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Ngere P, Langat D, Ngere I, Dawa J, Okunga E, Nasimiyu C, Kiama C, Lokamar P, Ngunu C, Makayotto L, Njenga MK, Osoro E. A protracted cholera outbreak in Nairobi City County accentuated by mass gathering events, Kenya, 2017. PLoS One 2024; 19:e0297324. [PMID: 39208189 PMCID: PMC11361576 DOI: 10.1371/journal.pone.0297324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024] Open
Abstract
Cholera continues to cause many outbreaks in low and middle-income countries due to inadequate water, sanitation, and hygiene services. We describe a protracted cholera outbreak in Nairobi City County, Kenya in 2017. We reviewed the cholera outbreak line lists from Nairobi City County in 2017 to determine its extent and factors associated with death. A suspected case of cholera was any person aged >2 years old who had acute watery diarrhea, nausea, or vomiting, whereas a confirmed case was where Vibrio cholerae was isolated from the stool specimen. We summarized cases using means for continuous variables and proportions for categorical variables. Associations between admission status, sex, age, residence, time to care seeking, and outbreak settings; and cholera associated deaths were assessed using odds ratio (OR) with 95% confidence interval (CI). Of the 2,737 cholera cases reported, we analyzed 2,347 (85.7%) cases including 1,364 (58.1%) outpatients, 1,724 (73.5%) not associated with mass gathering events, 1,356 (57.8%) male and 2,202 (93.8%) aged ≥5 years, and 35 deaths (case fatality rate: 1.5%). Cases were reported from all the Sub Counties of Nairobi City County with an overall county attack rate of 50 per 100,000 people. Vibrio cholerae Ogawa serotype was isolated from 78 (34.8%) of the 224 specimens tested and all isolates were sensitive to tetracycline and levofloxacin but resistant to amikacin. The odds of cholera-related deaths was lower among outpatient cases (aOR: 0.35; [95% CI: 0.17-0.72]), age ≥5 years old (aOR: 0.21 [95% CI: 0.09-0.55]), and mass gathering events (aOR: 0.26 [95% CI: 0.07-0.91]) while threefold higher odds among male (aOR: 3.04 [95% CI: 1.30-7.13]). Nairobi City County experienced a protracted and widespread cholera outbreak with a high case fatality rate in 2017.
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Affiliation(s)
- Philip Ngere
- Washington State University Global Health Program, Nairobi City, Kenya
- Division of Disease Surveillance and Response, Ministry of Health, Nairobi City, Kenya
| | - Daniel Langat
- Division of Disease Surveillance and Response, Ministry of Health, Nairobi City, Kenya
| | - Isaac Ngere
- Washington State University Global Health Program, Nairobi City, Kenya
| | - Jeanette Dawa
- Washington State University Global Health Program, Nairobi City, Kenya
| | - Emmanuel Okunga
- Division of Disease Surveillance and Response, Ministry of Health, Nairobi City, Kenya
| | - Carolyne Nasimiyu
- Washington State University Global Health Program, Nairobi City, Kenya
| | - Catherine Kiama
- Washington State University Global Health Program, Nairobi City, Kenya
| | - Peter Lokamar
- National Public Health Laboratory Services, Ministry of Health, Nairobi City, Kenya
| | - Carol Ngunu
- Department of Health Services, Nairobi City County Government, Nairobi City, Kenya
| | - Lyndah Makayotto
- Division of Disease Surveillance and Response, Ministry of Health, Nairobi City, Kenya
| | - M. Kariuki Njenga
- Washington State University Global Health Program, Nairobi City, Kenya
- Paul G Allen School for Global Health, Washington State University, Pullman, WA, United States of America
| | - Eric Osoro
- Washington State University Global Health Program, Nairobi City, Kenya
- Paul G Allen School for Global Health, Washington State University, Pullman, WA, United States of America
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Ahmed AK, Sijercic VC, Akhtar MS, Elbayomy A, Marouf MA, Zeleke MS, Sayad R, Abdelshafi A, Laird NJ, El‐Mokhtar MA, Ruthig GR, Hetta HF. Cholera rages in Africa and the Middle East: A narrative review on challenges and solutions. Health Sci Rep 2024; 7:e2013. [PMID: 38742091 PMCID: PMC11089255 DOI: 10.1002/hsr2.2013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/27/2024] [Accepted: 03/12/2024] [Indexed: 05/16/2024] Open
Abstract
Background and Aim Cholera is a life-threatening infectious disease that is still one of the most common acute watery diarrheal diseases in the world today. Acute diarrhea and severe dehydration brought on by cholera can cause hypovolemic shock, which can be fatal in minutes. Without competent clinical therapy, the rate of case fatality surpasses 50%. The purpose of this review was to highlight cholera challenges in Africa and the Middle East and explain the reasons for why this region is currently a fertile environment for cholera. We investigated cholera serology, epidemiology, and the geographical distribution of cholera in Africa and the Middle East in 2022 and 2023. We reviewed detection methods, such as rapid diagnostic tests (RDTs), and treatments, such as antibiotics and phage therapy. Finally, this review explored oral cholera vaccines (OCVs), and the vaccine shortage crisis. Methods We carried out a systematic search in multiple databases, including PubMed, Web of Science, Google Scholar, Scopus, MEDLINE, and Embase, for studies on cholera using the following keywords: ((Cholera) OR (Vibrio cholera) and (Coronavirus) OR (COVID-19) OR (SARS-CoV2) OR (The Middle East) OR (Africa)). Results and Conclusions Cholera outbreaks have increased dramatically, mainly in Africa and many Middle Eastern countries. The COVID-19 pandemic has reduced the attention devoted to cholera and disrupted diagnosis and treatment services, as well as vaccination initiatives. Most of the cholera cases in Africa and the Middle East were reported in Malawi and Syria, respectively, in 2022. RDTs are effective in the early detection of cholera epidemics, especially with limited advanced resources, which is the case in much of Africa. By offering both direct and indirect protection, expanding the use of OCV will significantly reduce the burden of current cholera outbreaks in Africa and the Middle East.
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Affiliation(s)
| | | | | | - Ahmed Elbayomy
- Faculty of MedicineMansoura UniversityMansouraEgypt
- School of Medicine and Public HealthUniversity of Wisconsin−MadisonMadisonWisconsinUSA
| | - Mohamed A. Marouf
- Faculty of MedicineMansoura UniversityMansouraEgypt
- Department of Internal Medicine, Morsani College of MedicineUniversity of South FloridaTampaFloridaUSA
| | - Mahlet S. Zeleke
- Menelik II Medical and Health Science CollegeKotebe Metropolitan UniversityAddis AbabaEthiopia
| | - Reem Sayad
- Faculty of MedicineAssiut UniversityAssiutEgypt
| | | | | | - Mohamed A. El‐Mokhtar
- Gilbert & Rose‐Marie Chagoury School of MedicineLebanese American UniversityByblosLebanon
| | | | - Helal F. Hetta
- Division of Microbiology and Immunology, Department of Natural Products and Alternative Medicine, Faculty of PharmacyUniversity of TabukTabukSaudi Arabia
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Naidoo M, Shephard W, Kambewe I, Mtshali N, Cope S, Rubio FA, Rasella D. Incorporating social vulnerability in infectious disease mathematical modelling: a scoping review. BMC Med 2024; 22:125. [PMID: 38500147 PMCID: PMC10949739 DOI: 10.1186/s12916-024-03333-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Highlighted by the rise of COVID-19, climate change, and conflict, socially vulnerable populations are least resilient to disaster. In infectious disease management, mathematical models are a commonly used tool. Researchers should include social vulnerability in models to strengthen their utility in reflecting real-world dynamics. We conducted a scoping review to evaluate how researchers have incorporated social vulnerability into infectious disease mathematical models. METHODS The methodology followed the Joanna Briggs Institute and updated Arksey and O'Malley frameworks, verified by the PRISMA-ScR checklist. PubMed, Clarivate Web of Science, Scopus, EBSCO Africa Wide Information, and Cochrane Library were systematically searched for peer-reviewed published articles. Screening and extracting data were done by two independent researchers. RESULTS Of 4075 results, 89 articles were identified. Two-thirds of articles used a compartmental model (n = 58, 65.2%), with a quarter using agent-based models (n = 24, 27.0%). Overall, routine indicators, namely age and sex, were among the most frequently used measures (n = 42, 12.3%; n = 22, 6.4%, respectively). Only one measure related to culture and social behaviour (0.3%). For compartmental models, researchers commonly constructed distinct models for each level of a social vulnerability measure and included new parameters or influenced standard parameters in model equations (n = 30, 51.7%). For all agent-based models, characteristics were assigned to hosts (n = 24, 100.0%), with most models including age, contact behaviour, and/or sex (n = 18, 75.0%; n = 14, 53.3%; n = 10, 41.7%, respectively). CONCLUSIONS Given the importance of equitable and effective infectious disease management, there is potential to further the field. Our findings demonstrate that social vulnerability is not considered holistically. There is a focus on incorporating routine demographic indicators but important cultural and social behaviours that impact health outcomes are excluded. It is crucial to develop models that foreground social vulnerability to not only design more equitable interventions, but also to develop more effective infectious disease control and elimination strategies. Furthermore, this study revealed the lack of transparency around data sources, inconsistent reporting, lack of collaboration with local experts, and limited studies focused on modelling cultural indicators. These challenges are priorities for future research.
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Affiliation(s)
- Megan Naidoo
- The Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, C/ del Rosselló, Barcelona, 171, 08036, Spain.
| | - Whitney Shephard
- The Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, C/ del Rosselló, Barcelona, 171, 08036, Spain
| | - Innocensia Kambewe
- The Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, C/ del Rosselló, Barcelona, 171, 08036, Spain
| | - Nokuthula Mtshali
- The Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, C/ del Rosselló, Barcelona, 171, 08036, Spain
| | - Sky Cope
- The Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, C/ del Rosselló, Barcelona, 171, 08036, Spain
| | - Felipe Alves Rubio
- The Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, C/ del Rosselló, Barcelona, 171, 08036, Spain
| | - Davide Rasella
- The Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, C/ del Rosselló, Barcelona, 171, 08036, Spain
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Chowdhury F, Ross AG, Islam MT, McMillan NAJ, Qadri F. Diagnosis, Management, and Future Control of Cholera. Clin Microbiol Rev 2022; 35:e0021121. [PMID: 35726607 PMCID: PMC9491185 DOI: 10.1128/cmr.00211-21] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cholera, caused by Vibrio cholerae, persists in developing countries due to inadequate access to safe water, sanitation, and hygiene. There are approximately 4 million cases and 143,000 deaths each year due to cholera. The disease is transmitted fecally-orally via contaminated food or water. Severe dehydrating cholera can progress to hypovolemic shock due to the rapid loss of fluids and electrolytes, which requires a rapid infusion of intravenous (i.v.) fluids. The case fatality rate exceeds 50% without proper clinical management but can be less than 1% with prompt rehydration and antibiotics. Oral cholera vaccines (OCVs) serve as a major component of an integrated control package during outbreaks or within zones of endemicity. Water, sanitation, and hygiene (WaSH); health education; and prophylactic antibiotic treatment are additional components of the prevention and control of cholera. The World Health Organization (WHO) and the Global Task Force for Cholera Control (GTFCC) have set an ambitious goal of eliminating cholera by 2030 in high-risk areas.
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Affiliation(s)
- Fahima Chowdhury
- International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Southport, Queensland, Australia
| | - Allen G. Ross
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | - Md Taufiqul Islam
- International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Southport, Queensland, Australia
| | - Nigel A. J. McMillan
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Southport, Queensland, Australia
| | - Firdausi Qadri
- International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
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Challa JM, Getachew T, Debella A, Merid M, Atnafe G, Eyeberu A, Birhanu A, Regassa LD. Inadequate Hand Washing, Lack of Clean Drinking Water and Latrines as Major Determinants of Cholera Outbreak in Somali Region, Ethiopia in 2019. Front Public Health 2022; 10:845057. [PMID: 35602140 PMCID: PMC9120658 DOI: 10.3389/fpubh.2022.845057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Cholera remains a serious public health problem characterized by a large disease burden, frequent outbreaks, persistent endemicity, and high mortality, particularly in tropical and subtropical low-income countries including Ethiopia. The recent cholera outbreak in the Somali region began on 4 September to 1 November 2019. Cholera may spread rapidly through a population so that an early detection and reporting of the cases is mandatory. This study aimed to identify determinants of cholera infection among >5 years of age population in Somali region, Ethiopia. Methods A community-based unmatched case-control study was conducted among 228 (76 cases and 152 controls, 1:2 ratio) systematically selected population. Data were collected using a structured questionnaire administered by an interviewer and a record review. Descriptive statistics and multivariable logistic regression analysis was used to identify the determinants of the risk factors of cholera infection with a 95% confidence interval and statistical significance was declared a tap-value < 0.05. Results A total of 228 participants (33.3% cases and 66.7% controls) were enrolled in this study. The majority of the cases were in the range of 20–49 years of age (69.7%). The odds of acquiring cholera infection increased significantly by drinking unsafe pipe water (AOR 4.3, 95% CI 1.65–11.2), not having a household level toilet/latrine (AOR 3.25, 95% CI 1.57–6.76), hand washing only sometimes after the toilet (AOR 3.04, 95% CI 1.58–5.86) and not using water purification methods (AOR 2.3, 95% CI 1.13–4.54). Conclusion Major risk factors for cholera infection were related to drinking water and latrine hygiene. Improvement in awareness creation about cholera prevention and control methods, including water treatment, hygiene and sanitation were crucial in combating this cholera outbreak. Primary public health actions are ensuring clean drinking water, delivery of water purification tablets, soap and hand sanitizers and provision of health care and outbreak response. Long term goals in cholera affected areas include comprehensive water and sanitation strategies. Overall, the strategic role of a multi-sectoral approach in the design and implementation of public health interventions aimed at preventing and controlling cholera are essential to avert cholera outbreaks. Preparedness should be highlighted in cholera prone areas like Somali region especially after drought periods.
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Affiliation(s)
- Jemal Mussa Challa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tamirat Getachew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- *Correspondence: Tamirat Getachew ; orcid.org/0000-0002-0057-9062
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Melkamu Merid
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Genanaw Atnafe
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abdi Birhanu
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemma Demissie Regassa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Samuel Amoo O, Awoderu O, Yisau J, Oladele D, David AN, Raheem T, Uwandu M, Bamidele M, Fesobi TW, AbdusSalam A, Nduaga S, Oparaugo CT, Ajayi M, Ogbonna F, Musa AZ, Adedeji A, Ige F, Ihemanma O, Nuhu B, Okebugwu U, Bello IW, Onuigbo TI, Ikemefuna AS, Oraegbu JI, Agboola H, Idris J, Ajayi A, Salako BL, Smith SI. Assessment of potential factors that support the endemicity of cholera in Nigeria from food handlers, health workers and the environment. MICROBIOLOGIA MEDICA 2021. [DOI: 10.4081/mm.2021.10058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and Aims: Diarrheal diseases caused by bacterial pathogens are widespread and they result in morbidity and mortality of a lot of people yearly. The aim of this study was to assess the role of the environment, health workers and food handlers as reservoirs of Vibrio cholerae, and other diarrhea causing bacteria. Methods: Healthcare workers were proportionally selected and multistage sampling technique was adopted in selecting food handlers for the study. A total of 374 participants consisting of health workers and food handlers were recruited. Socio-demographic and clinical information were collected using questionnaires, while stool and environmental samples were also collected. Results: More female 55.9 % than male 44.1 % participated in the study and the mean age of participants was 38.7 ± 10.9. A significant number of participants identified poor hygiene practices as the major cause of diarrhea. V. cholerae O1 serotype was not detected in any of the environmental samples nor stool samples of both food handlers and health workers. However, V. cholerae (Non O1/Non O139) was isolated from the stool samples of food handlers and health workers in Kano State implying that they could be serving a source of the continuous dissemination of the pathogen. Other bacterial pathogens that are aetiology of diarrhea including Salmonella spp. Escherichia coli, Klebsiella oxytoca, and Enterobacter spp. were also isolated. Conclusion: It is therefore imperative that food handlers and health workers undergo periodic health checks to ensure they are free of pathogens they could easily transmit through food or to patients.
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Alzain MA, Haruwn MH, Abdelaziz MO, Elsheikh M, Asweto CO, Algahtani FD, Adeboye AA, Elhassan NEE, Itumalla R. Association between Cholera Outbreak and Traditional Gold Mining in Northern State, Sudan 2017. J Glob Infect Dis 2021; 13:115-119. [PMID: 34703150 PMCID: PMC8491817 DOI: 10.4103/jgid.jgid_47_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction Cholera is one of the health problems causing considerable morbidity and mortality. The Northern State of Sudan experienced a recent cholera outbreak, however, there are limited data on the outbreak. Methods The objective of this study was to assess the magnitude and risk factors associated with the cholera outbreak in the Northern State of Sudan. A retrospective case series study was conducted in the Northern State of Sudan, which involved tracing cases of cholera outbreak of 2017. Data were collected through reports and interviews. A geographical information system was used to map all cases during the outbreak. Chi-square test and logistic regression were used to identify associated factors. Results There were 957 cholera cases reported in the state with an attack rate of 14.2/10,000 persons. Dalgo locality had the highest number (415) of cases reported with an attack rate of 167.2/10,000 persons. About 78% of cases were adult males, while 56.2% of cases were immigrants from other states. Immigrants in Halfa and Dalgo localities were four times (odds ratio [OR] = 4.031, 95% confidence interval [CI]: 2.482-6.547) and eight times (OR = 8.318, 95% CI: 5.674-12.193), respectively, at risk of cholera infection compared to immigrants in Dongola locality. The overall case-fatality rate was 1.9%. This was significantly higher in younger (5.8%) and older (22.7%) age groups (P < 0.05). Conclusions The study revealed that the cholera outbreak spread highly along with traditional gold mining areas due to poor sanitation. Therefore, improving sanitation services and establishing an effective surveillance system in these areas are essential to prevent future occurrence of outbreaks.
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Affiliation(s)
- Mohamed Ali Alzain
- Department of Public Health, College of Public Health and Health Informatics, University of Hail, Hail 81451, Kingdom of Saudi Arabia.,Department of Community Medicine, Faculty of Medicine and Health Sciences, University of Dongola, Dongola, PO BOX 47, Dongola 41111, Sudan
| | | | - Mohamed Osman Abdelaziz
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, University of Dongola, Dongola, PO BOX 47, Dongola 41111, Sudan
| | - Mohamed Elsheikh
- Department of Physiology, Faculty of Medicine and Health Sciences, University of Dongola, Dongola, PO BOX 47, Dongola 41111, Sudan
| | - Collins Otieno Asweto
- Department of Community Health, School of Nursing, University of Embu, PO Box 6-60100 Embu, Kenya
| | - Fahad D Algahtani
- Department of Public Health, College of Public Health and Health Informatics, University of Hail, Hail 81451, Kingdom of Saudi Arabia.,Molecular Diagnostic and Personalized Therapeutic Unit, Hail, PO BOX 2440, Hail 81451, Kingdom of Saudi Arabia
| | - Adeniyi Abolaji Adeboye
- Department of Public Health, College of Public Health and Health Informatics, University of Hail, Hail 81451, Kingdom of Saudi Arabia.,Department of Public Health, University of Texas Health Sciences at Houston, Houston, TX 77030, USA
| | - Najm Eldinn Elsser Elhassan
- Department of Public Health, College of Public Health and Health Informatics, University of Hail, Hail 81451, Kingdom of Saudi Arabia.,Department of Environmental Health, College of Public and Environmental Health, University of Bahri, Khartoum, PO BOX 166011111, Sudan
| | - Ramaiah Itumalla
- Department of Health Management, College of Public Health and Health Informatics, University of Hail, Hail, PO BOX 2440, Hail 81451, Kingdom of Saudi Arabia
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Mbala-Kingebeni P, Vogt F, Miwanda B, Sundika T, Mbula N, Pankwa I, Lubula L, Vanlerberghe V, Magazani A, Afoumbom MT, Muyembe-Tamfum JJ. Sachet water consumption as a risk factor for cholera in urban settings: Findings from a case control study in Kinshasa, Democratic Republic of the Congo during the 2017-2018 outbreak. PLoS Negl Trop Dis 2021; 15:e0009477. [PMID: 34237058 PMCID: PMC8266059 DOI: 10.1371/journal.pntd.0009477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 05/15/2021] [Indexed: 11/19/2022] Open
Abstract
Background Behavioural risk factors for cholera are well established in rural and semi-urban contexts, but not in densely populated mega-cities in Sub-Saharan Africa. In November 2017, a cholera epidemic occurred in Kinshasa, the Democratic Republic of the Congo, where no outbreak had been recorded for nearly a decade. During this outbreak, we investigated context-specific risk factors for cholera in an urban setting among a population that is not frequently exposed to cholera. Methodology/Principal findings We recruited 390 participants from three affected health zones of Kinshasa into a 1:1 matched case control study. Cases were identified from cholera treatment centre admission records, while controls were recruited from the vicinity of the cases’ place of residence. We used standardized case report forms for the collection of socio-demographic and behavioural risk factors. We used augmented backward elimination in a conditional logistic regression model to identify risk factors. The consumption of sachet water was strongly associated with the risk of being a cholera case (p-value 0.019), which increased with increasing frequency of consumption from rarely (OR 2.2, 95% CI 0.9–5.2) to often (OR 4.0, 95% CI 1.6–9.9) to very often (OR 4.1, 95% CI 1.0–16.7). Overall, more than 80% of all participants reported consumption of this type of drinking water. The risk factors funeral attendance and contact with someone suffering from diarrhoea showed a p-value of 0.09 and 0.08, respectively. No socio-demographic characteristics were associated with the risk of cholera. Conclusions/Significance Drinking water consumption from sachets, which are sold informally on the streets in most Sub-Saharan African cities, are an overlooked route of infection in urban cholera outbreaks. Outbreak response measures need to acknowledge context-specific risk factors to remain a valuable tool in the efforts to achieve national and regional targets to reduce the burden of cholera in Sub-Saharan Africa. Cholera is a diarrheal disease caused by ingestion of the Vibrio cholerae bacterium. Outbreaks in urban areas are becoming increasingly frequent in Sub-Saharan Africa. Risk factors for cholera have been studied in rural settings but not sufficiently in urban areas. Understanding context-specific risk factors is key for successful outbreak response. During a cholera outbreak in Kinshasa, the Democratic Republic of the Congo we were able to identify a previously unknown behavioural risk factor of particular relevance in urban settings–the consumption of drinking water from plastic sachets. Water sachets are sold on the streets of all major cities in Sub-Saharan Africa. It requires biting off an edge and sucking out the water, and we think that external contamination of these sachets was an important transmission route in the Kinshasa outbreak. Water sachets are predominantly consumed by socio-economically disadvantaged groups who lack piped water supply in their homes and have poor access to sanitary infrastructure. This makes our findings particularly relevant because these are the very populations who are at increased risk of getting and transmitting cholera. Health messaging and response measures should include consumption of water sachets as a potential risk factor during future cholera outbreaks in urban low-resource settings.
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Affiliation(s)
| | - Florian Vogt
- Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
- The Kirby Institute, University of New South Wales, Sydney, Australia
- * E-mail:
| | - Berthe Miwanda
- Institut National de la Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | | | - Nancy Mbula
- FELTP DRC, Kinshasa, Democratic Republic of the Congo
| | - Isaac Pankwa
- Institut National de la Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
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Qaserah AM, Al Amad MA, Al Serouri AA, Khader YS. Risk Factors of Cholera Transmission in Al Hudeidah, Yemen: Case-control study (Preprint). JMIR Public Health Surveill 2021; 7:e27627. [PMID: 36260393 PMCID: PMC8406125 DOI: 10.2196/27627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Mohammed Abdullah Al Amad
- Yemen Field Epidemiology Training Program, Yemen Ministry of Public Health and Population, Sana'a, Yemen
| | | | - Yousef Saleh Khader
- Department of Community Medicine, Public Health, and Family Medicine, Faculty of Medicine, Jordan University of Science & Technology, Amman, Jordan
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Kigen HT, Boru W, Gura Z, Githuka G, Mulembani R, Rotich J, Abdi I, Galgalo T, Githuku J, Obonyo M, Muli R, Njeru I, Langat D, Nsubuga P, Kioko J, Lowther S. A protracted cholera outbreak among residents in an urban setting, Nairobi county, Kenya, 2015. Pan Afr Med J 2020; 36:127. [PMID: 32849982 PMCID: PMC7422748 DOI: 10.11604/pamj.2020.36.127.19786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 06/03/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction in 2015, a cholera outbreak was confirmed in Nairobi county, Kenya, which we investigated to identify risk factors for infection and recommend control measures. Methods we analyzed national cholera surveillance data to describe epidemiological patterns and carried out a case-control study to find reasons for the Nairobi county outbreak. Suspected cholera cases were Nairobi residents aged >2 years with acute watery diarrhea (>4 stools/≤12 hours) and illness onset 1-14 May 2015. Confirmed cases had Vibrio cholerae isolated from stool. Case-patients were frequency-matched to persons without diarrhea (1:2 by age group, residence), interviewed using standardized questionaires. Logistic regression identified factors associated with case status. Household water was analyzed for fecal coliforms and Escherichia coli. Results during December 2014-June 2015, 4,218 cholera cases including 282 (6.7%) confirmed cases and 79 deaths (case-fatality rate [CFR] 1.9%) were reported from 14 of 47 Kenyan counties. Nairobi county reported 781 (19.0 %) cases (attack rate, 18/100,000 persons), including 607 (78%) hospitalisations, 20 deaths (CFR 2.6%) and 55 laboratory-confirmed cases (7.0%). Seven (70%) of 10 water samples from communal water points had coliforms; one had Escherichia coli. Factors associated with cholera in Nairobi were drinking untreated water (adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] 2.3-18.8), lacking health education (aOR 2.4, CI 1.1-7.9) and eating food outside home (aOR 2.4, 95% CI 1.2-5.7). Conclusion we recommend safe water, health education, avoiding eating foods prepared outside home and improved sanitation in Nairobi county. Adherence to these practices could have prevented this protacted cholera outbreak.
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Affiliation(s)
- Hudson Taabukk Kigen
- Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Waqo Boru
- Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Zeinab Gura
- Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - George Githuka
- Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Robert Mulembani
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Jacob Rotich
- Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Isack Abdi
- Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Tura Galgalo
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya.,African Field Epidemiology Network, Nairobi, Kenya
| | - Jane Githuku
- Ministry of Health, Nairobi, Kenya.,Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
| | - Mark Obonyo
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Raphael Muli
- Department of Health, County Government of Nairobi, Nairobi, Kenya
| | - Ian Njeru
- Ministry of Health, Nairobi, Kenya.,Division of Disease Surveillance and Response, Ministry of Health, Nairobi, Kenya
| | - Daniel Langat
- Ministry of Health, Nairobi, Kenya.,Division of Disease Surveillance and Response, Ministry of Health, Nairobi, Kenya
| | | | | | - Sara Lowther
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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11
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Phelps MD, Simonsen L, Jensen PKM. Individual and household exposures associated with cholera transmission in case–control studies: a systematic review. Trop Med Int Health 2019; 24:1151-1168. [DOI: 10.1111/tmi.13293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Matthew D. Phelps
- Copenhagen Center for Disaster Research, Department of Public Health, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Lone Simonsen
- Department of Science and Environment Roskilde University Roskilde Denmark
| | - Peter K. M. Jensen
- Copenhagen Center for Disaster Research, Department of Public Health, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
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12
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Ateudjieu J, Yakum MN, Goura AP, Nafack SS, Chebe AN, Azakoh JN, Chukuwchindun BA, Bayiha EJ, Kangmo C, Tachegno GVB, Bissek ACZK. Health facility preparedness for cholera outbreak response in four cholera-prone districts in Cameroon: a cross sectional study. BMC Health Serv Res 2019; 19:458. [PMID: 31286934 PMCID: PMC6615310 DOI: 10.1186/s12913-019-4315-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 07/01/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The risk of cholera outbreak remains high in Cameroon. This is because of the persistent cholera outbreaks in neighboring countries coupled with the poor hygiene and sanitation conditions in Cameroon. The objective of this study was to assess the readiness of health facilities to respond to cholera outbreak in four cholera-prone districts in Cameroon. METHODOLOGY A cross-sectional study was conducted targeting all health facilities in four health districts, labeled as cholera hotspots in Cameroon in August 2016. Data collection was done by interview with a questionnaire and by observation regarding the availability of resources and materials for surveillance and case management, access to water, hygiene, and sanitation. Data analysis was descriptive with STATA 11. PRINCIPAL FINDINGS A total of 134 health facilities were evaluated, most of which (108/134[81%]) were urban facilities. The preparedness regarding surveillance was limited with 13 (50%) health facilities in the Far North and 22(20%) in the Littoral having cholera case definition guide. ORS for Case management was present in 8(31%) health facilities in the Far North and in 94(87%) facilities in the littoral. Less than half of the health facilities had a hand washing protocol and 7(5.1%) did not have any source of drinking water or relied on unimproved sources like lake. A total of 4(3.0%) health facilities, all in the Far North region, did not have a toilet. CONCLUSIONS The level of preparedness of health facilities in Cameroon for cholera outbreak response presents a lot of weaknesses. These are present in terms of lack of basic surveillance and case management materials and resources, low access to WaSH. If not addressed now, these facilities might not be able to play their role in case there is an outbreak and might even turn to be transmission milieus.
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Affiliation(s)
- Jerome Ateudjieu
- M.A. SANTE (Meilleur accès aux soins de Santé), P.O. Box 33490, Yaoundé, Cameroon
- Department of Biomedical Sciences, University of Dschang, P.O. Box 067, Dschang, Cameroon
| | | | - Andre Pascal Goura
- M.A. SANTE (Meilleur accès aux soins de Santé), P.O. Box 33490, Yaoundé, Cameroon
| | - Sonia Sonkeng Nafack
- M.A. SANTE (Meilleur accès aux soins de Santé), P.O. Box 33490, Yaoundé, Cameroon
| | | | | | | | - Eugene Joel Bayiha
- M.A. SANTE (Meilleur accès aux soins de Santé), P.O. Box 33490, Yaoundé, Cameroon
| | - Corine Kangmo
- M.A. SANTE (Meilleur accès aux soins de Santé), P.O. Box 33490, Yaoundé, Cameroon
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13
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Richterman A, Sainvilien DR, Eberly L, Ivers LC. Individual and Household Risk Factors for Symptomatic Cholera Infection: A Systematic Review and Meta-analysis. J Infect Dis 2018; 218:S154-S164. [PMID: 30137536 PMCID: PMC6188541 DOI: 10.1093/infdis/jiy444] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Cholera has caused 7 global pandemics, including the current one which has been ongoing since 1961. A systematic review of risk factors for symptomatic cholera infection has not been previously published. Methods In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we performed a systematic review and meta-analysis of individual and household risk factors for symptomatic cholera infection. Results We identified 110 studies eligible for inclusion in qualitative synthesis. Factors associated with symptomatic cholera that were eligible for meta-analysis included education less than secondary level (summary odds ratio [SOR], 2.64; 95% confidence interval [CI], 1.41-4.92; I2 = 8%), unimproved water source (SOR, 3.48; 95% CI, 2.18-5.54; I2 = 77%), open container water storage (SOR, 2.03; 95% CI, 1.09-3.76; I2 = 62%), consumption of food outside the home (SOR, 2.76; 95% CI, 1.62-4.69; I2 = 64%), household contact with cholera (SOR, 2.91; 95% CI, 1.62-5.25; I2 = 89%), water treatment (SOR, 0.37; 95% CI, .21-.63; I2 = 74%), and handwashing (SOR, 0.29; 95% CI, .20-.43; I2 = 37%). Other notable associations with symptomatic infection included income/wealth, blood group, gastric acidity, infant breastfeeding status, and human immunodeficiency virus infection. Conclusions We identified potential risk factors for symptomatic cholera infection including environmental characteristics, socioeconomic factors, and intrinsic patient factors. Ultimately, a combination of interventional approaches targeting various groups with risk-adapted intensities may prove to be the optimal strategy for cholera control.
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Affiliation(s)
- Aaron Richterman
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Lauren Eberly
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Louise C Ivers
- Center for Global Health, Massachusetts General Hospital
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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14
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Recurrent cholera epidemics in Africa: which way forward? A literature review. Infection 2018; 47:341-349. [DOI: 10.1007/s15010-018-1186-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/27/2018] [Indexed: 02/03/2023]
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15
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Wolfe M, Kaur M, Yates T, Woodin M, Lantagne D. A Systematic Review and Meta-Analysis of the Association between Water, Sanitation, and Hygiene Exposures and Cholera in Case-Control Studies. Am J Trop Med Hyg 2018; 99:534-545. [PMID: 29968551 PMCID: PMC6090371 DOI: 10.4269/ajtmh.17-0897] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Case-control studies are conducted to identify cholera transmission routes. Water, sanitation, and hygiene (WASH) exposures can facilitate cholera transmission (risk factors) or interrupt transmission (protective factors). To our knowledge, the association between WASH exposures and cholera from case-control studies has not been systematically analyzed. A systematic review was completed to close this gap, including describing the theory of risk and protection, developing inclusion criteria, searching and selecting studies, assessing quality of evidence, and summarizing associations between cholera and seven predicted WASH protective factors and eight predicted WASH risk factors using meta-analysis and sensitivity analysis. Overall, 47 articles describing 51 individual studies from 30 countries met the inclusion criteria. All eight predicted risk factors were associated with higher odds of cholera (odds ratio [OR] = 1.9-5.6), with heterogeneity (I2) of 0-92%. Of the predicted protective factors, five of seven were associated with lower odds of cholera (OR = 0.35-1.4), with heterogeneity of 57-91%; exceptions were insignificant associations for improved water source (OR = 1.1, heterogeneity 91%) and improved sanitation (OR = 1.4, heterogeneity 68%). Results were robust; 3/70 (5%) associations changed directionality or significance in sensitivity analysis. Meta-analysis results highlight that predicted risk factors are associated with cholera; however, predicted protective factors are not as consistently protective. This variable protection is attributed to 1) cholera transmission via multiple routes and 2) WASH intervention implementation quality variation. Water, sanitation, and hygiene interventions should address multiple transmission routes and be well implemented, according to international guidance, to ensure that field effectiveness matches theoretical efficacy. In addition, future case-control studies should detail WASH characteristics to contextualize results.
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Affiliation(s)
- Marlene Wolfe
- Tufts University Civil and Environmental Engineering Department, Medford, Massachusetts
| | - Mehar Kaur
- Tufts University Civil and Environmental Engineering Department, Medford, Massachusetts
| | - Travis Yates
- Tufts University Civil and Environmental Engineering Department, Medford, Massachusetts
| | - Mark Woodin
- Tufts University Civil and Environmental Engineering Department, Medford, Massachusetts
| | - Daniele Lantagne
- Tufts University Civil and Environmental Engineering Department, Medford, Massachusetts
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16
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Cholera: an overview with reference to the Yemen epidemic. Front Med 2018; 13:213-228. [DOI: 10.1007/s11684-018-0631-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/18/2017] [Indexed: 12/12/2022]
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17
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Saha A, Hayen A, Ali M, Rosewell A, Clemens JD, Raina MacIntyre C, Qadri F. Socioeconomic risk factors for cholera in different transmission settings: An analysis of the data of a cluster randomized trial in Bangladesh. Vaccine 2017; 35:5043-5049. [PMID: 28765003 DOI: 10.1016/j.vaccine.2017.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/16/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cholera remains a threat globally, and socioeconomic factors play an important role in transmission of the disease. We assessed socioeconomic risk factors for cholera in vaccinated and non-vaccinated communities to understand whether the socioeconomic risk factors differ by transmission patterns for cholera. METHODS We used data from a cluster randomized control trial conducted in Dhaka, Bangladesh. There were 90 geographic clusters; 30 in each of the three arms of the study: vaccine (VAC), vaccine plus behavioural change (VBC), and non-intervention. The data were analysed for the three populations: (1) vaccinees in the vaccinated communities (VAC and VBC arms), (2) non-vaccinated individuals in the vaccinated communities and (3) all individuals in the non-vaccinated communities (non-intervention arm). A generalized estimating equation with logit link function was used to evaluate the risk factors for cholera among these different populations adjusting for household level correlation in the data. RESULTS A total of 528 cholera and 226 cholera with severe dehydration (CSD) in 268,896 persons were observed during the two-year follow-up. For population 1, the cholera risk was not associated with any socioeconomic factors; however CSD was less likely to occur among individuals living in a household having ≤4 members (aOR=0.55, 95% CI=0.32-0.96). Among population 2, younger participants and individuals reporting diarrhoea during registration were more likely to have cholera. Females and individuals reporting diarrhoea during registration were at increased risk of CSD. Among population 3, individuals living in a household without a concrete floor, in an area with high population density, closer to the study hospital, or not treating drinking water were at significantly higher risk for both cholera and CSD. CONCLUSION The profile of socioeconomic factors associated with cholera varies by individuals' vaccination status as well as the transmission setting. In a vaccinated community where transmission would be expected to be lower, socioeconomic factors may not increase the risk of the disease.
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Affiliation(s)
- Amit Saha
- School of Public Health and Community Medicine, UNSW Australia, NSW, Australia; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Andrew Hayen
- School of Public Health and Community Medicine, UNSW Australia, NSW, Australia; Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Australia
| | - Mohammad Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Alexander Rosewell
- School of Public Health and Community Medicine, UNSW Australia, NSW, Australia
| | - John D Clemens
- School of Public Health and Community Medicine, UNSW Australia, NSW, Australia; UCLA Fielding School of Public Health, Los Angeles, USA; Korea University School of Medicine, Seoul, South Korea
| | - C Raina MacIntyre
- School of Public Health and Community Medicine, UNSW Australia, NSW, Australia
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
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