DAKAR, 7 September 2010 (IRIN) - As school resumes in Cameroon, some 1.6 million students in the north are receiving cholera-prevention messages via SMS, flyers, stickers and special textbooks, in a public-private effort to stem the country's worst outbreak in 20 years.

"We want to avoid a new explosion as the school year begins," said Jean Sangola, head of hygiene in the district of Mokolo in the Far North region. Since May at least 4,451 people have been infected in the Far North and North regions, with 331 deaths, and the disease continues to spread, according to the Health Ministry.

Cholera has also infected thousands of people in nearby Chad, Niger and Nigeria.

Scarce access to latrines and potable water makes northern Cameroon what one UN sanitation expert called "a breeding ground" for cholera; but while building proper facilities is indispensable, prevention messages can go a long way, according to the UN Children's Fund (UNICEF).

"Of course infrastructure is the first thing we have to deal with, but prevention messages are important," said Chris Cormency, UNICEF regional water, sanitation and hygiene adviser for West and Central Africa. "For example [where access to safe water and latrines is a problem] messages around treating water, isolating faeces and the importance of practicing good hygiene help prevent transmission."

He said in some villages people are handling their human waste more safely, just based on prevention messages. And more people seek medical care because of awareness campaigns, he said. "This is critical as 90 percent of cholera can be treated without hospital stays if detected early."

TV and radio spots as well as free soap will also be part of the prevention push, which UNICEF says is "groundbreaking" for its collaboration between public and private sectors.

Education and awareness can go only so far in areas like the Far North, where, according to Health Ministry disease prevention head Gervais Ondobo, 29 percent of the people have access to potable water and 5 percent to latrines.

Messages incomplete?

For researcher Henry Tourneux, based in the Far North town of Maroua, to date cholera-prevention messages have been incomplete and therefore ineffective.

"The message is do this or don't do that - but without explanations of the reasons behind it," he said. "This means people might indeed wash their hands [because a poster says you should do so] but then inadvertently do other things that pose a cholera risk."

UNICEF's Cormency said health officials do not know the source of cholera infections in northern Cameroon, so it is important to spread information about every possible vector.

"The key is we must get the information to the community level and passing the messages in schools is a way to get to the communities."

But many children might be missing the lessons. Residents told IRIN some families are keeping their children at home, fearing that classrooms only days ago used as cholera treatment centres could cause infection.