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Baličević SA, Elimian KO, King C, Diaconu K, Akande OW, Ihekweazu V, Trolle H, Gaudenzi G, Forsberg B, Alfven T. Influences of community engagement and health system strengthening for cholera control in cholera reporting countries. BMJ Glob Health 2023; 8:e013788. [PMID: 38084475 PMCID: PMC10711916 DOI: 10.1136/bmjgh-2023-013788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
The 2030 Global Task Force on Cholera Control Roadmap hinges on strengthening the implementation of multistranded cholera interventions, including community engagement and health system strengthening. However, a composite picture of specific facilitators and barriers for these interventions and any overlapping factors existing between the two, is lacking. Therefore, this study aims to address this shortcoming, focusing on cholera-reporting countries, which are disproportionately affected by cholera and may be cholera endemic. A scoping methodology was chosen to allow for iterative mapping, synthesis of the available research and to pinpoint research activity for global and local cholera policy-makers and shareholders. Using the Arksey and O'Malley framework for scoping reviews, we searched PubMed, Web of Science and CINAHL. Inclusion criteria included publication in English between 1990 and 2021 and cholera as the primary document focus in an epidemic or endemic setting. Data charting was completed through narrative descriptive and thematic analysis. Forty-four documents were included, with half relating to sub-Saharan African countries, 68% (30/44) to cholera endemic settings and 21% (9/44) to insecure settings. We identified four themes of facilitators and barriers to health systems strengthening: health system cooperation and agreement with external actors; maintaining functional capacity in the face of change; good governance, focused political will and sociopolitical influences on the cholera response and insecurity and targeted destruction. Community engagement had two themes: trust building in the health system and growing social cohesion. Insecurity and the community; cooperation and agreement; and sociopolitical influences on trust building were themes of factors acting at the interface between community engagement and health system. Given the decisive role of the community-health system interface for both sustained health system strengthening and community engagement, there is a need to advocate for conflict resolution, trust building and good governance for long-term cholera prevention and control in cholera reporting countries.
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Affiliation(s)
| | - Kelly Osezele Elimian
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Exhale Health Foundation, Abuja, Nigeria
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Diaconu
- Institute of Global Health, Queen Margaret University, Edinburgh, UK
| | - Oluwatosin Wuraola Akande
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Hanna Trolle
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Giulia Gaudenzi
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Protein Science, SciLifeLab, Stockholm, Sweden
| | - Birger Forsberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Alfven
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm, Sweden
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Grimm PY, Oliver S, Merten S, Han WW, Wyss K. Enhancing the Understanding of Resilience in Health Systems of Low- and Middle-Income Countries: A Qualitative Evidence Synthesis. Int J Health Policy Manag 2022; 11:899-911. [PMID: 33619924 PMCID: PMC9808204 DOI: 10.34172/ijhpm.2020.261] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 12/19/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND A country's health system faces pressure when hit by an unexpected shock, such as what we observe in the midst of the coronavirus disease 2019 (COVID-19) pandemic. The concept of resilience is highly relevant in this context and is a prerequisite for a health system capable of withstanding future shocks. By exploring how the key dimensions of the resilient health system framework are applied, the present systematic review synthesizes the vital features of resilient health systems in low- and middle-income countries. The aim of this review is to ascertain the relevance of health system resilience in the context of a major shock, through better understanding its dimensions, uses and implications. METHODS The review uses the best-fit framework synthesis approach. An a priori conceptual framework was selected and a coding framework created. A systematic search identified 4284 unique citations from electronic databases and reports by non-governmental organisations, 12 of which met the inclusion criteria. Data were extracted and coded against the pre-existing themes. Themes outside of the a priori framework were collated to form a refined list of themes. Then, all twelve studies were revisited using the new list of themes in the context of each study. RESULTS Ten themes were generated from the analysis. Five confirmed the a priori conceptual framework that capture the dynamic attributes of a resilient system. Five new themes were identified as foundational for achieving resilience: realigned relationships, foresight and motivation as drivers, and emergency preparedness and change management as organisational mechanisms. CONCLUSION The refined conceptual model shows how the themes inter-connect. The foundations of resilience appear to be critical especially in resource-constrained settings to unlock the dynamic attributes of resilience. This review prompts countries to consider building the foundations of resilience described here as a priority to better prepare for future shocks.
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Affiliation(s)
- Pauline Yongeun Grimm
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sandy Oliver
- Social Science Research Unit, University College London, London, UK
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Sonja Merten
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Wai Wai Han
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Zeng W, Cui Y, Jarawan E, Avila C, Li G, Turbat V, Bouey J, Farag M, Mutasa R, Ahn H, Sun D, Shen J. Optimizing immunization schedules in endemic cholera regions: cost-effectiveness assessment of vaccination strategies for cholera control in Bangladesh. Vaccine 2021; 39:6356-6363. [PMID: 34579976 DOI: 10.1016/j.vaccine.2021.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/06/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
This study is to examine the cost-effectiveness of deployment strategies of oral cholera vaccines (OCVs) in controlling cholera in Bangladesh. We developed a dynamic compartment model to simulate costs and health outcomes for 12 years for four OCVs deployment scenarios: (1) vaccination of children aged one and above with two doses of OCVs, (2) vaccination of population aged 5 and above with a single dose of OCVs, (3) vaccination of children aged 1-4 with two doses of OCVs; and (4) combined strategy of (2) and (3). We obtained all parameters from the literature and performed a cost-effectiveness analysis from both health systems and societal perspectives, in comparison with the base scenario of no vaccination.The incremental cost-effectiveness ratios (ICERs) for the four strategies from the societal perspective were $2,236, $2,250, $1,109, and $2,112 per DALY averted, respectively, with herd immunity being considered. Without herd immunity, the ICERs increased substantially for all four scenarios except for the scenario that vaccinates children aged 1-4 only. The major determinants of ICERs were the case fatality rate and the incidence of cholera, as well as the efficacy of OCVs. The projection period and frequency of administering OCVs would also affect the cost-effectiveness of OCVs. With the cut-off of 1.5 times gross domestic product per capita, the four OCVs deployment strategies are cost-effective. The combined strategy is more efficient than the strategy of vaccinating the population aged one and above with two doses of OCVs and could be considered in the resource-limited settings.
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Affiliation(s)
- Wu Zeng
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, DC, USA.
| | - Yujie Cui
- Shanghai Jiao Tong University School of Medicine, Shanghai, China; China Hospital Management Institute, Shanghai Jiao Tong University, Shanghai, China.
| | - Eva Jarawan
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, DC, USA.
| | | | - Guohong Li
- Shanghai Jiao Tong University School of Medicine, Shanghai, China; China Hospital Management Institute, Shanghai Jiao Tong University, Shanghai, China.
| | - Vincent Turbat
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, DC, USA.
| | - Jennifer Bouey
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington, DC, USA.
| | - Marwa Farag
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada School of Public Administration and Development Economics, Doha Institute for Graduate Studies, Doha, Qatar.
| | | | - Haksoon Ahn
- School of Social Work, University of Maryland, Baltimore, MD, USA.
| | - Daxin Sun
- College of Transportation and Civil Engineering, Fujian Agriculture and Forestry University, Fuzhou, China.
| | - Jie Shen
- Shanghai Jiao Tong University School of Medicine, Shanghai, China; China Hospital Management Institute, Shanghai Jiao Tong University, Shanghai, China.
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Learning and Collaboration during Crisis: A Novel University-Community Partnership to Manufacture Medical Personal Protective Equipment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052258. [PMID: 33668790 PMCID: PMC7956350 DOI: 10.3390/ijerph18052258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/20/2021] [Accepted: 02/21/2021] [Indexed: 11/29/2022]
Abstract
Research on crisis management focuses on pre-planning for disasters in order to understand potential barriers. However, one significant barrier to crisis response is that organizations may come together in unplanned configurations during crisis response. This means that significant opportunities exist for understanding the process by which individuals learn, collaborate, and create new systems during crises. In this case report, we present the case of face shield production by a university, academic medical center, and community partners during the supply chain collapse of the early COVID-19 pandemic with the aim of identifying the relationships that formed during the COVID-19 response, so that this case of relationship formation and participant experiences might inform similar disaster response challenges in the future. Thirteen participants responded to an in-depth questionnaire designed to simulate an asynchronous in-depth interview. Respondents reported on the activities of 80 individuals from 38 units/organizations, providing insight into communication challenges and resolutions. Responses were analyzed using thematic analysis, highlighting roles and relationships among participants. The findings grant insight into the experience of learning from crisis response efforts, responding to recent calls for social scientific work on COVID-19 responses.
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Wolfe CM, Hamblion EL, Dzotsi EK, Mboussou F, Eckerle I, Flahault A, Codeço CT, Corvin J, Zgibor JC, Keiser O, Impouma B. Systematic review of Integrated Disease Surveillance and Response (IDSR) implementation in the African region. PLoS One 2021; 16:e0245457. [PMID: 33630890 PMCID: PMC7906422 DOI: 10.1371/journal.pone.0245457] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 12/30/2020] [Indexed: 01/02/2023] Open
Abstract
Background The WHO African region frequently experiences outbreaks and epidemics of infectious diseases often exacerbated by weak health systems and infrastructure, late detection, and ineffective outbreak response. To address this, the WHO Regional Office for Africa developed and began implementing the Integrated Disease Surveillance and Response strategy in 1998. Objectives This systematic review aims to document the identified successes and challenges surrounding the implementation of IDSR in the region available in published literature to highlight areas for prioritization, further research, and to inform further strengthening of IDSR implementation. Methods A systematic review of peer-reviewed literature published in English and French from 1 July 2012 to 13 November 2019 was conducted using PubMed and Web of Science. Included articles focused on the WHO African region and discussed the use of IDSR strategies and implementation, assessment of IDSR strategies, or surveillance of diseases covered in the IDSR framework. Data were analyzed descriptively using Microsoft Excel and Tableau Desktop 2019. Results The number of peer-reviewed articles discussing IDSR remained low, with 47 included articles focused on 17 countries and regional level systems. Most commonly discussed topics were data reporting (n = 39) and challenges with IDSR implementation (n = 38). Barriers to effective implementation were identified across all IDSR core and support functions assessed in this review: priority disease detection; data reporting, management, and analysis; information dissemination; laboratory functionality; and staff training. Successful implementation was noted where existing surveillance systems and infrastructure were utilized and streamlined with efforts to increase access to healthcare. Conclusions and implications of findings These findings highlighted areas where IDSR is performing well and where implementation remains weak. While challenges related to IDSR implementation since the first edition of the technical guidelines were released are not novel, adequately addressing them requires sustained investments in stronger national public health capabilities, infrastructure, and surveillance processes.
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Affiliation(s)
- Caitlin M. Wolfe
- Health Emergency Information and Risk Assessment, Health Emergencies Programme, World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
- University of South Florida College of Public Health, Tampa, Florida, United States of America
- * E-mail:
| | - Esther L. Hamblion
- Health Emergency Information and Risk Assessment, Health Emergencies Programme, World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Emmanuel K. Dzotsi
- Health Emergency Information and Risk Assessment, Health Emergencies Programme, World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Franck Mboussou
- Health Emergency Information and Risk Assessment, Health Emergencies Programme, World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Isabelle Eckerle
- Division of Infectious Diseases, Geneva Centre for Emerging Viral Diseases, University Hospital of Geneva, Geneva, Switzerland
| | - Antoine Flahault
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Claudia T. Codeço
- National School of Public Health (ENSP/Fiocruz), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Jaime Corvin
- University of South Florida College of Public Health, Tampa, Florida, United States of America
| | - Janice C. Zgibor
- University of South Florida College of Public Health, Tampa, Florida, United States of America
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Benido Impouma
- Health Emergency Information and Risk Assessment, Health Emergencies Programme, World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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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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Ndumbi P, Mboussou F, Otiobanda F, Mbayo G, Bompangue D, Mukinda V, Nsambu MN, Kanyonga JM, Ngom R, Hamblion E, Impouma B. Assessing the preparedness of primary healthcare facilities during a cholera outbreak in Kinshasa, Democratic Republic of the Congo, 2018. Public Health 2020; 183:102-109. [PMID: 32470696 DOI: 10.1016/j.puhe.2020.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE During the 2017-2018 cholera outbreak in Kinshasa, many patients initially reported to primary healthcare centers (HCs) before being transferred to the nearest cholera treatment centers. This study aims to assess the level of preparedness of HCs in responding to cholera outbreaks. STUDY DESIGN Descriptive cross-sectional survey. METHODS We conducted a descriptive cross-sectional survey in 180 of 374 primary HCs in Kinshasa. We collected data on 14 cholera preparedness criteria and described their prevalence among HCs. We used logistic regression to assess the association between each preparedness criteria and previous reporting of cholera cases by HCs. RESULTS The median number of preparedness criteria met by HCs was 5 [range: 0-11]. Five percent (n = 9) of HCs [95% confidence interval (CI): 2.3%-9.3%] met at least 10 criteria. HCs that previously reported ≥3 cholera cases were less likely to meet the criteria for 'presence of an isolation unit' (adjusted odds ratio [aOR]: 0.12; 95% CI [0.03-0.61]) and 'availability of sufficient quantity of chlorine' (aOR: 0.13; 95% CI [0.02-0.64]). CONCLUSIONS Despite past experience of cholera cases, health facilities in Kinshasa exhibit a low level of cholera preparedness. There is a need to prioritize the reinforcement of the preparedness of primary HCs to prevent future cholera outbreaks.
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Affiliation(s)
- P Ndumbi
- World Health Organization Regional Office for Africa, Emergency Preparedness and Response, Brazzaville, Congo.
| | - F Mboussou
- World Health Organization Regional Office for Africa, Emergency Preparedness and Response, Brazzaville, Congo.
| | - F Otiobanda
- University Hospital Centre, Brazzaville, Congo
| | - G Mbayo
- World Health Organization Regional Office for Africa, Health Emergency, Brazzaville, Congo
| | - D Bompangue
- National Programme for Cholera Elimination, Kinshasa, Congo
| | - V Mukinda
- World Health Organization Country Office, Kinshasa, Congo
| | - M N Nsambu
- World Health Organization Country Office, Kinshasa, Congo
| | | | - R Ngom
- World Health Organization Regional Office for Africa, Emergency Preparedness and Response, Brazzaville, Congo
| | - E Hamblion
- World Health Organization Regional Office for Africa, Emergency Preparedness and Response, Brazzaville, Congo
| | - B Impouma
- World Health Organization Regional Office for Africa, Emergency Preparedness and Response, Brazzaville, Congo
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Iramiot JS, Rwego IB, Kansiime C, Asiimwe BB. Epidemiology and antibiotic susceptibility of Vibrio cholerae associated with the 2017 outbreak in Kasese district, Uganda. BMC Public Health 2019; 19:1405. [PMID: 31664972 PMCID: PMC6819361 DOI: 10.1186/s12889-019-7798-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uganda is among the 51 countries where cholera outbreaks are common with epidemics occurring predominantly along the western border with Democratic Republic of Congo (DRC), Kampala city slums, Busia district which is a border town with Western Kenya, Mbale district and the Karamoja Sub-region. This report summarizes findings from the epidemiologic investigation, which aimed at identifying the mode of transmission and antibiotic susceptibility patterns of the Vibrio cholerae isolated in Kasese district, Uganda. METHODS A descriptive cross-sectional study was carried out between 2017 and 2018 to describe the epidemiology of the cholera epidemic in Kasese district, Uganda. Rectal swabs were collected from 69 suspected case-persons and cultured on Thiosulphate-Citrate-Bile-Salts Sucrose (TCBS™; SEIKEN Japan) agar and incubated at 37 °C for 18-24 h. The isolates were serotyped with polyvalent 01 antiserum and monovalent serotype Inaba and Ogawa antisera (Denka Seiken, Tokyo, Japan) to determine which serotype was responsible for the outbreak. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method on Mueller-Hinton agar. A list of discharged patients was obtained from the isolation units of Bwera hospital and Kagando hospital and the individuals were followed to the community where they live. Questionnaires were administered to a total of 75 participants who were either the cases or relatives to the case. GPS points of the homes of the cases and pictures of potential source infection were also taken and cases were mapped. RESULTS A total of 222 cases were recorded in the Kasese District outbreak between the month of September 2017 and January 2018 with the case fatality rate (CFR) of 1.4%. Children below the age of 14 years contributed the biggest proportion of the cases (70%) and out of these, 33% were aged below 5 years. Culture isolated 69 V. cholerae 01 serotype Inaba from the total of 71 samples. Salmonella typhi was Isolated from the other two samples which were negative for V. cholerae. Antibiotic susceptibility using Kirby-Bauer disc diffusion method was done on isolates from 69 participants and showed 100% resistance to Ampicillin and over 50% were resistant to trimethoprim/Sulfamethoxazole whereas gentamicin showed 100% susceptibility. Environmental assessment revealed rampant cases of open defecation. CONCLUSION Though we did not culture water to confirm contamination with Vibrio cholerae, we hypothesize that the cholera epidemic in Kasese 2017 was sparked off by consumption of contaminated water following the heavy floods that washed away latrines into water sources in Bwera, Isango and Nakiyumbu sub-counties. V. cholerae was also highly resistant to the commonly used antibiotics.
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Affiliation(s)
- Jacob Stanley Iramiot
- Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda. .,Department of Microbiology and Immunology Faculty of Health Sciences, Busitema University, Mbale, Uganda.
| | - Innocent B Rwego
- One Health Central and Eastern Africa (OHCEA) network, School of Public Health, Makerere University, Kampala, Uganda.,Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda.,One Health Division, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA
| | - Catherine Kansiime
- One Health Central and Eastern Africa (OHCEA) network, School of Public Health, Makerere University, Kampala, Uganda
| | - Benon B Asiimwe
- Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda.,One Health Central and Eastern Africa (OHCEA) network, School of Public Health, Makerere University, Kampala, Uganda
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