1
|
Agundu I, Oluwayomi O, Ford T. Exploring the Impact of Traditional Practices on Vibrio cholerae Outbreaks in Rural Nigerian Communities: A Field Study with Educational and Behavioral Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2025; 22:483. [PMID: 40283712 PMCID: PMC12027203 DOI: 10.3390/ijerph22040483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2025] [Revised: 03/16/2025] [Accepted: 03/21/2025] [Indexed: 04/29/2025]
Abstract
This study examined the link between traditional practices, water stewardship, and cholera outbreaks in three rural Nigerian communities (Enugu, Delta, and Ondo States) in 2020. A sample of 180 participants, representing different socio-economic backgrounds, was surveyed using a mixed-methods approach. Knowledge-based pre-test and post-test measures were employed to assess changes in the understanding of cholera transmission, prevention, and water infrastructure. Chi-square and logistic regression analyses were applied to examine the relationship between socioeconomic status, trust in traditional water sources, and cholera knowledge. Educational seminars were conducted, followed by six months, before administering the post-test to the same population. Key findings revealed that 47% of respondents washed animals in water sources, 42% did not treat their water, and 53% were unaware of cholera-reporting practices. The post-test results showed that 80% of participants could correctly identify cholera symptoms following educational interventions (p < 0.001). Water, sanitation, and hygiene (WaSH) program awareness was significantly associated with reduced cholera incidence (p = 0.005), while certain cultural practices, such as washing slaughtered animals in main water sources, were associated with increased cholera (p < 0.002). This study highlights the need for increased awareness of source water quality, better stewardship, and trust-building efforts to provide culturally appropriate interventions in mitigating these outbreaks.
Collapse
Affiliation(s)
- Ijebusonma Agundu
- Department of Public Health, University of Massachusetts Lowell, Lowell, MA 01854-5127, USA
| | | | - Tim Ford
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA 01854-5125, USA
| |
Collapse
|
2
|
Kayembe Ntumba HC, Taty N, Mako S, Batumbo DB. Assessment of knowledge, attitudes and practices regarding cholera among people living in a cholera-endemic health zone in the Democratic Republic of the Congo. BMJ Open 2025; 15:e091360. [PMID: 39979048 PMCID: PMC11842978 DOI: 10.1136/bmjopen-2024-091360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 02/05/2025] [Indexed: 02/22/2025] Open
Abstract
OBJECTIVES To assess cholera-related knowledge, attitudes and practices (KAP) and identify associated factors in a cholera endemic health zone in the Democratic Republic of the Congo (DRC). DESIGN A community-based cross-sectional study. SETTING The study was conducted in Kalemie health zone, which is located in the Tanganyika province in eastern DRC. PARTICIPANTS A total of 455 participants were enrolled in this study using a three-stage random sampling procedure. MAIN OUTCOME MEASURES Sociodemographic characteristics, cholera and water, sanitation and hygiene (WASH)-related KAP, and their associated factors. RESULTS The study revealed that the population demonstrated a good knowledge (64%), a positive attitude (73.6%) and good WASH practices (73.8%) regarding cholera. The identification of cholera symptoms, modes of transmission and means of prevention ranged from 79.6% to 94.3%, 38.2% to 41.5% and 32.5% to 56.3%, respectively. It was also noted a high prevalence of tap water use (93.4%) and limited access to water treatment (43.1% to 57.1%), as well as a significant proportion of latrine access (70.8%) with the presence of open defecation (16.3%). In multivariable logistic regression, poor knowledge about cholera was associated with being aged 18 years or younger, having limited education and practising poor WASH habits. No significant factors influenced participants' attitudes. Poor WASH practices were associated with being from households with daily expenditures of less than 1 USD and 5 USD, as well as having poor knowledge about cholera. In addition, believers from Catholic and Muslim backgrounds were less likely to have poor WASH practices. CONCLUSIONS Our findings indicate that health education initiatives targeting younger demographics should be intensified to enhance awareness of cholera prevention and household water treatment. Furthermore, there is a need for targeted interventions to provide public standpipes and community boreholes, as well as to improve the coverage of covered pit latrines, especially for poorer households.
Collapse
Affiliation(s)
- Harry César Kayembe Ntumba
- One Health Institute for Africa, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
| | - Nadège Taty
- One Health Institute for Africa, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
| | - Sandra Mako
- Ministry of Health, Hygiene and Prevention, Kinshasa, Congo (the Democratic Republic of the)
| | - Doudou Boloweti Batumbo
- Faculty of Medicine, University of Bandundu, Bandundu-Ville, Congo (the Democratic Republic of the)
| |
Collapse
|
3
|
Koua EL, Moussana FH, Sodjinou VD, Kambale F, Kimenyi JP, Diallo S, Okeibunor J, Gueye AS. Exploring the burden of cholera in the WHO African region: patterns and trends from 2000 to 2023 cholera outbreak data. BMJ Glob Health 2025; 10:e016491. [PMID: 39848637 PMCID: PMC11891530 DOI: 10.1136/bmjgh-2024-016491] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 12/19/2024] [Indexed: 01/25/2025] Open
Abstract
INTRODUCTION Cholera outbreaks remain persistent in the WHO African region, with an increased trend in recent years. This study analyses actual drivers of cholera including correlations with water, sanitation, and hygiene (WASH) indicators, and climate change trends. METHODS This was a cross-sectional descriptive and analytic study. Cholera data from 2000 to 2023 and data relating to cholera drivers were compiled and analysed through multi-level exploratory analysis. We cross-referenced several WASH indicators, and generated a similarity matrix to categorise countries or subnational units into groups using principal component analysis and K-means clustering. We integrated cholera outbreak data with WASH indicators and created a matrix of indicators relevant for analysing cholera burden. We conducted summary statistics, temporal visualisations, Geographic Information System (GIS) mapping, trend analysis and statistical tests for correlations to derive patterns and trends from the data, derive similarities and develop projections. RESULTS A total of 2 727 172 cases and 63 182 deaths were reported from 44 countries, representing 94% of the 47 countries in the region, from 2000 to 2023. The case fatality ratio of 2.3% is suggestive of issues in case management. A total of 684 outbreaks were reported, with the highest burdens in Nigeria and the Democratic Republic of the Congo. Median detection time to outbreak was 2 days, while median time for outbreak control was 92 days. Cholera incidence seemed higher in the period 2014 to 2023 than in the period before 2014. The study results confirmed correlations between WASH indicators and cholera outbreaks. Risks factors include drinking surface water, lacking soap and/or water, and open defaecation. Over 29% and 58.8% of the population lack access to basic water and basic sanitation, respectively. CONCLUSION Insufficient access to WASH services remains the main predisposing factor for cholera in the WHO African region. Political leaders should invest more in access to WASH, strengthen multisectoral collaboration, and improve availability of needed tools to increase the likelihood of meeting cholera elimination goals by 2030.
Collapse
Affiliation(s)
| | | | - Vincent Dossou Sodjinou
- Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Dakar, Senegal
| | | | | | | | - Joseph Okeibunor
- Emergency Preparedness and Response, World Health Organization, Brazzaville, Congo
- Department of Sociology/Anthropology, University of Nigeria, Nsukka, Nigeria
| | | |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Jutla A, Usmani M, Brumfield KD, Singh K, McBean F, Potter A, Gutierrez A, Gama S, Huq A, Colwell RR. Anticipatory decision-making for cholera in Malawi. mBio 2023; 14:e0052923. [PMID: 37962395 PMCID: PMC10746182 DOI: 10.1128/mbio.00529-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
Climate change raises an old disease to a new level of public health threat. The causative agent, Vibrio cholerae, native to aquatic ecosystems, is influenced by climate and weather processes. The risk of cholera is elevated in vulnerable populations lacking access to safe water and sanitation infrastructure. Predictive intelligence, employing mathematical algorithms that integrate earth observations and heuristics derived from microbiological, sociological, and weather data, can provide anticipatory decision-making capabilities to reduce the burden of cholera and save human lives. An example offered here is the recent outbreak of cholera in Malawi, predicted in advance by such algorithms.
Collapse
Affiliation(s)
- Antarpreet Jutla
- Department of Environmental Engineering Sciences, GeoHealth and Hydrology Laboratory, University of Florida, Gainesville, Florida, USA
| | - Moiz Usmani
- Department of Environmental Engineering Sciences, GeoHealth and Hydrology Laboratory, University of Florida, Gainesville, Florida, USA
| | - Kyle D. Brumfield
- Maryland Pathogen Research Institute, University of Maryland, College Park, Maryland, USA
- University of Maryland Institute for Advanced Computer Studies, University of Maryland, College Park, Maryland, USA
| | - Komalpreet Singh
- Department of Environmental Engineering Sciences, GeoHealth and Hydrology Laboratory, University of Florida, Gainesville, Florida, USA
| | - Fergus McBean
- Foreign, Commonwealth & Development Office, London, United Kingdom
| | - Amy Potter
- Foreign, Commonwealth & Development Office, London, United Kingdom
| | - Angelica Gutierrez
- Office of Water Prediction, National Oceanic and Atmospheric Administration (NOAA), Silver Spring, Maryland, USA
| | - Samuel Gama
- Department of Disaster Management Affairs, Office of the President and Cabinet, Lilongwe, Malawi
| | - Anwar Huq
- Maryland Pathogen Research Institute, University of Maryland, College Park, Maryland, USA
- University of Maryland Institute for Advanced Computer Studies, University of Maryland, College Park, Maryland, USA
| | - Rita R. Colwell
- Maryland Pathogen Research Institute, University of Maryland, College Park, Maryland, USA
- University of Maryland Institute for Advanced Computer Studies, University of Maryland, College Park, Maryland, USA
| |
Collapse
|
6
|
Islam MT, Hegde ST, Khan AI, Bhuiyan MTR, Khan ZH, Ahmmed F, Begum YA, Afrad MH, Amin MA, Tanvir NA, Khan II, Habib ZH, Alam AN, McMillan NA, Shirin T, Azman AS, Qadri F. National Hospital-Based Sentinel Surveillance for Cholera in Bangladesh: Epidemiological Results from 2014 to 2021. Am J Trop Med Hyg 2023; 109:575-583. [PMID: 37580033 PMCID: PMC10484282 DOI: 10.4269/ajtmh.23-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/06/2023] [Indexed: 08/16/2023] Open
Abstract
Despite focusing on cholera burden, epidemiologic studies in Bangladesh tend to be limited in geographic scope. National-level cholera surveillance data can help inform cholera control strategies and assess the effectiveness of preventive measures. Hospital-based sentinel surveillance among patients with suspected diarrhea in different sites across Bangladesh has been conducted since 2014. We selected an age-stratified sample of 20 suspected cholera cases each week from each sentinel site, tested stool for the presence of Vibrio cholerae O1/O139 by culture, and characterized antibiotic susceptibility in a subset of culture-positive isolates. We estimated the odds of being culture positive among suspected cholera cases according to different potential risk factors. From May 4, 2014 through November 30, 2021, we enrolled 51,414 suspected cases from our sentinel surveillance sites. We confirmed V. cholerae O1 in 5.2% of suspected cases through microbiological culture. The highest proportion of confirmed cholera cases was from Chittagong (9.7%) and the lowest was from Rangpur Division (0.9%). Age, number of purges, duration of diarrhea, occupation, and season were the most relevant factors in distinguishing cholera-positive suspected cases from cholera-negative suspected cases. Nationwide surveillance data show that cholera is circulating in Bangladesh and the southern region is more affected than the northern region. Antimicrobial resistance patterns indicate that multidrug resistance (resistance to three or more classes of antibiotics) of V. cholerae O1 could be a major threat in the future. Alignment of these results with Bangladesh's cholera-control program will be the foundation for future research into the efficacy of cholera-control initiatives.
Collapse
Affiliation(s)
- Md Taufiqul Islam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- School of Medical Science, Griffith University, Gold Coast, Australia
| | - Sonia Tara Hegde
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ashraful Islam Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Taufiqur Rahman Bhuiyan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Zahid Hasan Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Faisal Ahmmed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Yasmina Ara Begum
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mokibul Hassan Afrad
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Ashraful Amin
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nabid Anjum Tanvir
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ishtiakul Islam Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Zakir Hossain Habib
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Ahmed Nawsher Alam
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Nigel A. McMillan
- School of Medical Science, Griffith University, Gold Coast, Australia
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Andrew S. Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| |
Collapse
|
7
|
Shama AT, Terefa DR, Geta ET, Cheme MC, Biru B, Feyisa JW, Lema M, Desisa AE, Feyisa BR, Gebre DS. Latrine utilization and associated factors among districts implementing and not-implementing community-led total sanitation and hygiene in East Wollega, Western Ethiopia: A comparative cross-sectional study. PLoS One 2023; 18:e0288444. [PMID: 37440482 DOI: 10.1371/journal.pone.0288444] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Discharge of excreta to the environment lead to surface and groundwater contamination and human exposure to disease-causing micro-organisms. There is limitation of evidences regarding the latrine utilization among community-led total sanitation and hygiene implemented and non-implemented districts of the East Wollega Zone. Hence, this study aimed to determine the magnitude and associated factors of latrine utilization among households in community-led total sanitation and hygiene implemented and non-implemented Districts in East Wollega Zone, Western Ethiopia. METHODS A cross-sectional study was conducted. A Multi-stage sampling technique was applied to select the 461 households. Data were collected using interviews and observations guided by a pre-structured questionnaire. Data were entered using Epi Data and exported to SPSS software version 25 for data recording, cleaning, and statistical analysis. Bivariable logistic regression was run to identify the candidate variables at p-value <0.25. Variables that had associations with latrine utilization in the bi-variable analysis were entered together into multivariable logistic regression. An Adjusted odds ratio with a 95% confidence interval was calculated and P-value< 0.05 was used to declare a statistically significant association. RESULT The overall prevalence of latrine utilization was found to be 52.7% (95%CI:48%, 57.3%). Religion (AOR = 0.149;95%CI:0.044,0.506), education (AOR = 3.861;95%CI:1.642,9.077), occupation, absence of children <5 years (AOR = 4.724;95%CI:2.313,9.648), toilet cleaning (AOR = 10.662;95%CI:5.571,20.403), frequency of latrine construction (AOR = 6.441;95%CI:2.203,18.826), maintenance need (AOR = 6.446; 95%CI:3.023,13.744), distance from health institution (AOR = 0.987; 95%CI:0.978, 0.996), distance from kebele office (AOR = 6.478; 95%CI:2.137,19.635), and latrine distance from dwelling (AOR = 11.656; 95%CI:2.108, 64.44) were the factors associated with latrine use. CONCLUSION The latrine utilization in this study is low as compared to other studies. Religion, education, occupation, absence of children <5 years, toilet cleaning, frequency of latrine construction, maintenance need of the toilet, distance from health institution, distance from kebele, and latrine distance from dwelling are the associated factors of latrine utilization. Both households and health workers have to work together to improve latrine utilization and the safe disposal of children's feces.
Collapse
Affiliation(s)
- Adisu Tafari Shama
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemt, Ethiopia
| | - Dufera Rikitu Terefa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemt, Ethiopia
| | - Edosa Tesfaye Geta
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemt, Ethiopia
| | - Melese Chego Cheme
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemt, Ethiopia
| | - Bayise Biru
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemt, Ethiopia
- Department of Human Nutrition and Dietetics, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Jira Wakoya Feyisa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemt, Ethiopia
| | - Matiyos Lema
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemt, Ethiopia
| | - Adisu Ewunetu Desisa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemt, Ethiopia
| | - Bikila Regassa Feyisa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemt, Ethiopia
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Dejene Seyoum Gebre
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemt, Ethiopia
| |
Collapse
|
8
|
Kiama C, Okunga E, Muange A, Marwanga D, Langat D, Kuria F, Amoth P, Were I, Gachohi J, Ganda N, Martinez Valiente M, Njenga MK, Osoro E, Brunkard J. Mapping of cholera hotspots in Kenya using epidemiologic and water, sanitation, and hygiene (WASH) indicators as part of Kenya's new 2022-2030 cholera elimination plan. PLoS Negl Trop Dis 2023; 17:e0011166. [PMID: 36930650 PMCID: PMC10058159 DOI: 10.1371/journal.pntd.0011166] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/29/2023] [Accepted: 02/13/2023] [Indexed: 03/18/2023] Open
Abstract
Cholera is an issue of major public health importance. It was first reported in Kenya in 1971, with the country experiencing outbreaks through the years, most recently in 2021. Factors associated with the outbreaks in Kenya include open defecation, population growth with inadequate expansion of safe drinking water and sanitation infrastructure, population movement from neighboring countries, crowded settings such as refugee camps coupled with massive displacement of persons, mass gathering events, and changes in rainfall patterns. The Ministry of Health, together with other ministries and partners, revised the national cholera control plan to a multisectoral cholera elimination plan that is aligned with the Global Roadmap for Ending Cholera. One of the key features in the revised plan is the identification of hotspots. The hotspot identification exercise followed guidance and tools provided by the Global Task Force on Cholera Control (GTFCC). Two epidemiological indicators were used to identify the sub-counties with the highest cholera burden: incidence per population and persistence. Additionally, two indicators were used to identify sub-counties with poor WASH coverage due to low proportions of households accessing improved water sources and improved sanitation facilities. The country reported over 25,000 cholera cases between 2015 and 2019. Of 290 sub-counties, 25 (8.6%) sub-counties were identified as a high epidemiological priority; 78 (26.9%) sub-counties were identified as high WASH priority; and 30 (10.3%) sub-counties were considered high priority based on a combination of epidemiological and WASH indicators. About 10% of the Kenyan population (4.89 million) is living in these 30-combination high-priority sub-counties. The novel method used to identify cholera hotspots in Kenya provides useful information to better target interventions in smaller geographical areas given resource constraints. Kenya plans to deploy oral cholera vaccines in addition to WASH interventions to the populations living in cholera hotspots as it targets cholera elimination by 2030.
Collapse
Affiliation(s)
- Catherine Kiama
- Washington State University, Global Health Kenya, Nairobi, Kenya
- * E-mail:
| | | | | | - Doris Marwanga
- Washington State University, Global Health Kenya, Nairobi, Kenya
| | | | | | | | - Ian Were
- Kenya Ministry of Health, Nairobi, Kenya
| | - John Gachohi
- Washington State University, Global Health Kenya, Nairobi, Kenya
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | | | | | - M. Kariuki Njenga
- Washington State University, Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, United States of America
| | - Eric Osoro
- Washington State University, Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, United States of America
| | - Joan Brunkard
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
9
|
Usmani M, Brumfield KD, Magers BM, Huq A, Barciela R, Nguyen TH, Colwell RR, Jutla A. Predictive Intelligence for Cholera in Ukraine? GEOHEALTH 2022; 6:e2022GH000681. [PMID: 36185317 PMCID: PMC9514009 DOI: 10.1029/2022gh000681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/02/2022] [Accepted: 08/06/2022] [Indexed: 06/16/2023]
Abstract
Cholera, an ancient waterborne diarrheal disease, remains a threat to public health, especially when climate/weather processes, microbiological parameters, and sociological determinants intersect with population vulnerabilities of loss of access to safe drinking water and sanitation infrastructure. The ongoing war in Ukraine has either damaged or severely crippled civil infrastructure, following which the human population is at risk of health disasters. This editorial highlights a perspective on using predictive intelligence to combat potential (and perhaps impending) cholera outbreaks in various regions of Ukraine. Reliable and judicious use of existing earth observations inspired mathematical algorithms integrating heuristic understanding of microbiological, sociological, and weather parameters have the potential to save or reduce the disease burden.
Collapse
Affiliation(s)
- Moiz Usmani
- GeoHealth and Hydrology LaboratoryDepartment of Environmental Engineering SciencesUniversity of FloridaGainesvilleFLUSA
| | - Kyle D. Brumfield
- Maryland Pathogen Research InstituteUniversity of MarylandCollege ParkMDUSA
- University of Maryland Institute for Advanced Computer StudiesUniversity of MarylandCollege ParkMDUSA
| | - Bailey M. Magers
- GeoHealth and Hydrology LaboratoryDepartment of Environmental Engineering SciencesUniversity of FloridaGainesvilleFLUSA
| | - Anwar Huq
- Maryland Pathogen Research InstituteUniversity of MarylandCollege ParkMDUSA
- University of Maryland Institute for Advanced Computer StudiesUniversity of MarylandCollege ParkMDUSA
| | | | - Thanh H. Nguyen
- Department of Civil and Environmental EngineeringUniversity of Illinois at Urbana‐ChampaignUrbanaILUSA
| | - Rita R. Colwell
- Maryland Pathogen Research InstituteUniversity of MarylandCollege ParkMDUSA
- University of Maryland Institute for Advanced Computer StudiesUniversity of MarylandCollege ParkMDUSA
| | - Antarpreet Jutla
- GeoHealth and Hydrology LaboratoryDepartment of Environmental Engineering SciencesUniversity of FloridaGainesvilleFLUSA
| |
Collapse
|
10
|
Zheng Q, Luquero FJ, Ciglenecki I, Wamala JF, Abubakar A, Welo P, Hussen M, Wossen M, Yennan S, Keita A, Lessler J, Azman AS, Lee EC. Cholera outbreaks in sub-Saharan Africa during 2010-2019: a descriptive analysis. Int J Infect Dis 2022; 122:215-221. [PMID: 35605949 PMCID: PMC9439956 DOI: 10.1016/j.ijid.2022.05.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Cholera remains a public health threat but is inequitably distributed across sub-Saharan Africa. Lack of standardized reporting and inconsistent outbreak definitions limit our understanding of cholera outbreak epidemiology. METHODS From a database of cholera incidence and mortality, we extracted data from sub-Saharan Africa and reconstructed outbreaks of suspected cholera starting in January 2010 to December 2019 based on location-specific average weekly incidence rate thresholds. We then described the distribution of key outbreak metrics. RESULTS We identified 999 suspected cholera outbreaks in 744 regions across 25 sub-Saharan African countries. The outbreak periods accounted for 1.8 billion person-months (2% of the total during this period) from January 2010 to January 2020. Among 692 outbreaks reported from second-level administrative units (e.g., districts), the median attack rate was 0.8 per 1000 people (interquartile range (IQR), 0.3-2.4 per 1000), the median epidemic duration was 13 weeks (IQR, 8-19), and the median early outbreak reproductive number was 1.8 (range, 1.1-3.5). Larger attack rates were associated with longer times to outbreak peak, longer epidemic durations, and lower case fatality risks. CONCLUSIONS This study provides a baseline from which the progress toward cholera control and essential statistics to inform outbreak management in sub-Saharan Africa can be monitored.
Collapse
Affiliation(s)
- Qulu Zheng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Francisco J Luquero
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Global Alliance for Vaccines and Immunization (GAVI), Geneva, Switzerland
| | | | | | | | - Placide Welo
- PNECHOL-MD, Community IMCI, Ministry of Health, Democratic Republic of the Congo
| | - Mukemil Hussen
- Disease and Health Events Surveillance and Response Directorate, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Mesfin Wossen
- Disease and Health Events Surveillance and Response Directorate, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Sebastian Yennan
- Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Alama Keita
- Regional Office for West & Central Africa, UNICEF, Dakar, Senegal
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Corresponding author
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Corresponding author
| | - Elizabeth C Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Corresponding author
| |
Collapse
|
11
|
Omer N, Bitew BD, Engdaw GT, Getachew A. Utilization of Latrine and Associated Factors Among Rural Households in Takussa District, Northwest Ethiopia: A Community-Based Cross-Sectional Study. ENVIRONMENTAL HEALTH INSIGHTS 2022; 16:11786302221091742. [PMID: 35431551 PMCID: PMC9008866 DOI: 10.1177/11786302221091742] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/07/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND The use of sanitation facilities is known to interrupt the transmission of fecal-oral related diseases. However, the evidence was limited about the utilization of latrines within the rural community of Takussa district. Therefore, this study was conducted to assess the utilization of latrines and associated factors among households in Takussa district, northwest Ethiopia. METHODS A community-based cross-sectional study design was employed to survey 801 rural households among initially computed 812 participants from February 15 to March 15, 2019. A structured questionnaire with face-to-face interviews was used to collect the data. SPSS version 20 was used to analyze the completed data. A binary logistic regression model was used to process bivariate and multivariable analysis of the data. The adjusted odds ratio was used for the interpretation of the data after controlling for the confounders. RESULTS The proper latrine utilization rate was 41.9%, with a 95% confidence interval of (38.8, 45.3). Households with school-aged children (AOR: 2.27, 95% CI: (1.44, 3.56), a clean latrine (AOR: 3.34, 95% CI: (1.26, 4.93), the optimal distance from the living room (AOR: 1.56, 95% CI: (1.09, 2.25), and perceived benefit (AOR: 3.64, 95% CI: (1.13, 11.67) were statistically associated factors. CONCLUSION The Proper utilization of latrines was low among rural households in the Takussa district. School children, distance, cleanliness, and the benefit of latrines were statistically associated factors. As a result, encouraging health extension workers integrated into district schools to pay special attention to frequent follow-up in order to promote proper latrine utilization at the household level.
Collapse
Affiliation(s)
- Nuruhusan Omer
- Kolla Diba Hospital, Denbia District,
Central Gondar, Ethiopia
| | - Bikes Destaw Bitew
- Department of Environmental and
Occupational Health and Safety, Institute of Public Health, College of Medicine and
Health Sciences, University of Gondar, Gondar Ethiopia
| | - Garedew Tadege Engdaw
- Department of Environmental and
Occupational Health and Safety, Institute of Public Health, College of Medicine and
Health Sciences, University of Gondar, Gondar Ethiopia
| | - Atalay Getachew
- Department of Environmental Health,
Debre Markos University, Debre Markos, Ethiopia
| |
Collapse
|
12
|
de Souza AA, Mingoti SA, Paes-Sousa R, Heller L. Combination of conditional cash transfer program and environmental health interventions reduces child mortality: an ecological study of Brazilian municipalities. BMC Public Health 2021; 21:627. [PMID: 33789623 PMCID: PMC8011115 DOI: 10.1186/s12889-021-10649-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 03/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to assess the interactive effects of Brazilian public interventions, environmental health programs (access to water, sanitation and solid waste collection) and a Conditional Cash Transfer Program (PBF), on the mortality reduction due to diarrhea and malnutrition among children under 5 years old. METHODS The study design is ecological, with longitudinal analysis in a balanced panel. The period covered is 2006 to 2016, including 3467 municipalities from all regions of the country, which resulted in 38,137 observations. The generalized linear models were adjusted considering the Negative Binomial (NB) distribution for the number of deaths due to malnutrition and diarrhea, with fixed effects. NB models with and without zero-inflation were assessed. Subsequent interaction models were applied to assess the combined effects of the two public policies. RESULTS In relation to the decline of mortality rates due to diarrhea in the municipalities, positive effect modification were observed in the presence of: high coverage of the target population by the PBF and access to water, 0.54 (0.28-1.04) / 0.55 (0.29-1.04); high coverage by the total population by the PBF and access to water, 0.97 (0.95-1.00) and high coverage by the total population by the PBF and access to sanitation, 0.98 (0.97-1.00). Decline on diarrhea mortality was also observed in the joint presence of high coverage of solid waste collection and access to water, categories 1 (> 60% ≤85%): 0.98 (0.96-1.00), 0.98 (0.97-1, 00) and 2 (> 85% ≤ 100%): 0.97 (0.95-0.98), 0.97 (0.95-0.99). Negative effect modification were observed for mortality due to malnutrition in the presence of simultaneous high coverage of the total population by the PBF and access to sanitation categories 1 (≥ 20 < 50%): 1.0061 (0.9991-1.0132) and 2 (≥ 50 < 100%): 1.0073 (1.0002-1.0145) and high coverage of the total population by the PBF and solid waste collection, 1.0004 (1.0002-1.0005), resulting in malnutrition mortality rates increase. CONCLUSION Implementation of environmental health services and the coverage expansion by the PBF may enhance the prevention of early deaths in children under 5 years old due to diarrhea, a poverty related disease.
Collapse
Affiliation(s)
- Anelise Andrade de Souza
- René Rachou Institute, Fiocruz Minas, Avenida Augusto de Lima, 1715, Barro Preto, Belo Horizonte, Minas Gerais, Brazil.
| | - Sueli Aparecida Mingoti
- Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rômulo Paes-Sousa
- René Rachou Institute, Fiocruz Minas, Avenida Augusto de Lima, 1715, Barro Preto, Belo Horizonte, Minas Gerais, Brazil
| | - Leo Heller
- René Rachou Institute, Fiocruz Minas, Avenida Augusto de Lima, 1715, Barro Preto, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
13
|
de Souza AA, Mingoti SA, Paes-Sousa R, Heller L. Combined effects of conditional cash transfer program and environmental health interventions on diarrhea and malnutrition morbidity in children less than five years of age in Brazil, 2006-2016. PLoS One 2021; 16:e0248676. [PMID: 33784331 PMCID: PMC8009376 DOI: 10.1371/journal.pone.0248676] [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: 10/25/2020] [Accepted: 03/03/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Governmental measures aiming at social protection, with components of disease control, have potential positive impacts in the nutritional and health outcomes of the beneficiaries. The concomitant presence of these measures with environmental sanitation interventions may increase their positive effect. The context of simultaneous improvement of social protection and environmental sanitation is found in Brazil since 2007 and an assessment of the combined effects of both programs has not been performed so far. OBJECTIVE To evaluate whether interaction effects between improvement of access to water, sanitation and solid waste collection with the Bolsa Família Program [PBF] were related to better responses in the reduction of morbidity due to diarrhea and malnutrition in children less than five years of age, acknowledging the positive results of these improved conditions and the PBF separately in coping with these diseases. METHODS Descriptive and inferential analyses were performed through Generalized Linear Models of the Negative Binomial type of fixed effects, with and without addition of zeros. Interaction models were inserted in order to evaluate the outcomes when the two public policies of interest in the current study were present simultaneously in the municipalities. RESULTS Interaction with negative effect when a concomitantly high municipal coverage of the Bolsa Família Program and adequate access to sanitation and solid waste collection were present. In contrast, regardless of municipal coverage by the PBF, the simultaneous presence of water and sanitation (0.028% / 0.019%); water and solid waste collection (0.033% / 0.014%); sanitation and solid waste collection (0.018% / 0.021%), all resulted in a positive effect, with a decrease in the average morbidity rates for both diseases. CONCLUSION Investments aimed at universalizing water, sanitation and solid waste collection services should be priorities, aiming at reducing the incidence of morbidity due to malnutrition and diarrhea and preventing deaths from these poverty-related diseases.
Collapse
Affiliation(s)
| | - Sueli Aparecida Mingoti
- Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rômulo Paes-Sousa
- Instituto René Rachou, Fiocruz Minas, Belo Horizonte, Minas Gerais, Brazil
| | - Léo Heller
- Instituto René Rachou, Fiocruz Minas, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
14
|
Kisera N, Luxemburger C, Tornieporth N, Otieno G, Inda J. A descriptive cross-sectional study of cholera at Kakuma and Kalobeyei refugee camps, Kenya in 2018. Pan Afr Med J 2021; 37:197. [PMID: 33505566 PMCID: PMC7813661 DOI: 10.11604/pamj.2020.37.197.24798] [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: 07/04/2020] [Accepted: 07/29/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction cholera is a significant public health concern among displaced populations. Oral cholera vaccines are safe and can effectively be used as an adjunct to prevent cholera in settings with limited access to water and sanitation. Results from this study can inform future consideration for cholera vaccination at Kakuma and Kalobeyei. Methods a descriptive cross-sectional study of cholera cases at Kakuma refugee camp and Kalobeyei integrated settlement was carried out between May 2017 to May 2018 (one year). Data were extracted from the medical records and line lists at the cholera treatment centres. Results the results found 125 clinically suspected and confirmed cholera cases and one related death (CFR 0.8%). The cumulative incidence of all cases was 0.67 (95% CI=0.56-0.80) cases/1000 persons. Incidence of cholera was higher in children under the age of five 0.94(95% CI=0.63-1.36) cases/1000 persons. Children aged <5 years showed 51% increased risk of cholera compared to those aged ≥5 years (RR=1.51; 95% CI=1.00-2.31, p=0.051). Individuals from the Democratic Republic of Congo had nearly 9-fold risk of reporting cholera (RR=8.62; 95% CI=2.55-37.11, p<0.001) while individuals from South Sudan reported 7 times risk of cholera case compared to those from Somalia (RR=7.39; 95% CI=2.78-27.73, p<0.001). Conclusion in addition to the improvement of water, sanitation and hygiene (WaSH), vaccination could be implemented as a short-medium term measure of preventing cholera outbreaks. Age, country of origin and settlement independently predicted the risk of cholera.
Collapse
Affiliation(s)
- Nereah Kisera
- Kenya Medical Research Institute (KEMRI) and Centres for Disease Control and Prevention (CDC), Nairobi, Kenya
| | | | | | - George Otieno
- Kenya Medical Research Institute (KEMRI) and Centres for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Javan Inda
- Turkana County Health Department, Turkana, Kenya
| |
Collapse
|
15
|
Souza AAD, Heller L. Bolsa Família Program and environmental health: a systematic review of the effects on diarrhea and malnutrition. CIENCIA & SAUDE COLETIVA 2020; 26:3087-3098. [PMID: 34378700 DOI: 10.1590/1413-81232021268.07362020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/17/2020] [Indexed: 11/22/2022] Open
Abstract
The Bolsa Família Programme and environmental health interventions are public policies that can have a combined positive effect on health inequities. The Bolsa Família Programme is designed to improve health conditions, reduce food insecurity and increase family incomes. Environmental health interventions aim to ensure public health and environmental protection. This study reviewed the literature for possible interactions between these two types of intervention that influence morbidity and mortality outcomes due to diarrhoea and malnutrition in the under-fives. A total of 1,658 articles were identified in the LILACS, SciELO and PubMed databases. The studies' methodologies were evaluated by scores on an adapted Downs & Black scale and four met all the study inclusion criteria. The findings showed evidence of the positive independent effects of the Bolsa Família Programme and of environmental health interventions in reducing illness and death from diarrhoea and malnutrition in the study age group. However, none of the articles offered results that might elucidate a joint effect of these public policies on an interaction model, revealing a gap in the literature on these diseases attributable particularly to poverty.
Collapse
Affiliation(s)
- Anelise Andrade de Souza
- Instituto René Rachou, Fundação Oswaldo Cruz. Av. Augusto de Lima 1715, Barro Preto. 30190-002 Belo Horizonte MG Brasil.
| | - Léo Heller
- Instituto René Rachou, Fundação Oswaldo Cruz. Av. Augusto de Lima 1715, Barro Preto. 30190-002 Belo Horizonte MG Brasil.
| |
Collapse
|