimmanci wajen hana da sarrafa yaɗuwar kwalara da sauran cututtuka.

WHO Afrika tana kuma ba da shawarar wanke hannu da sabulu ko toka bayan amfani da bayan-gida da kuma kafin sarrafa abinci ko cin abinci domin rigakafin kwalara.

* Ana zargin zubar da najasa ko datti daga sansanin Majalisar Ɗinkin Duniya cikin wani tafki a kusa da Port-au-Prince ya taimaka wajen yaɗuwar annobar kwalara ta Haiti ta shekarar 2010 bayan girgizar ƙasa, wadda ta kashe dubban mutane.
* Misalin busasshen bayan-gida mai raba fitsari a yankin Haiti da kwalara ta shafa. Irin wannan bayan-gida yana dakatar da yaɗuwar cuta ta hanyar gurɓatar ruwa da bayan-gida.
* Asibitin kwalara a Dhaka, yana nuna irin gadajen da ake amfani da su ga marasa lafiya na kwalara.

### Sa Ido da Bibiyar Cuta

Amfani da bayanan tauraron ɗan adam wajen ƙirƙirar taswirar haɗarin barkewar kwalara a yankuna daban-daban na duniya.
Sa ido da bayar da rahoton cuta cikin gaggawa na taimakawa wajen dakile annobar kwalara cikin sauri. A ƙasashe da dama da cutar ke yawaita, kwalara cuta ce mai bin yanayi kuma tana faruwa duk shekara musamman a lokacin damina. Tsarin sa ido na iya ba da gargadin farko game da barkewar cuta, wanda zai taimaka wajen tsara martani cikin haɗin gwiwa da kuma shirye-shiryen tunkarar annoba. Ingantaccen tsarin sa ido yana kuma taimakawa wajen tantance haɗarin barkewar kwalara a nan gaba. Domin rigakafi ya yi tasiri, yana da muhimmanci a rika kai rahoton dukkan lokutan kamuwa da cutar ga hukumomin lafiya na ƙasa.

### Rigakafin Allura

Allurar rigakafin kwalara ta baki Euvichol-plus
Likitan Spain Jaume Ferran i Clua ne ya samar da allurar rigakafin kwalara ta farko mai nasara a shekarar 1885, wanda ya zama mutum na farko da ya yi rigakafin wata cutar ƙwayoyin cuta ga mutane. Duk da cewa allurarsa ta fuskanci suka da ƙin amincewa daga takwarorinsa da kwamitocin bincike, daga baya ta tabbatar da ingancinta kuma aka amince da ita. Daga cikin mutane 30,000 da ya yi wa rigakafi, mutum 54 kacal suka mutu.

Masanin ƙwayoyin cuta ɗan asalin Rasha da Faransa, Waldemar Haffkine, shi ma ya samar da allurar rigakafin kwalara ga mutane a watan Yulin 1892. Ya gudanar da babban shirin yin rigakafi a Birtaniyyar Indiya.

Mutanen da suka tsira daga kamuwa da kwalara suna samun kariya mai ɗorewa daga sake kamuwa da cutar na aƙalla shekaru uku (gwargwadon lokacin da aka gwada). Akwai alluran rigakafin kwalara da dama na baki waɗanda suke da aminci kuma suna da tasiri. Hukumar Lafiya ta Duniya (WHO) ta amince da alluran kwalara na baki guda uku: Dukoral, Sanchol da Euvichol. Dukoral, wanda allura ce ta baki mai ɗauke da ƙwayoyin cuta da aka kashe (whole-cell vaccine), tana da tasiri kusan kashi 52% a shekara ta farko bayan karɓa, da kuma kashi 62% a shekara ta biyu, tare da ƙarancin illa. Ana samun ta a ƙasashe sama da 60. Sai dai a halin yanzu Cibiyar Kula da Cututtuka ta Amurka (CDC) ba ta ba da shawarar amfani da ita ga mafi yawan matafiya daga Amurka zuwa ƙasashen da kwalara ta yawaita ba. Allurar da Hukumar Kula da Abinci da Magunguna ta Amurka (FDA) ke ba da shawara ita ce Vaxchora, wata allurar baki mai rai amma raunana (oral attenuated live vaccine), wadda take da tasiri ga manya masu shekaru 18 zuwa 64 idan aka ba su kashi guda ɗaya.
An gano wata allurar da ake yi ta allura a jiki tana da tasiri har tsawon shekaru biyu zuwa uku. Tasirin kariyarta ya ragu da kashi 28% a cikin yara masu ƙasa da shekaru biyar. Duk da haka, as of 2010, samun wannan allurar yana da iyaka. Ana ci gaba da bincike kan rawar da yin rigakafi ga jama'a gaba ɗaya zai taka. WHO tana ba da shawarar yi wa ƙungiyoyin da ke cikin haɗari, kamar yara da mutanen da ke ɗauke da HIV, rigakafi a ƙasashen da cutar ke yawaita. Idan aka yi wa jama'a da yawa rigakafi, kariyar garke (herd immunity) na samuwa, wanda ke rage yawan gurɓata muhalli da ƙwayoyin cutar.

WHO tana ba da shawarar a yi la'akari da amfani da allurar kwalara ta baki a yankunan da cutar ke yawaita (musamman a lokutan da take ƙaruwa bisa yanayi), a matsayin wani ɓangare na martani ga barkewar cuta, ko kuma a lokacin rikicin jin kai inda haɗarin kwalara ya yi yawa. An amince da allurar kwalara ta baki (OCV) a matsayin wata ƙarin hanya ta rigakafi da sarrafa kwalara. WHO ta amince da alluran kwalara guda uku masu kare nau'ikan O1 da O139: Dukoral (na kamfanin SBL Vaccines), wanda ke ɗauke da wani sashi mara guba na gubar kwalara (B-subunit), da kuma ShanChol (Shantha Biotec) da Euvichol (EuBiologics Co.) waɗanda aka ƙera ta amfani da fasaha iri ɗaya. Ana iya amfani da allurar kwalara ta baki a yanayi daban-daban, daga yankunan da cutar ke yawaita zuwa wuraren rikicin jin kai, amma har yanzu babu cikakkiyar matsaya kan yadda ya kamata a rika amfani da ita a kowane yanayi.

### Tace Ruwa da Sari

Women at a village pond in Matlab, Bangladesh, washing utensils and vegetables. The woman on the right is putting a sari filter onto a water-collecting pot (or kalash) to filter water for drinking.
An ƙirƙiri hanyar "tace ruwa da sari" domin amfani a Bangladesh. Wannan hanya ce mai sauƙi kuma mai arha ta fasahar da ta dace (appropriate technology) domin rage gurɓacewar ruwan sha. Ana fi son amfani da tsohuwar ƙyallen sari, amma ana iya amfani da wasu tsofaffin yadudduka ma, duk da cewa ingancinsu zai bambanta. Tsohon yadi ya fi sabo tasiri saboda yawan wankewa yana rage tazarar da ke tsakanin zarurrukan yadin. Ruwan da aka tace ta wannan hanya yana da ƙarancin ƙwayoyin cuta sosai, ko da yake ba lallai ne ya zama cikakken tsarkakakke ba. Duk da haka, wannan babban ci gaba ne ga talakawa masu ƙarancin zaɓuɓɓuka.

A Bangladesh, an gano cewa wannan hanya ta rage yawan kamuwa da kwalara da kusan rabin adadin da ake samu a baya. Hanyar tana buƙatar a naɗe sari sau huɗu zuwa takwas kafin a yi amfani da ita wajen tace ruwa. Bayan amfani, ya kamata a wanke yadin da ruwa mai tsabta sannan a busar da shi a rana domin kashe duk wata ƙwayar cuta da za ta iya kasancewa a jikinsa. An kuma gano cewa yadin nailan (nylon) yana aiki kusan daidai da sari, amma ba shi da sauƙin samu ko araha kamar sari.

## Magani

Ana kula da mara lafiyar kwalara ta hanyar maganin mayar da ruwa ta baki (oral rehydration therapy) a shekarar 1992
Ci gaba da cin abinci yana taimakawa wajen saurin dawo da aikin hanji yadda ya kamata. Hukumar Lafiya ta Duniya (WHO) tana ba da wannan shawara ga mafi yawan lokutan gudawa ba tare da la’akari da abin da ya haddasa su ba. Littafin horo na CDC da aka tanada musamman don kwalara ya bayyana cewa: "A ci gaba da shayar da jariri nono idan yana fama da gudawa mai ruwa, ko da kuwa ana kan hanyar zuwa neman magani. Manya da yara masu girma su ma su ci gaba da cin abinci akai-akai."

### Ruwa da Mayar da Ruwa a Jiki

Kuskuren da aka fi yi wajen kula da marasa lafiya masu kwalara shi ne raina saurin da kuma yawan ruwan da ake buƙatar ba su. A mafi yawan lokuta, ana iya samun nasarar magance kwalara ta amfani da maganin mayar da ruwa ta baki (ORT), wanda yake da tasiri sosai, mai aminci, kuma mai sauƙin amfani. Ana fifita magungunan da aka yi da shinkafa maimakon waɗanda aka yi da glucose saboda sun fi tasiri.

A lokutan da rashin ruwa ya yi tsanani sosai, ana iya buƙatar mayar da ruwa ta hanyar allurar jijiya (intravenous rehydration). Ringer's lactate shi ne ruwan da aka fi so a yi amfani da shi, sau da yawa tare da ƙarin potassium. Ana iya buƙatar ba da ruwa mai yawa da ci gaba da maye gurbinsa har sai gudawar ta tsaya. Wani lokaci ana iya buƙatar ba mutum ruwa da ya kai kashi 10% na nauyin jikinsa cikin awanni biyu zuwa huɗu na farko. An fara gwada wannan hanya a babban mataki a lokacin Yaƙin 'Yancin Bangladesh, kuma an samu nasara sosai.

Duk da abin da mutane da yawa ke zato, ruwan 'ya'yan itatuwa da abubuwan sha masu sukari kamar kola ba su dace wajen mayar da ruwa ga mutanen da ke fama da mummunan ciwon hanji ba, kuma yawan sukarinsu na iya ma hana jiki shan ruwa yadda ya kamata.

Idan magungunan ORS da aka ƙera a masana'anta suna da tsada ko kuma suna da wahalar samu, ana iya yin su a gida. Wata hanyar haɗawa ita ce: lita ɗaya na ruwan da aka tafasa, rabin ƙaramin cokali na gishiri, cokali shida na sukari, tare da ƙara ayaba da aka murƙushe domin samar da potassium da kuma inganta ɗanɗano.

### Sinadaran Jiki (Electrolytes)

Saboda yawan lokuta na farko suna tare da acidosis, matakin potassium na iya kasancewa daidai duk da cewa an rasa mai yawa daga jiki. Yayin da ake gyara rashin ruwa, matakin potassium na iya sauka da sauri, saboda haka ana buƙatar maye gurbinsa. Hanya mafi dacewa ita ce ta amfani da maganin ORS.

### Magungunan Rigakafin Ƙwayoyin Cuta

Amfani da magungunan rigakafin ƙwayoyin cuta (antibiotics) na tsawon rana ɗaya zuwa uku yana rage tsawon lokacin cutar kuma yana rage tsanantar alamominta. Haka kuma yana rage yawan ruwan da ake buƙatar bai wa mara lafiya. Duk da haka, marasa lafiya galibi suna murmurewa gaba ɗaya ba tare da amfani da maganin rigakafin ƙwayoyin cuta ba muddin an kula da mayar da ruwa yadda ya kamata. WHO tana ba da shawarar amfani da antibiotics ne kawai ga mutanen da ke fama da tsananin rashin ruwa.

Doxycycline shi ne maganin da aka fi amfani da shi da farko, ko da yake wasu nau'ikan *V. cholerae* sun nuna juriya ga shi. Gwajin juriya a lokacin annoba na taimakawa wajen zaɓar magungunan da suka fi dacewa a nan gaba. Sauran magungunan da aka tabbatar suna da tasiri sun haɗa da cotrimoxazole, erythromycin, tetracycline, chloramphenicol da furazolidone. Fluoroquinolones kamar ciprofloxacin ma ana iya amfani da su, amma an ruwaito juriya ga su.

Magungunan rigakafin ƙwayoyin cuta suna inganta sakamako ga mutanen da ke fama da tsanani ko marar tsanani na rashin ruwa. Azithromycin da tetracycline na iya yin aiki fiye da doxycycline ko ciprofloxacin.

### Ƙarin Zinc

A Bangladesh, ƙarin zinc ya rage tsawon lokaci da tsananin gudawa a yara masu kwalara lokacin da aka ba su tare da antibiotics da kuma maganin mayar da ruwa idan ya zama dole. Ya rage tsawon lokacin cutar da awanni takwas kuma ya rage yawan bayan-gidan gudawa da kashi 10%.

Ƙarin zinc yana kuma da alama yana da tasiri wajen magani da rigakafin gudawa mai kamuwa da cuta daga wasu dalilai daban-daban a tsakanin yara a ƙasashe masu tasowa.

## Hasashen Lafiya

Idan aka yi wa mutanen da suka kamu da kwalara magani cikin gaggawa da kuma yadda ya dace, yawan mace-mace bai fi kashi 1% ba; duk da haka, idan ba a yi magani ba, yawan mace-mace na iya kaiwa kashi 50–60%.

Ga wasu nau’ikan kwayar cutar kwalara na musamman, kamar wanda ya bayyana a lokacin annobar Haiti ta shekarar 2010 da kuma barkewar cutar a Indiya a shekarar 2004, mutuwa na iya faruwa cikin awanni biyu bayan kamuwa da cutar.

## Kimiyyar Yaduwar Cututtuka (Epidemiology)

Kwalara tana shafar kimanin mutane miliyan 2.8 a daukacin duniya, kuma tana sanadiyar mutuwar kusan mutane 95,000 a shekara (mizanin rashin tabbas: 21,000–143,000) as of 2015. Mafi yawa wannan yana faruwa ne a kasashe masu tasowa.

A farkon shekarun 1980, an yi amon cewa yawan mace-mace ya ma fi miliyan uku a shekara. Yana da wahala a lissafta ainihin adadin mutanen da suka kamu da cutar, duba da cewa ba a bayar da rahoton da yawa daga cikinsu ba saboda fargabar cewa bullar cutar na iya yin tasiri mara kyau ga fannin yawon bude ido na kasa. Ya zuwa shekarar 2004, kwalara ta kasance annoba (epidemic) kuma cuta mai dorewa (endemic) a yankuna da dama na duniya.

Babban bazuwar cutar na baya-bayan nan sun hada da barkewar kwalara a Haiti a shekarun 2010 da kuma barkewar kwalara a Yemen ta shekarun 2016–2022. A watan Oktoba na shekarar 2016, an sami barkewar kwalara a kasar Yemen da yaki ya daidaita. Hukumar Lafiya ta Duniya (WHO) ta kira ta da "mafi munin barkewar kwalara a duniya". A shekarar 2019, kashi 93% na mutane 923,037 da aka ruwaito sun kamu da kwalara sun fito ne daga kasar Yemen (tare da mutuwar mutane 1911 da aka ruwaito). Tsakanin watan Satumba 2019 da Satumba 2020, an ruwaito jimillar mutane fiye da 450,000 da suka kamu da cutar da kuma mace-mace sama da 900 a duniya; sai dai, ingancin wadannan alkaluma yana fuskantar matsalar karin gishiri daga kasashen da ke ba da rahoton mutanen da ake zargi kawai (kuma ba wadanda dakin gwaje-gwaje ya tabbatar ba), da kuma karancin rahoto daga kasashen da ba sa bayar da alkaluma na hukuma (kamar Bangladesh, Indiya da Philippines).

Kodayake an san abubuwa da yawa game da hanyoyin da kwalara ke bi wajen yaduwa, masu bincike har yanzu ba su da cikakken fahimta kan abin da ke sa kwalara ke barkewa a wasu wurare amma ba a wasu ba. Karancin amintacciyar hanya ta zubar da najasar dan adam da rashin isasshen tacewa ko kula da ruwan sha yana taimakawa kwarai da gaske wajen yaduwarta. An gano cewa guraren tara ruwa suna zama matsayin mazaunin kwayoyin cutar, kuma abincin teku (seafood) da ake jigila zuwa wurare masu nisa na iya yada cutar. Adadin kamuwa da kwalara ya fi yawa a lokutan ambaliyar ruwa da kuma na fari fiye da lokutan da babu ko guda daga cikin wadannan abubuwa guda biyu.

Kwalara ta bace daga yankin Amurka (Americas) a mafi yawancin karni na 20, amma ta sake bayyana a karshen wancan karnin, inda ta fara da mummunar barkewa a kasar Peru. Wannan kuma ya samo asali ne sanadiyar barkewar kwalara a Haiti a shekarun 2010 da kuma wata barkewar kwalara a Haiti a lokacin rikicin Haiti na shekarun 2018–2023. Ya zuwa watan Agusta 2021, cutar tana da dorewa (endemic) a Afirka da wasu yankuna na gabashi da yammacin Asiya (Bangladesh, Indiya da Yemen). Kwalara ba cuta ce mai dorewa ba a Turai; dukkan mutanen da aka ruwaito sun kamu suna da tarihin tafiya zuwa yankunan da cutar ke da dorewa.

### Tarihin barkewar cutar

Zubar da gawa a lokacin annobar kwalara a Palermo a shekarar 1835
Taswirar barkewar kwalara ta 2008–2009 a yankin kudu da hamadar sahara na Afirka (sub-Saharan Africa) yana nuna kididdigar kamar yaddda take a ranar 12 ga Fabrairu 2009
Kalmar kwalara ta fito ne daga harshen karkashin Helenanci (Greek) wato **Script error: The function "langx" does not exist.kholera* daga χολή *kholē* ma'ana "bile" (ruwan daci na madaciya). Kwalara tana da tushe ne tun can asali daga yankin yankin Indiya (Indian subcontinent) kamar yaddda ya tabbata sakamakon dorewarta a yankin na tsawon daruruwan shekaru.

Bayanai game da kwalara sun bayyana a cikin adabin Turai tun a shekarar 1642, daga bayanin likitan kasar Holland mai suna Jakob de Bondt a cikin littafinsa De Medicina Indorum. (Kalmar "Indorum" a cikin sunan tana nufin Gabashin Indiya. Ya kuma bayar da bayanai na farko na Turai game da sauran cututtuka.) Amma a wancan lokacin, likitocin Turai sun saba amfani da kalmar "kwalara" don yin nuni ga kowace irin matsala ta ciki da ke kawo gudawa mai launin rawaya. Don haka de Bondt ya yi amfani da kalmar da aka riga aka saba amfani da ita don bayyana sabuwar cutar. Wannan ya kasance tsohuwar dabi'a ce ta wancan lokacin. Ba a sauya sunan gudawa mai tsanani ta launin rawaya a cikin harshen Turanci daga "cholera" zuwa "cholera morbus" ba sai a shekarun 1830 domin bambanta ta da abin da aka sani a lokacin da "Asiatic cholera" (Kwalara ta Asiya), ko kuma wadda ke da alaka da asali daga Indiya da Gabas.

An yi imanin cewa farkon barkewar cutar a yankin Indiya ya kasance ne sakamakon cunkoso da munanan yanayin rayuwa, gami da kasancewar gungun ruwa maras gudu (stagnant water), wadanda duka biyun ke samar da kyakkyawan yanayi don kwalara ta yadu. Cutar ta fara yaduwa ne ta hannun matafiya ta hanyoyin kasuwanci (na kasa da na teku) zuwa kasar Rasha a shekarar 1817, daga baya zuwa sauran sassan Turai, kuma daga Turai zuwa Arewacin Amurka da sauran sassan duniya, (wannan ne ya kawo sunan "Asiatic cholera"). Annobar kwalara guda bakwai (seven pandemics) sun faru tun farkon karni na 19; ta farko ba ta isa yankun Amurka ba. Annoba ta bakwai ta samo asali ne daga kasar Indonesiya a shekarar 1961.

Annobar kwalara ta farko ta faru ne a yankin Bengal na kasar Indiya, kusa da Calcutta tun daga shekarar 1817 zuwa 1824. Cutar ta bazu daga Indiya zuwa Kudu maso Gabashin Asiya, Gabas Ta Tsakiya, Turai, da Gabashin Afirka. An yi imanin cewa zirga-zirgar jiragen ruwa na Sojojin Biritaniya da na ruwa gami da ma'aikata sun taimaka wajen bazuwar annobar, tun da jiragen sun dauki mutane masu dauke da cutar zuwa gabar tekun fadin Tekun Indiya, daga Afirka zuwa Indonesiya, da kuma arewa zuwa China da Japan.

Annoba ta biyu ta kasance daga shekarar 1826 zuwa 1837 kuma ta shafi Arewacin Amurka da Turai musamman. Ci gaba a fannin sufuri da kasuwancin duniya, da karuwar kaura ta mutane, hadda sojoji, ya sanya mutane da yawa dauke da cutar zuwa wurare masu nisa.

Annoba ta uku ta barke ne a shekarar 1846, ta ci gaba har zuwa 1860, ta bazu zuwa Arewacin Afirka, kuma ta isa Arewacin da Kudancin Amurka. An shigar da ita Arewacin Amurka ne a Quebec, kasar Kanada, ta hannun bakin haure na kasar Ireland daga babban yunwa (Great Famine). A cikin wannan annobar ne kasar Brazil ta fuskanci cutar a karon farko.

Annoba ta hudu ta kasance daga shekarar 1863 zuwa 1875, inda ta bazu daga Indiya zuwa Naples da Spain, kuma ta isa Amurka a New Orleans, Louisiana a shekarar 1873. Ta bazu cikin daukacin tsarin Kogin Mississippi a yankin.

Annoba ta biyar ta kasance daga shekarar 1881 zuwa 1896. Ta fara ne a Indiya ta bazu zuwa Turai, Asiya, da Kudancin Amurka. Annoba ta shida kuma ta kasance daga shekarar 1899 zuwa 1923. Wadannan annobobi sun sami karancin mace-mace saboda likitoci da masu bincike sun sami kyakkyawar fahimta game da kwayoyin cutar kwalara (cholera bacteria). Kasashen Masar, yankin Larabawa, Persia, Indiya, da Philippines ne suka fi fuskantar kalubale a lokacin wadannan annobobi. Sauran yankuna, kamar Jamus a shekarar 1892 (musamman birnin Hamburg, inda mutane sama da 8,600 suka mutu) da Naples daga shekarar 1910 zuwa 1911, su ma sun sami mummunar barkewa.
Annoba ta bakwai ta samo asali ne a shekarar 1961 a kasar Indonesiya kuma an santa ne sanadiyar bayyanar wani sabon nau'i na cutar, wanda aka yi masa lakabi da *El Tor*, wanda har yanzu yana nan (as of 2018) a kasashe masu tasowa. Wannan annoba ta fara raguwa a kusa da shekarar 1975 kuma an yi tunanin ta kare, amma kamar yadda aka sani, ta dore. An sami karuwar mace-mace a shekarun 1990 da kuma bayan haka.

Kwalara ta bazu sosai a karni na 19. Tun daga lokacin ta kashe dubun-dubatar miliyoyin mutane. A Daular Rasha (Russian Empire) kadai, tsakanin shekarar 1847 da 1851, mutane sama da miliyan daya ne suka mutu sanadiyar cutar. Dr. Snow ya ba da shawarar asalin ƙwayoyin cuta na annobar kwalara a shekara ta 1849. A cikin babban bitar "halin da ake ciki" na shekara ta 1855, ya gabatar da tsari mai cikakken tsari kuma daidai na musabbabin cutar. A cikin biyu na farko na binciken cututtuka na fannin epidemiology, ya sami damar nuna cewa gurɓatar da najasa na ɗan adam shine mafi yuwuwar hanyar watsa cutar a cikin manyan annoba biyu a Landan a shekara ta 1854. Tsarinsa bai samu karɓuwa kai tsaye ba, amma an ƙara ganinsa a matsayin mai yuwuwa yayin da ilimin ƙananan ƙwayoyin cuta na likitanci ya ci gaba a cikin shekaru 30 masu zuwa. Saboda aikinsa kan kwalara, John Snow ana ɗaukansa a matsayin "Uban Epidemiology".

Ƙwayar cutar an ware ta a shekara ta 1854 ta hanyar masanin jiki na Italiya Filippo Pacini, amma ainihin yanayinta da sakamakonsa ba a san su sosai ba. A cikin wannan shekara, ɗan Catalonia Joaquim Balcells i Pascual ya gano ƙwayar cutar. A shekara ta 1856 António Augusto da Costa Simões da José Ferreira de Macedo Pinto, masu bincike biyu na Portugal, ana kyakkyawan zaton sun yi haka.
Tsakanin tsakiyar shekarun 1850 zuwa 1900, birane a ƙasashe masu ci gaba sun yi babban saka hannun jari a samar da ruwa mai tsabta da kuma tsarin kula da najasa da aka raba sosai. Wannan ya kawar da barazanar annobar kwalara daga manyan biranen duniya masu ci gaba. A shekara ta 1883, Robert Koch ya gano *V. cholerae* tare da na'urar microscope a matsayin ƙwayar cutar da ke haifar da cutar.

Hemendra Nath Chatterjee, masanin kimiyya na Bengal, shine na farko wanda ya tsara kuma ya nuna tasirin oral rehydration salt (ORS) don magance zawo. A cikin takardarsa ta 1953, da aka buga a *The Lancet*, ya bayyana cewa promethazine na iya dakatar da amai yayin kwalara sannan kuma maye gurbin ruwa ta baki zai yiwu. Tsarin maganin maye gurbin ruwa shine 4g na sodium chloride, 25g na glucose da 1000ml na ruwa.

Prof. Sambhu Nath De, wanda ya gano toxin na kwalara kuma ya nuna nasarar watsa cutar kwalara ta hanyar *bacterial enteric toxin*
Masanin likitanci na Indiya Sambhu Nath De ya gano toxin na kwalara, samfurin dabbobi na kwalara, kuma ya nuna nasarar hanyar watsa cutar kwalara *Vibrio cholerae*.

Robert Allan Phillips, yana aiki a US Naval Medical Research Unit Two a Kudu maso Gabashin Asiya, ya tantance yanayin cutar ta amfani da fasahar kimiyyar labarato ta zamani. Ya ƙirƙiri tsari don maye gurbin ruwa. Bincikensa ya sa Lasker Foundation ta ba shi kyautar ta a shekara ta 1967.

A baya-bayan nan, a shekara ta 2002, Alam, *et al.*, sun yi nazarin samfuran najasa daga marasa lafiya a Cibiyar Binciken Cututtukan Zawo ta Duniya a Dhaka, Bangladesh. Daga cikin gwaje-gwajen da suka yi, masu binciken sun gano alaƙa tsakanin wucewar *V. cholerae* ta cikin tsarin narkewar abinci na ɗan adam da kuma halin ƙara yaduwa. Bugu da ƙari, masu binciken sun gano cewa ƙwayar cutar tana haifar da halin ƙwayar cuta mai yawa inda kwayoyin halitta da ke sarrafa haɓakar amino acid, tsarin ɗaukar ƙarfe, da samuwar rukunin nitrate reductase a cikin periplasmic sun haɓaka kafin a yi bayan gida. Waɗannan halayen da aka haɓaka suna ba da damar ƙwayoyin vibrio na kwalara su tsira a cikin najasar "ruwan shinkafa", yanayi mai ƙarancin iska da ƙarfe, na marasa lafiya da ke da cutar kwalara.

### Dabarar Duniya

A shekarar 2017, Hukumar Lafiya ta Duniya (WHO) ta ƙaddamar da dabarar “Ending Cholera: a global roadmap to 2030” wacce ke da nufin rage mace-macen kwalara da kashi 90% kafin shekarar 2030. Wannan dabarar ta samo asali ne daga Global Task Force on Cholera Control (GTFCC) wanda ke tsara tsare-tsaren ƙasashe da kuma bibiyar ci gaba. Hanyoyin cimma wannan buri sun haɗa da sa ido, tsaftar ruwa, maganin sake shakar ruwa da amfani da allurar rigakafi ta baki. Babban ginshiƙin dabarar ya ƙunshi matakai uku: i) gano da wuri da kuma amsa wa barkewar cuta don takaita ta, ii) dakatar da yaɗuwar kwalara ta hanyar tsafta da allurar rigakafi a wuraren da cutar ta fi kamari, iii) kafa tsarin duniya na kula da kwalara ta hannun GTFCC.

WHO da GTFCC ba su ɗauki kawar da kwalara gaba ɗaya a duniya a matsayin buri mai yiwuwa ba. Ko da yake ɗan adam ne kaɗai ke zama mai ɗaukar kwalara, ƙwayar cutar na iya ci gaba da rayuwa a muhalli ba tare da ɗan adam ba. Duk da cewa kawar da ita gaba ɗaya ba zai yiwu ba, kawar da yaɗuwar cutar daga mutum zuwa mutum na iya yiwuwa. Hakan ma na iya yiwuwa a matakin ƙasa, kamar yadda aka yi a Haiti a lokacin barkewar kwalara na shekarun 2010. Haiti ta sa burin samun takardar shaidar kawar da cutar nan da shekarar 2022.

GTFCC na mai da hankali ga ƙasashe 47, inda ƙasashe 13 suka riga suka kafa kamfen ɗin rigakafi.

## Al'umma da Al'adu

Wani budurwa 'yar Vienna da ta mutu sakamakon cutar kwalara, an nuna ta lokacin tana lafiya da kuma sa'o'i huɗu kafin mutuwa, Janairu 1831
### Manufofin Lafiya

A yawancin ƙasashe masu tasowa, har yanzu kwalara tana kaiwa waɗanda abin ya shafa ta hanyar gurɓataccen ruwa, kuma ƙasashe da ba su da ingantattun hanyoyin kula da tsabtace ruwa suna fama da cutar sosai. Gwamnatoci na iya taka rawa a wannan. A shekara ta 2008, alal misali, annobar kwalara ta Zimbabwe ta kasance wani bangare sakamakon rawar da gwamnati ta taka, bisa ga rahoton James Baker Institute. Rashin iya samar da ruwan sha mai tsabta na gwamnatin Haiti bayan girgizar ƙasa ta 2010 ya haifar da karuwar cutar kwalara.

Hakazalika, annobar kwalara ta Afirka ta Kudu ta tsananta sakamakon manufar gwamnati ta sayar da shirye-shiryen ruwa. Masu hannu da shuni a ƙasar sun iya sayen ruwa mai tsabta yayin da sauran suka yi amfani da ruwa daga koguna masu cutar kwalara.

Bisa ga ra'ayin Rita R. Colwell na James Baker Institute, idan kwalara ta fara yaduwa, shirye-shiryen gwamnati yana da muhimmanci. Iya kawar da cutar ta gwamnati kafin ta faɗo zuwa wasu wurare na iya hana yawan mace-mace da haɓakar annoba ko ma annobar duniya. Sa ido mai inganci kan cututtuka na iya tabbatar da cewa an gano annobar kwalara da wuri kuma a magance ta yadda ya kamata. Sau da yawa, wannan zai ba da damar shirye-shiryen lafiyar jama'a su gano da kuma sarrafa musabbabin lamuran, ko ruwa mara tsabta ne ko kuma abincin teku da ya taru da ƙwayoyin Vibrio cholerae. Samun shirin sa ido mai inganci yana taimakawa gwamnati wajen hana yaduwar kwalara. A shekara ta 2000 a jihar Kerala a Indiya, an tabbatar da gundumar Kottayam a matsayin "mai fama da kwalara"; wannan sanarwa ta haifar da ƙungiyoyin aiki waɗanda suka mai da hankali kan ilimantar da 'yan ƙasa tare da tarurruka 13,670 game da lafiyar ɗan adam. Waɗannan ƙungiyoyin aiki sun inganta tafasa ruwa don samun ruwa mai tsabta, kuma sun samar da chlorine da gishirin maye gurbin ruwa na baki. A ƙarshe, wannan ya taimaka wajen shawo kan yaduwar cutar zuwa wasu wurare da rage mace-mace. A gefe guda kuma, masu bincike sun nuna cewa yawancin 'yan ƙasar da suka kamu da cutar a lokacin annobar kwalara ta Bangladesh a 1991 suna zaune a yankunan karkara, kuma ba a gane su ba a shirin sa ido na gwamnati. Wannan ya hana likitoci gano lamuran kwalara da wuri.
Bisa ga Colwell, inganci da haɗaɗɗiyar tsarin kiwon lafiya na ƙasa yana shafar shawo kan kwalara, kamar yadda ya faru a annobar kwalara ta Zimbabwe. Duk da yake ayyukan tsabtace ruwa suna da muhimmanci, idan gwamnatoci suka mayar da martani da sauri kuma suna da allurai masu sauƙin samu, ƙasar za ta sami ƙarancin mace-mace sakamakon kwalara. Sauƙin sayan allurai na iya zama matsala; idan gwamnatoci ba su samar da allurai ba, masu hannu da shuni kawai za su iya saya kuma za a sami babban nauyi a kan matalauta na ƙasar. Saurin da shugabannin gwamnati ke mayar da martani ga annobar kwalara yana da muhimmanci.

Baya ga taimakawa wajen ingantaccen tsarin kiwon lafiyar jama'a da maganin tsabtace ruwa, gwamnati na iya yin tasiri a fannin shawo kan kwalara da tasirin martani ga cutar. Gwamnatin ƙasa na iya yin tasiri ga iya hana cututtuka da sarrafa yaduwar su. Saurin martani na gwamnati tare da cikakken tsarin kiwon lafiya da albarkatun kuɗi na iya hana yaduwar kwalara. Wannan yana takaita yawan mace-mace na kwalara, ko aƙalla raguwar ilimi, yayin da ake barin yara a gida don rage haɗarin kamuwa. Akasin haka, rashin kyakkyawan martani na gwamnati na iya haifar da tashin hankali da cholera riots.

### Sanannun Lamura

Samfuri:Further

Shugaban Amurka James K. Polk ya kasance sanannen wanda cutar kwalara ta addabi.
* Mutuwar Tchaikovsky ana danganta ta da kwalara a al'adance, wanda ya yiwu ya kamu da ita ta hanyar shan gurɓataccen ruwa kwanaki da suka wuce. Mahaifiyar Tchaikovsky ta mutu sakamakon kwalara, kuma mahaifinsa ya kamu da cutar a wannan lokaci amma ya warke sosai. Wasu masana, duk da haka, ciki har da masanin kiɗa na Ingila kuma masanin Tchaikovsky David Brown da marubucin tarihin Anthony Holden, sun yi hasashen cewa mutuwarsa ta kasance kashe kansa.
* Annobar kwalara ta Haiti a shekarun 2010. Watanni goma bayan girgizar ƙasa ta 2010, annoba ta mamaye Haiti, an samo asali daga sansanin Majalisar Dinkin Duniya na sojojin sulhu daga Nepal. Wannan ita ce mafi munin annobar kwalara a tarihi na baya-bayan nan, kuma mafi kyawun rubutaccen tarihi na annobar kwalara a kiwon lafiyar jama'a na zamani.
* Adam Mickiewicz, mawaƙin Poland kuma marubuci, ana kyakkyawan zaton ya mutu sakamakon kwalara a Istanbul a shekara ta 1855.
* Sadi Carnot, masanin kimiyyar lissafi, majagaba a fannin thermodynamics (mutu 1832)
* Charles X, Sarkin Faransa (mutu 1836)
* James K. Polk, shugaban Amurka na goma sha ɗaya (mutu 1849)
* Carl von Clausewitz, soja na Prussia kuma masanin ka'idar yaƙi na Jamus (mutu 1831)
* Elliot Bovill, Babban Alkali na Straits Settlements (1893)
* Nikola Tesla, ɗan Amurka mai asalin Serbia, mai ƙirƙira, injiniyoyi kuma mai hangen nesa da aka sani da gudummawar sa ga tsarin wutar lantarki na zamani (AC), ya kamu da kwalara a shekara ta 1873 yana da shekara 17. Ya kwanta a gado har tsawon watanni tara, kuma ya kusan mutuwa sau da yawa, amma ya tsira kuma ya warke sosai.

### A cikin Shahararrun Al'adu

Baya ga cutar tarin fuka ("consumption") wadda a cikin wallafe-wallafe da fasaha galibi ana yin ta da kyakkyawan gani a matsayin cutar mazaunan ƙarƙashin duniya ko waɗanda ke da yanayin fasaha, kwalara cuta ce da kusan gaba ɗaya tana shafar matalauta da ke zaune a wurare marasa tsabta. Wannan, da kuma yadda cutar ke faruwa – wanda ya ƙunshi zawo mai yawa na "ruwan shinkafa", zubar da ruwa daga baki, da kuma ƙarfi na tsokoki wanda ke ci gaba ko bayan mutuwa – ya hana cutar yin ta da kyakkyawan gani, ko ma a bayyana ta a zahiri a cikin shahararrun al'adu.

* Littafin 1889 *Mastro-don Gesualdo* na Giovanni Verga ya nuna yaduwar annobar kwalara a tsibirin Sicily, amma bai nuna wahalar waɗanda abin ya shafa ba.
* Kwalara babban abin da ya faru a cikin littafin The Painted Veil, littafi na 1925 na W. Somerset Maugham. Labarin ya shafi masanin ƙananan ƙwayoyin cuta mai kunya wanda ya gano matarsa kyakkyawa tana yin zina. Likitan ya ɗauki fansa a kan matarsa ta hanyar tilasta mata tafiya tare da shi zuwa babban ƙasar Sin wacce ke fama da mummunar annobar kwalara. An bayyana yadda cutar ke lalata a cikin littafin.
* A cikin littafin novella na Thomas Mann *Death in Venice*, wanda aka fara buga a 1912 a matsayin Der Tod in Venedig, Mann "ya gabatar da cutar a matsayin alamar ƙarshen 'ƙasƙancin dabbobi' na marubucin da ya keta ƙa'ida na jima'i Gustav von Aschenbach." Sabanin gaskiyar yadda kwalara ke kashe da ƙarfi, Mann ya sa jaririnsa ya mutu cikin nutsuwa a bakin teku a kan kujera. Fim ɗin Luchino Visconti na 1971 kuma ya ɓoye daga masu kallo ainihin yanayin cutar. An kuma sanya littafin novella na Mann a matsayin wasan opera na Benjamin Britten a 1973, na ƙarshe, da kuma ballet na John Neumeier ga ƙungiyar Hamburg Ballet a Disamba 2003.\*
* The Horseman on the Roof (asali Faransanci Le Hussard sur le toit) littafi ne na kasada na 1951 wanda Jean Giono ya rubuta. Yana ba da labarin Angelo Pardi, matashin Italiyanin carbonaro kyaftin na sojojin dawakai, wanda ya shiga cikin annobar kwalara ta 1832 a Provence. A 1995, an sanya shi fim mai suna The Horseman on the Roof wanda Jean-Paul Rappeneau ya jagoranta.
* A cikin littafin Gabriel Garcia Márquez na 1985 *Love in the Time of Cholera*, kwalara "ta kasance babban abin da ke bayan fage maimakon babban jigo da ke buƙatar mugun bayani." An daidaita littafin a 2007 don fim mai suna Love in the Time of Cholera wanda Mike Newell ya jagoranta.
* A cikin littafin The Secret Garden, iyayen Mary Lennox sun mutu sakamakon kwalara.

## Misalai na Ƙasashe

### Zambia

A Zambia, annobar kwalara ta yadu tun shekara ta 1977, galibi a babban birnin ƙasar Lusaka. A shekara ta 2017, an ayyana annobar kwalara a Zambia bayan tabbatar da *Vibrio cholerae* O1, biotype El Tor, serotype Ogawa, daga samfuran najasa na marasa lafiya biyu da ke fama da zawo mai ruwa. An sami saurin karuwar adadin marasa lafiya daga ɗaruruwan lokuta a farkon Disamba 2017 zuwa kimanin 2,000 a farkon Janairu 2018. Tare da ƙaruwar ruwan sama, sabbin lamura sun ƙaru kullum suna kaiwa kololuwa a makon farko na Janairu 2018 tare da fiye da lamura 700 da aka ruwaito.

A haɗin gwiwa tare da abokan aiki, Ma'aikatar Lafiya ta Zambia (MoH) ta ƙaddamar da martani na kiwon lafiyar jama'a mai fannoni da yawa wanda ya haɗa da ƙara sinadarin chlorine a cikin ruwan birni na Lusaka, samar da ruwa na gaggawa, sa ido kan ingancin ruwa da gwaji, ƙarfafa sa ido, binciken cututtuka, yaƙin allurar kwalara, kulawar marasa lafiya da horo ga ma'aikatan kiwon lafiya, da gwajin samfuran asibiti a dakin gwaje-gwaje.

Ma'aikatar Lafiya ta Zambia ta aiwatar da yaƙin rigakafin allurar kwalara ta baki (OCV) na kashi ɗaya a Afrilu 2016 a unguwannin Lusaka guda uku, sannan kuma wani zagaye na biyu na rigakafi a Disamba.

### Nigeria

A watan Yuni 2024, Cibiyar Kula da Cututtuka ta Najeriya (NCDC) ta sanar da jimlar shari'o'i 1,141 da ake zargi da kuma tabbatattun shari'o'i 65 na kwalara tare da mutuwar mutane 30 daga ƙananan hukumomi (LGAs) 96 a jihohi 30 na ƙasar. NCDC, a cikin shawarwarin lafiyar jama'a, ta ce Abia, Bayelsa, Bauchi, Cross River, Delta, Imo, Katsina, Lagos, Nasarawa da Zamfara sune jihohi 10 da suka ba da kashi 90 na nauyin kwalara a ƙasar a wancan lokacin.

### India

Birnin Kolkata na fama da annobar kwalara akai-akai.
Birnin Kolkata, a Indiya, a jihar West Bengal a yankin kwarin Ganges, an bayyana shi a matsayin "mahaifar kwalara", tare da annoba akai-akai da bayyanar yanayi. A Indiya, inda cutar ta zama na yau da kullum, annobar kwalara na faruwa kowace shekara tsakanin lokacin rani da lokacin ruwan sama. Indiya kuma tana da yawan jama'a, ruwan sha mara tsabta, magudanan ruwa a fili, da rashin tsabta, waɗanda ke ba da wurin da ya dace don tsira, rayuwa, da yaduwar Vibrio cholerae.

### Jamhuriyar Dimokuradiyyar Kongo

A Goma a Jamhuriyar Dimokuradiyyar Kongo, kwalara ta bar alama mai dorewa a tarihin ɗan adam da likitanci. Annobar kwalara a ƙarni na 19 da 20 ta haifar da haɓakar ilimin cututtuka a matsayin kimiyya kuma a cikin 'yan shekarun nan ta ci gaba da inganta fahimtar ilimin yanayin cututtuka, ilimin ƙwayoyin halitta na asali, da siginar transmembrane da kuma amfani da bayanan kimiyya da ƙirar magani.

## Manazarta

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