HARARE, Zimbabwe (AP) — These days, Catherine Mangosho locks her 3-year-old grandson in the house for hours on end in an attempt to shield him from a deadly cholera outbreak in Zimbabwe.

The virulent bacterial disease is killing the young and the old in the southern African country, with health authorities reporting more than 150 suspected deaths and over 8,000 suspected cases since February.

Cholera has often broken out across Zimbabwe in recent years with deadly consequences and has surged and spread again over the last month, driven by the sometimes terrible sanitation conditions in poor, neglected townships and neighbourhoods in the capital, Harare, and elsewhere.

Many like Mangosho, 50, fear their family might be next.

She points to a group of barefoot children playing street soccer near her house. The ball made from plastic bread wrappers frequently plunges into ponds of sewage. The children pick it out and continue their game.

“Those boys are playing with fire,” she said. “We buried a boy from this area last week. He was playing soccer in the street just like these boys one day. He fell sick overnight and died at the hospital. They said it was cholera.”

Since the start of the latest outbreak, Zimbabwe’s Health Ministry has recorded 8,087 suspected cholera cases and 1,241 laboratory confirmed cases. It said there have been 152 suspected cholera deaths and 51 laboratory confirmed deaths.

The country of 15 million people has been recording more than 500 cases a week since late October, the highest rate since February, said the International Federation of Red Cross and Red Crescent Societies. The group made an emergency appeal this month.

Cholera is a water-borne disease caused by ingesting contaminated food or water and can kill within hours if left untreated, yet it is usually easily treated by rehydrating patients if cases are caught in time.

The World Health Organization has said that cholera cases in Africa are rising exponentially amid a global surge. The African continent accounted for 21 per cent of cases and 80 per cent of deaths across the globe from 2014 to 2021, according to the WHO.

The outbreak in Zimbabwe is spreading from urban to rural areas and putting at risk over 10 million people, including more than five million children, said the Red Cross Federation. It said major causes were poor hygiene, but also a lack of awareness and religious practices that include self-proclaimed prophets ordering sect members to rely on prayer and items such as holy water rather than seek medical treatment.

Cholera is now in all of the country’s 10 provinces, Health Minister Douglas Mombeshora said at a clinic in the hotspot township of Kuwadzana in Harare this weekend. At Kuwadzana Polyclinic, cholera patients lined up in a special tent set up for them and were given a cup of rehydrating sugar and salt solution on arrival.

“We have had a flare-up in urban areas,” said Mombeshora, adding that seven of the 13 people who have died in Harare are from Kuwadzana. “We are approaching the rainy season and the conditions cause a scare for us. We have to take it as an emergency.”

The conditions in areas like Kuwadzana and neighbouring Glen View make them fertile ground for infections.

At shopping centers bustling with activity, flies crawl over heaps of uncollected trash. Raw sewage from burst pipes flows in streets and sometimes in the yards of homes. Many people have dug trenches to direct the flow away from their houses.

Long-running local government failures see many residents go for months without tap water, forcing them to dig shallow wells and boreholes that have also been contaminated by sewage.

Joyleen Nyachuru, a water, sanitation and hygiene officer with the Community Water Alliance non-governmental organisation, and also a resident of the Glen View township, said she fears a repeat of 2008, when more than 4,000 people died in Zimbabwe’s worst outbreak.

“Some don’t even know the signs and symptoms of cholera, so people are just falling sick in their houses without knowing what exactly is happening to them. It’s terrifying,” said Nyachuru, who recently delivered a petition to council offices signed by dozens of residents demanding safe drinking water and an end to the dire, unhygienic conditions.

In Glen View, Mangosho is living in daily fear. She lets her grandson out for only a short while to play while watching him closely.

“The whole neighbourhood has children who are sick. Some, including adults, are dying,” she said. “We are afraid.”