Four people have died in a second cholera outbreak in the last two weeks in Zimbabwe, bringing the death toll to 11, state media reported on Friday.

The latest deaths occurred in Zimbabwe’s rural Buhera district, over a week after 7 people were reported to have died in neighbouring Chikomba and Chivhu, the official Herald newspaper quoted Health Minister David Parirenyatwa as saying.

The paper said 181 cases of cholera had so far been reported in all three districts. Health ministry officials were not immediately available for comment.

Several outbreaks of cholera and other diseases in Zimbabwe over the last few years have put further strain on a health system that has all but broken down in an economic crisis that has hampered importation of essential drugs and equipment.

Last November health officials said that more than 200 people had been diagnosed with dysentery in the capital Harare and nearby Chitungwiza.

In Malawi, health officials said 7 people died from cholera this week in a crowded township on the outskirts of the commercial capital Blantyre.

Southern African countries are most vulnerable to the disease at this time of year during the summer rains.