A prolonged cholera outbreak caused by drinking contaminated stream water, Kyangwali refugee settlement, Hoima District,
- PDF / 988,825 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 57 Downloads / 182 Views
(2020) 9:154
RESEARCH ARTICLE
Open Access
A prolonged cholera outbreak caused by drinking contaminated stream water, Kyangwali refugee settlement, Hoima District, Western Uganda: 2018 Fred Monje1*, Alex Riolexus Ario1,2, Angella Musewa1, Kenneth Bainomugisha1, Bernadette Basuta Mirembe1, Dativa Maria Aliddeki1, Daniel Eurien1, Godfrey Nsereko1, Carol Nanziri1, Esther Kisaakye1, Vivian Ntono1, Benon Kwesiga1, Daniel Kadobera1, Lilian Bulage1, Godfrey Bwire2, Patrick Tusiime2, Julie Harris3 and Bao-Ping Zhu1,4
Abstract Background: On 23 February 2018, the Uganda Ministry of Health (MOH) declared a cholera outbreak affecting more than 60 persons in Kyangwali Refugee Settlement, Hoima District, bordering the Democratic Republic of Congo (DRC). We investigated to determine the outbreak scope and risk factors for transmission, and recommend evidence-based control measures. Methods: We defined a suspected case as sudden onset of watery diarrhoea in any person aged ≥ 2 years in Hoima District, 1 February–9 May 2018. A confirmed case was a suspected case with Vibrio cholerae cultured from a stool sample. We found cases by active community search and record reviews at Cholera Treatment Centres. We calculated case-fatality rates (CFR) and attack rates (AR) by sub-county and nationality. In a case-control study, we compared exposure factors among case- and control-households. We estimated the association between the exposures and outcome using Mantel-Haenszel method. We conducted an environmental assessment in the refugee settlement, including testing samples of stream water, tank water, and spring water for presence of fecal coliforms. We tested suspected cholera cases using cholera rapid diagnostic test (RDT) kits followed by culture for confirmation. Results: We identified 2122 case-patients and 44 deaths (CFR = 2.1%). Case-patients originating from Demographic Republic of Congo were the most affected (AR = 15/1000). The overall attack rate in Hoima District was 3.2/1000, with Kyangwali sub-county being the most affected (AR = 13/1000). The outbreak lasted 4 months, which was a multiple point-source. Environmental assessment showed that a stream separating two villages in Kyangwali Refugee Settlement was a site of open defecation for refugees. Among three water sources tested, only stream water was feacally-contaminated, yielding > 100 CFU/100 ml. Of 130 stool samples tested, 124 (95%) yielded V. cholerae by culture. Stream water was most strongly associated with illness (odds ratio [OR] = 14.2, 95% CI: 1.5–133), (Continued on next page)
* Correspondence: [email protected] 1 Uganda Public Health Fellowship Program, Kampala, Uganda Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the
Data Loading...
