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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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Lawrence Grant S, Lange S, Almeida S, Hoque B, Kjær Mackie Jensen P. Influence of Seasonal Hazards on Water, Sanitation, and Hygiene-Related Behavior and Implications for Cholera Transmission in Bangladesh. Am J Trop Med Hyg 2023; 108:518-523. [PMID: 36689946 PMCID: PMC9978562 DOI: 10.4269/ajtmh.21-0708] [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: 06/23/2021] [Accepted: 11/01/2022] [Indexed: 01/24/2023] Open
Abstract
Most cholera outbreaks in Bangladesh are seasonal, peaking in the dry and post-monsoon periods. Therefore, we investigated whether changes in water, sanitation, and hygiene (WASH) behavior in three populations in Bangladesh during the year could help explain why these two periods are particular to cholera transmission. The study used a mixed-method design, including a repeated cross-sectional study, focus group discussions, and key informant interviews. Through a repeated cross-sectional study, WASH-related variables were assessed during the dry, monsoon, and control seasons in 600 households from coastal Satkhira, inland Sirajganj, and the Dhaka slums. Seasonal behavioral changes were observed in all study areas. Dhaka and Satkhira had an increased mean distance to water sources during the dry and monsoon seasons (Dhaka: control season, 12 m [95% CI, 11-13]; dry season, 36 m [95% CI, 18-55]; and monsoon season, 180 m [95% CI, 118-243]; Satkhira: control season, 334 m [95% CI, 258-411]; dry season, 669 m [95% CI, 515-822]; and monsoon season, 2,437 m [95% CI, 1,665-3,209]). The participants attributed this to pollution of the usual water source. Perceived water quantity was lowest during the dry season in Dhaka and Sirajganj, and during the monsoon season in Satkhira. Handwashing with soap declined in all areas during the dry and monsoon seasons. Open defecation was frequent among children younger than 5 years, increasing during seasonal climate hazards. Results show that WASH-related behavior changed seasonally, increasing the risk of cholera transmission through multiple hygiene-related transmission pathways. Future research would benefit by ensuring that the length of studies covers all seasons throughout the year and also by looking in more detail at people's behavior and hygiene practices.
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Affiliation(s)
- Stephen Lawrence Grant
- Copenhagen Center for Disaster Research, Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sina Lange
- Copenhagen Center for Disaster Research, Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sara Almeida
- Copenhagen Center for Disaster Research, Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bilqis Hoque
- Environment and Population Research Centre, Dhaka, Bangladesh
| | - Peter Kjær Mackie Jensen
- Copenhagen Center for Disaster Research, Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Rahman Zuthi MF, Hossen MA, Pal SK, Mazumder MH, Hasan SMF, Hoque MM. Evaluating knowledge, awareness and associated water usage towards hand hygiene practices influenced by the current COVID-19 pandemic in Bangladesh. GROUNDWATER FOR SUSTAINABLE DEVELOPMENT 2022; 19:100848. [PMID: 36164324 PMCID: PMC9493147 DOI: 10.1016/j.gsd.2022.100848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
Hand hygiene is considered as one of the most effective ways for preventing transmissible diseases, especially for preventing virus-borne diseases. The study has been conducted to evaluate changes in knowledge, awareness and practices of hand hygiene due to the outbreak of the coronavirus disease (COVID-19) in Bangladesh. The potential factors influencing human behaviours for maintaining hand hygiene have also been explored. Moreover, a probable increase in daily water demand associated with the changed situation has been assessed. An online survey was performed among a total of 367 Bangladeshi residents about their practices of hand hygiene during pre-corona, corona, and of their perceived future practices at post-corona period. It has been observed that a significant percentage (62.1%) of the respondents have received basic hygiene education at any level of their academic education. Nevertheless, their hygiene practices were very poor before the COVID-19 pandemic. The outbreak of the COVID-19 has reinforced their previous knowledge and greatly influenced their behavioural changes towards practicing hand hygiene as per World Health Organization guidelines for preventing the virus outbreak. The changes, however, have created increased water demand. The estimated water usage is found to be 2.68 times (9.15 L/c/d) and 2.52 times (8.59 L/c/d) higher in the corona and post-corona period respectively than that of the pre-corona situation (3.41 L/c/d). The principal component analysis (PCA) elucidated that an individual's practice of hand hygiene was associated with income, level of academic and hygiene education, and the COVID-19 outbreak itself. Moreover, the influence of hygiene education and COVID-19 outbreak affecting the duration of handwashing are found highly significant (p-value < 0.001) from the regression analysis. Raising awareness towards behavioural change of an individual about water usage, improvement of academic curriculum regarding hand hygiene and provision of water pricing are recommended to attain sustainable development goals of the country.
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Affiliation(s)
- Mst Farzana Rahman Zuthi
- Center for Environmental Science & Engineering Research (CESER), Chittagong University of Engineering and Technology (CUET), Chattogram, 4349, Bangladesh
- Department of Civil Engineering, Chittagong University of Engineering and Technology (CUET), Chattogram, 4349, Bangladesh
| | - Md Arif Hossen
- Center for Environmental Science & Engineering Research (CESER), Chittagong University of Engineering and Technology (CUET), Chattogram, 4349, Bangladesh
| | - Sudip Kumar Pal
- Department of Civil Engineering, Chittagong University of Engineering and Technology (CUET), Chattogram, 4349, Bangladesh
| | - Maruful Hasan Mazumder
- Department of Disaster Engineering and Management, Chittagong University of Engineering and Technology (CUET), Chattogram, 4349, Bangladesh
| | - S M Farzin Hasan
- Department of Civil Engineering, Chittagong University of Engineering and Technology (CUET), Chattogram, 4349, Bangladesh
| | - Md Muzamamel Hoque
- Department of Civil Engineering, Chittagong University of Engineering and Technology (CUET), Chattogram, 4349, Bangladesh
- Southern University Bangladesh, Chattogram, 4000, Bangladesh
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Chae SR, Lukupulo H, Kim S, Walker T, Hardy C, Abade A, Urio LJ, Mghamba J, Quick R. An Assessment of Household Knowledge and Practices during a Cholera Epidemic- Dar es Salaam, Tanzania, 2016. Am J Trop Med Hyg 2022; 107:766-772. [PMID: 36067990 PMCID: PMC9651532 DOI: 10.4269/ajtmh.21-0597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 03/05/2022] [Indexed: 12/30/2022] Open
Abstract
From August 15, 2015 to March 5, 2016, Tanzania reported 16,521 cholera cases and 251 deaths, with 4,596 cases and 44 deaths in its largest city, Dar es Salaam. To evaluate outbreak response efforts, we conducted a household survey with drinking water testing in the five most affected wards in Dar es Salaam. We interviewed 641 households 6 months after the beginning of the outbreak. Although most respondents knew that cholera causes diarrhea (90%) and would seek care if suspecting cholera (95%), only 45% were aware of the current outbreak in the area and only 5% would use oral rehydration salts (ORS) if ill. Of 200 (31%) respondents reporting no regular water treatment, 46% believed treatment was unnecessary and 18% believed treatment was too expensive. Fecal contamination was found in 45% of water samples and was associated with water availability (P = 0.047). Only 11% of samples had detectable free chlorine residual, which was associated with water availability (P = 0.025), reported current water treatment (P = 0.006), and observed free chlorine product in the household (P = 0.015). The provision of accessible, adequately chlorinated water supply, and implementation of social mobilization campaigns advocating household water treatment and use of ORS should be prioritized to address gaps in cholera prevention and treatment activities.
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Affiliation(s)
- Sae-Rom Chae
- Division of Foodborne and Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;,Address correspondence to Sae-Rom Chae, Division of Foodborne and Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA. E-mail:
| | - Haji Lukupulo
- Tanzania Field Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania
| | - Sunkyung Kim
- Division of Foodborne and Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tiffany Walker
- Division of Foodborne and Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Colleen Hardy
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ahmed Abade
- Tanzania Field Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania
| | - Loveness J. Urio
- Tanzania Field Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania
| | - Janneth Mghamba
- Ministry of Health, Community Development, Gender, Elderly and Children, United Republic of Tanzania, Dar es Salaam, Tanzania
| | - Robert Quick
- Division of Foodborne and Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Delva S, Marseille B, Foronda CL, Solomon AY, Pfaff T, Baptiste DL. Hand hygiene practices in Caribbean and Latin American countries: An integrative review. J Clin Nurs 2022; 32:2140-2154. [PMID: 35773957 DOI: 10.1111/jocn.16415] [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: 04/12/2021] [Revised: 03/01/2022] [Accepted: 05/16/2022] [Indexed: 11/27/2022]
Abstract
AIM AND OBJECTIVE To explore what is known about knowledge, attitudes and beliefs that influence hand hygiene practices in in low- and middle-income Caribbean and Latin American countries. BACKGROUND With the emergence of infectious diseases such as the recent COVID-19 pandemic, handwashing is key to preventing communicable diseases as they disproportionately affect populations in low-income countries. While hand hygiene is known to be the single most effective method for avoiding the transmission of infection, little is known about the beliefs and practices of individuals in these regions. METHODS Following PRISMA 2020 Checklist, an integrative review of studies published from 2008-2020 was conducted (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Whittemore and Knafl's method was used to review the literature. Six databases were searched, and the Johns Hopkins Evidence Based Rating Scale was used for study appraisal. RESULTS The review yielded 18 studies conducted across Latin America. Poor handwashing practices are influenced by various factors including inadequate education and training, cultural beliefs, lack of resources and substandard government regulations. Communicable diseases and other diarrheal illnesses were highly prevalent, especially after a major disease outbreak. CONCLUSION Future post-disaster campaigns aimed at improving hand hygiene and handwashing practices should focus on beliefs and attitudes to affect behaviour change since there was a higher disease susceptibility during those times. Barriers to proper hand hygiene include false attitudes such as, washing hands only after touching bodily fluids/patient contact or not washing hands at all after open defecation. RELEVANCE TO CLINICAL PRACTICE Researchers working with populations in Latin America and the Caribbean should partner with local community health workers to improve compliance to recommended hand hygiene practices.
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Affiliation(s)
- Sabianca Delva
- Boston College Connell School of Nursing, Chestnut Hill, Massachusetts, USA
| | | | - Cynthia L Foronda
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| | | | - Teresa Pfaff
- Center for Global Initiatives, Department of Community-Public Health, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Diana-Lyn Baptiste
- Department of Nursing, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
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6
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Lugo-Robles R, Garges EC, Olsen CH, Brett-Major DM. Identifying Nontraditional Epidemic Disease Risk Factors Associated with Major Health Events from World Health Organization and World Bank Open Data. Am J Trop Med Hyg 2021; 105:896-902. [PMID: 34460422 PMCID: PMC8592146 DOI: 10.4269/ajtmh.20-1318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 07/09/2021] [Indexed: 11/22/2022] Open
Abstract
Health events emerge from host, community, environment, and pathogen factors-forecasting epidemics is a complex task. We describe an exploratory analysis to identify economic risk factors that could aid epidemic risk assessment. A line list was constructed using the World Health Organization Disease Outbreak News (2016-2018) and economic indicators from the World Bank. Poisson regression employing forward imputations was used to establish relationships with the frequency with which countries reported public health events. Economic indicators demonstrated strong performance appropriate for further assessment in surveillance programming. In our analysis, three economic indicators were significantly associated to event reporting: how much the country's urban population changed, its average forest area, and a novel economic indicator we developed that assessed how much the gross domestic product changed per capita. Other economic indicators performed less well: changes in total, female, urban, and rural population sizes; population density; net migration; change in per cent forest area; total forest area; and another novel indicator, change in percent of trade as a fraction of the total economy. We then undertook a further analysis of the start of the current COVID-19 pandemic that revealed similar associations, but confounding by global disease burden is likely. Continued development of forecasting approaches capturing information relevant to whole-of-society factors (e.g., economic factors as assessed in our study) could improve the risk management process through earlier hazard identification and inform strategic decision processes in multisectoral strategies to preventing, detecting, and responding to pandemic-threat events.
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Affiliation(s)
- Roberta Lugo-Robles
- Department of Preventive Medicine and Biostatics, Uniformed Services University, Bethesda, Maryland
- Henry M. Jackson Foundation, Bethesda, Maryland
| | - Eric C. Garges
- Department of Preventive Medicine and Biostatics, Uniformed Services University, Bethesda, Maryland
| | - Cara H. Olsen
- Department of Preventive Medicine and Biostatics, Uniformed Services University, Bethesda, Maryland
| | - David M. Brett-Major
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
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Griffiths K, Moise K, Piarroux M, Gaudart J, Beaulieu S, Bulit G, Marseille JP, Jasmin PM, Namphy PC, Henrys JH, Piarroux R, Rebaudet S. Delineating and Analyzing Locality-Level Determinants of Cholera, Haiti. Emerg Infect Dis 2021; 27:170-181. [PMID: 33350917 PMCID: PMC7774537 DOI: 10.3201/eid2701.191787] [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] [Indexed: 11/19/2022] Open
Abstract
Centre Department, Haiti, was the origin of a major cholera epidemic during 2010–2019. Although no fine-scale spatial delineation is officially available, we aimed to analyze determinants of cholera at the local level and identify priority localities in need of interventions. After estimating the likely boundaries of 1,730 localities by using Voronoi polygons, we mapped 5,322 suspected cholera cases reported during January 2015–September 2016 by locality alongside environmental and socioeconomic variables. A hierarchical clustering on principal components highlighted 2 classes with high cholera risk: localities close to rivers and unimproved water sources (standardized incidence ratio 1.71, 95% CI 1.02–2.87; p = 0.04) and urban localities with markets (standardized incidence ratio 1.69, 95% CI 1.25–2.29; p = 0.0006). Our analyses helped identify and characterize areas where efforts should be focused to reduce vulnerability to cholera and other waterborne diseases; these methods could be used in other contexts.
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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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Huong LTT, Hoang LT, Tuyet-Hanh TT, Anh NQ, Huong NT, Cuong DM, Quyen BTT. Reported handwashing practices of Vietnamese people during the COVID-19 pandemic and associated factors: a 2020 online survey. AIMS Public Health 2020; 7:650-663. [PMID: 32968684 PMCID: PMC7505781 DOI: 10.3934/publichealth.2020051] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/20/2020] [Indexed: 01/14/2023] Open
Abstract
COVID-19 pandemic currently affects nearly all countries and regions in the world. Washing hands, together with other preventive measures, to be considered one of the most important measures to prevent the disease. This study aimed to characterize reported handwashing practices of Vietnamese people during the COVID-19 pandemic and associated factors. Kobo Toolbox platform was used to design the online survey. There were 837 people participating in this survey. All independent variables were described by calculating frequencies and percentages. Univariate linear regression was used with a significant level of 0.05. Multiple linear regression was conducted to provide a theoretical model with collected predictors. Seventy-nine percent of the respondents used soap as the primary choice when washing their hands. Sixty percent of the participants washed their hands at all essential times, however, only 26.3% practiced washing their hands correctly, and only 28.4% washed their hands for at least 20 seconds. Although 92.1% washed hands after contacting with surfaces at public places (e.g., lifts, knob doors), only 66.3% practiced handwashing after removing masks. Females had better reported handwashing practices than male participants (OR = 1.88; 95% CI: 1.15–3.09). Better knowledge of handwashing contributed to improving reported handwashing practice (OR = 1.30; 95% CI: 1.20–1.41). Poorer handwashing practices were likely due, at least in part, to the COVID-19 pandemic information on the internet, social media, newspapers, and television. Although the number of people reported practicing their handwashing was rather high, only a quarter of them had corrected reported handwashing practices. Communication strategy on handwashing should emphasize on the minimum time required for handwashing as well as the six handwashing steps.
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Affiliation(s)
- Le Thi Thanh Huong
- Environmental Health Department, Hanoi University of Public Health, Hanoi, Vietnam
| | - Le Tu Hoang
- Biostatistics Department, Hanoi University of Public Health, Hanoi, Vietnam
| | - Tran Thi Tuyet-Hanh
- Environmental Health Department, Hanoi University of Public Health, Hanoi, Vietnam
| | - Nguyen Quynh Anh
- Environmental Health Department, Hanoi University of Public Health, Hanoi, Vietnam
| | - Nguyen Thi Huong
- Environmental Health Department, Hanoi University of Public Health, Hanoi, Vietnam
| | - Do Manh Cuong
- Vietnam Health Environment Management Agency, Ministry of Health, Hanoi, Vietnam
| | - Bui Thi Tu Quyen
- Biostatistics Department, Hanoi University of Public Health, Hanoi, Vietnam
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Nanzaluka FH, Davis WW, Mutale L, Kapaya F, Sakubita P, Langa N, Gama A, N’cho HS, Malambo W, Murphy J, Blackstock A, Mintz E, Riggs M, Mukonka V, Sinyange N, Yard E, Brunkard J. Risk Factors for Epidemic Cholera in Lusaka, Zambia-2017. Am J Trop Med Hyg 2020; 103:646-651. [PMID: 32458780 PMCID: PMC7410454 DOI: 10.4269/ajtmh.20-0089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/20/2020] [Indexed: 11/07/2022] Open
Abstract
On October 6, 2017, the Zambia Ministry of Health declared a cholera outbreak in Lusaka. By December, 1,462 cases and 38 deaths had occurred (case fatality rate, 2.6%). We conducted a case-control study to identify risk factors and inform interventions. A case was any person with acute watery diarrhea (≥ 3 loose stools in 24 hours) admitted to a cholera treatment center in Lusaka from December 16 to 21, 2017. Controls were neighbors without diarrhea during the same time period. Up to two controls were matched to each case by age-group (1-4, 5-17, and ≥ 18 years) and neighborhood. Surveyors interviewed cases and controls, tested free chlorine residual (FCR) in stored water, and observed the presence of soap in the home. Conditional logistic regression was used to generate matched odds ratios (mORs) based on subdistricts and age-groups with 95% CIs. We enrolled 82 cases and 132 controls. Stored water in 71% of case homes had an FCR > 0.2 mg/L. In multivariable analyses, those who drank borehole water (mOR = 2.4, CI: 1.1-5.6), had close contact with a cholera case (mOR = 6.2, CI: 2.5-15), and were male (mOR = 2.5, CI: 1.4-5.0) had higher odds of being a cholera case than their matched controls. Based on these findings, we recommended health education about household water chlorination and hygiene in the home. Emergency responses included providing chlorinated water through emergency tanks and maintaining adequate FCR levels through close monitoring of water sources.
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Affiliation(s)
- Francis H. Nanzaluka
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
| | - William W. Davis
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lwito Mutale
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
| | - Fred Kapaya
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
| | - Patrick Sakubita
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
| | - Nelia Langa
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
| | - Angela Gama
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
| | - Hammad S. N’cho
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Warren Malambo
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Murphy
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna Blackstock
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric Mintz
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Margaret Riggs
- U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Victor Mukonka
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
- School of Medicine, Copperbelt University, Lusaka, Zambia
| | - Nyambe Sinyange
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
| | - Ellen Yard
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
- U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Joan Brunkard
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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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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Wichaidit W, Biswas S, Begum F, Yeasmin F, Nizame FA, Najnin N, Leontsini E, Winch PJ, Unicomb L, Luby SP, Ram PK. Effectiveness of a large‐scale handwashing promotion intervention on handwashing behaviour in Dhaka, Bangladesh. Trop Med Int Health 2019; 24:972-986. [DOI: 10.1111/tmi.13277] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Wit Wichaidit
- Department of Epidemiology and Environmental Health State University of New York Buffalo NY USA
| | - Shwapon Biswas
- Johns Hopkins University Baltimore MD USA
- International Centre for Diarrhoeal Disease Research Dhaka Bangladesh
| | - Farzana Begum
- International Centre for Diarrhoeal Disease Research Dhaka Bangladesh
| | - Farzana Yeasmin
- International Centre for Diarrhoeal Disease Research Dhaka Bangladesh
| | | | - Nusrat Najnin
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Australia
| | - Elli Leontsini
- Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | | | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research Dhaka Bangladesh
| | | | - Pavani K. Ram
- Department of Epidemiology and Environmental Health State University of New York Buffalo NY USA
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13
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Richterman A, Franke MF, Constant G, Jerome G, Ternier R, Ivers LC. Food insecurity and self-reported cholera in Haitian households: An analysis of the 2012 Demographic and Health Survey. PLoS Negl Trop Dis 2019; 13:e0007134. [PMID: 30699107 PMCID: PMC6370226 DOI: 10.1371/journal.pntd.0007134] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 02/11/2019] [Accepted: 01/06/2019] [Indexed: 11/30/2022] Open
Abstract
Background Both cholera and food insecurity tend to occur in impoverished communities where poor access to food, inadequate sanitation, and an unsafe water supply often coexist. The relationship between the two, however, has not been well-characterized. Methods We performed a secondary analysis of household-level data from the 2012 Demographic and Health Survey in Haiti, a nationally and sub-nationally representative cross-sectional household survey conducted every five years. We used multivariable logistic regression to evaluate the relationship between household food security (as measured by the Household Hunger Scale) and (1) reported history of cholera since 2010 by any person in the household and (2) reported death by any person in the household from cholera (among households reporting at least one case). We performed a complete case analysis because there were <1% missing data for all variables. Results There were 13,181 households in the survey, 2,104 of which reported at least one household member with history of cholera. After adjustment for potential confounders, both moderate hunger in the household [Adjusted Odds Ratio (AOR) 1.51, 95% Confidence Interval (CI) 1.30–1.76; p <.0001] and severe hunger in the household (AOR 1.73, 95% CI 1.45–2.08; p <.0001) were significantly associated with reported history of cholera in the household. Severe hunger in the household (AOR 1.85, 95% CI 1.05–3.26; p = 0.03), but not moderate hunger in the household, was independently associated with reported death from cholera in households with at least one case of cholera. Conclusions In this study we identified an independent relationship between household food insecurity and both reported history of cholera and death from cholera in a general population. The directionality of this relationship is uncertain and should be further explored in future prospective research. In this study, we identified an independent relationship between household food insecurity, defined as a persistent lack of access to food in adequate quantity or quality and measured using the Household Hunger Scale, and reported history of cholera and death from cholera in a general population. We performed a secondary analysis of household-level data from the 2012 Demographic and Health Survey (DHS) in Haiti, a nationally and sub-nationally representative cross-sectional household survey conducted every five years. The 2012 survey was conducted during the height of the cholera epidemic, with 453,536 suspected cases and 3,835 deaths in Haiti from 2011–2012. We used multivariable logistic regression to control for measured confounders. The underlying mechanisms and directionality of the association between food insecurity and reported history of cholera are uncertain and should be explored in future prospective research. A better understanding of the relationship between food insecurity and cholera could inform both future cholera outbreak prediction and response, particularly in settings where poor food access and cholera risk factors are known to co-exist.
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Affiliation(s)
- Aaron Richterman
- Department of Medicine, Brigham & Women’s Hospital, Boston, Massachusetts, United States of America
- * E-mail:
| | - Molly F. Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | | | - Louise C. Ivers
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Massachusetts General Hospital, Center for Global Health, Boston, Massachusetts, United States of America
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14
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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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15
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Oyugi EO, Boru W, Obonyo M, Githuku J, Onyango D, Wandeba A, Omesa E, Mwangi T, Kigen H, Muiruri J, Gura Z. An outbreak of cholera in western Kenya, 2015: a case control study. Pan Afr Med J 2018; 28:12. [PMID: 30167037 PMCID: PMC6113693 DOI: 10.11604/pamj.supp.2017.28.1.9477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 04/03/2016] [Indexed: 11/11/2022] Open
Abstract
Introduction in February 2015, an outbreak of acute watery diarrhea was reported in two sub counties in western Kenya. Vibrio cholerae 01 serotype Ogawa was isolated from 26 cases and from water samples collected from a river mainly used by residents of the two sub-counties for domestic purposes. We carried out an investigation to determine factors associated with the outbreak. Methods we conducted a frequency matched case control study in the community. We defined cases as episodes of watery diarrhea (at least three motions in 24 hours) in persons ≥ 2 years who were residents of Rongo or Ndhiwa sub-counties from January 23-February 25, 2015. Cases were systematically recruited from a cholera line list and matched to two controls (persons without diarrhea since January 23, 2015) by age category and residence. A structured questionnaire was administered to evaluate exposures in cases and controls and multivariable logistic regression done to determine independent factors associated with the outbreak. Results we recruited 52 cases and 104 controls. Females constituted 61% (95/156) of all participants. Overall latrine coverage was 58% (90/156). Latrine coverage was 44% (23/52) for cases and 64% (67/104) for controls. Having no latrine at home (aOR = 10.9; 95% CI: 3.02-39.21), practicing communal hand washing in a basin (aOR = 6.5; 95% CI: 2.30-18.11) and vending of food as an occupation (aOR = 3.4; 95% CI: 1.06-10.74) were independently associated with the outbreak. Conclusion poor latrine coverage and personal hygiene practices were identified as the main drivers of the outbreak. We recommended improved public health education on latrine usage and promotion of hand washing with soap and water in the community.
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Affiliation(s)
- Elvis O Oyugi
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya
| | - Waqo Boru
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya
| | - Mark Obonyo
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Kenya
| | - Jane Githuku
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya
| | - Dickens Onyango
- Kisumu County Department of Health, Ministry of Health, Kenya
| | - Alfred Wandeba
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Kenya
| | - Eunice Omesa
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Kenya
| | - Tabitha Mwangi
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Kenya
| | - Hudson Kigen
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Kenya
| | - Joshua Muiruri
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Kenya
| | - Zeinab Gura
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Kenya.,Ministry of Agriculture, Livestock and Fisheries, Kenya
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16
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Building a Methodology for Assessing Service Quality under Intermittent Domestic Water Supply. WATER 2018. [DOI: 10.3390/w10091164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This document proposes a methodology for assessing the quality of water distribution service in the context of intermittent supply, based on a comparison of joint results from literature reviews and feedback from drinking water operators who had managed these networks, with standards for defining the quality of drinking water service. The paper begins by reviewing and proposing an analysis of the definition and characterization of intermittent water supply (IWS), highlighting some important findings. The diversity of approaches used to address the issue and the difficulty of defining a precise and detailed history of water supply in the affected systems broadens the spectrum of intermittency characterization and the problems it raises. The underlined results are then used to structure an evaluation framework for the water service and to develop improvement paths defined in the intermittent networks. The resulting framework highlights the means available to water stakeholders to assess their operational and management performance in achieving the improvement objectives defined by the environmental and socio-economic contexts in which the network operates. Practical examples of intermittent system management are collected from water system operators and presented for illustration purposes (Jeddah, Algiers, Port-au-Prince, Amman, Cartagena, Barranquilla, Mexico, Cancun, Saltillo, Mumbai, Delhi, Coimbatore …).
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17
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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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18
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Richterman A, Cheung HC, Meiselbach MK, Jerome G, Ternier R, Ivers LC. Risk Factors for Self-Reported Cholera Within HIV-Affected Households in Rural Haiti. Open Forum Infect Dis 2018; 5:ofy127. [PMID: 29942825 PMCID: PMC6007289 DOI: 10.1093/ofid/ofy127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/30/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cholera continues to be a major cause of morbidity and mortality worldwide and is now endemic in Haiti since first being introduced in 2010. Cholera and HIV have significant geographic overlap globally, but little is known about the clinical features and risk of cholera among HIV-infected people and their households. METHODS We assessed HIV-affected households originally recruited for a randomized controlled trial of food supplements. We assessed for correlation between household and individual factors and reported history of cholera since 2010 using univariable and multivariable analyses. RESULTS There were 352 HIV-infected household members, 32 with reported history of medically attended cholera, and 1968 other household members, 55 with reported history of medically attended cholera. Among HIV-infected individuals in this study, no variables correlated with reported history of cholera in univariable analyses. Among all household members, known HIV infection (adjusted odds ratio [AOR], 3.75; 95% CI, 2.43-5.79; P < .0001), source of income in the household (AOR, 1.82; 95% CI, 1.05-3.15; P = .034), time required to fetch water (AOR, 1.07 per 5-minute increase; 95% CI, 1.01-1.12; P = .015), and severe household food insecurity (AOR, 3.23; 95% CI, 1.25-8.34; P = .016) were correlated with reported history of cholera in a multivariable analysis. CONCLUSIONS Known HIV infection, source of household income, time required to fetch water, and severe household food insecurity were independently associated with reported history of medically attended cholera in HIV-affected households in rural Haiti. Further research is required to better understand the interactions between HIV and cholera.
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Affiliation(s)
- Aaron Richterman
- Department of Medicine, Brigham & Women’s Hospital, Boston, Massachusetts
| | | | | | | | | | - Louise C Ivers
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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19
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Gidado S, Awosanya E, Haladu S, Ayanleke HB, Idris S, Mamuda I, Mohammed A, Michael CA, Waziri NE, Nguku P. Cholera outbreak in a naïve rural community in Northern Nigeria: the importance of hand washing with soap, September 2010. Pan Afr Med J 2018; 30:5. [PMID: 30123408 PMCID: PMC6093587 DOI: 10.11604/pamj.2018.30.5.12768] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 03/24/2018] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Cholera outbreaks in rural communities are associated with high morbidity and mortality. Effective interventions to control these outbreaks require identification of source and risk factors for infection. In September, 2010 we investigated a cholera outbreak in Bashuri, a cholera naïve rural community in northern Nigeria to identify the risk factors and institute control measures. METHODS We conducted an unmatched case-control study. We defined a case as any resident of Bashuri community two years and above with acute watery diarrhea with or without vomiting and a control as any resident two years and above without acute watery diarrhea and vomiting. We recruited 80 hospital-based cases and 80 neighborhood controls. We collected and analyzed data on demographic characteristics, clinical information and risk factors. Laboratory analysis was performed on 10 stool samples and 14 open-well samples. RESULTS Mean age was 29 years (± 20 years) for cases and 32 years (± 16 years) for controls; 38 (47.5%) of cases and 60 (75%) of controls were males. Compared to controls, cases were less likely to have washed hands with soap before eating (age-adjusted odds ratio (AAOR) = 0.27, 95% confidence interval (CI): 0.10-0.72) and less likely to have washed hands with soap after using the toilet (AAOR = 0.34, 95% CI: 0.15-0.75). Vibrio cholerae O1 was isolated from six stool samples but not from any open-well samples. CONCLUSION Unhygienic hand washing practices was the key risk factor in this outbreak. We educated the community on personal hygiene focusing on the importance of hand washing with soap.
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Affiliation(s)
- Saheed Gidado
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | - Emmanuel Awosanya
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | - Suleiman Haladu
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | | | - Suleman Idris
- Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Ismaila Mamuda
- Epidemiology Unit, Ministry of Health, Jigawa State, Nigeria
| | - Abdulaziz Mohammed
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | | | | | - Patrick Nguku
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
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20
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Rinaldo A, Gatto M, Rodriguez-Iturbe I. River networks as ecological corridors: A coherent ecohydrological perspective. ADVANCES IN WATER RESOURCES 2018; 112:27-58. [PMID: 29651194 PMCID: PMC5890385 DOI: 10.1016/j.advwatres.2017.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 05/14/2023]
Abstract
This paper draws together several lines of argument to suggest that an ecohydrological framework, i.e. laboratory, field and theoretical approaches focused on hydrologic controls on biota, has contributed substantially to our understanding of the function of river networks as ecological corridors. Such function proves relevant to: the spatial ecology of species; population dynamics and biological invasions; the spread of waterborne disease. As examples, we describe metacommunity predictions of fish diversity patterns in the Mississippi-Missouri basin, geomorphic controls imposed by the fluvial landscape on elevational gradients of species' richness, the zebra mussel invasion of the same Mississippi-Missouri river system, and the spread of proliferative kidney disease in salmonid fish. We conclude that spatial descriptions of ecological processes in the fluvial landscape, constrained by their specific hydrologic and ecological dynamics and by the ecosystem matrix for interactions, i.e. the directional dispersal embedded in fluvial and host/pathogen mobility networks, have already produced a remarkably broad range of significant results. Notable scientific and practical perspectives are thus open, in the authors' view, to future developments in ecohydrologic research.
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Affiliation(s)
- Andrea Rinaldo
- Laboratory of Ecohydrology ECHO/IIE/ENAC, École Polytechinque Fédérale de Lausanne, Lausanne, CH, Switzerland
- Dipartimento ICEA, Università di Padova, Padova, IT, Italy
| | - Marino Gatto
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano IT, Italy
| | - Ignacio Rodriguez-Iturbe
- Department of Ocean Engineering, Department of Civil Engineering and Department of Biological and Agricultural Engineering, Texas A & M University, College Station (TX), USA
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21
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Cohen A, Colford JM. Effects of Boiling Drinking Water on Diarrhea and Pathogen-Specific Infections in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2017; 97:1362-1377. [PMID: 29016318 PMCID: PMC5817760 DOI: 10.4269/ajtmh.17-0190] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/05/2017] [Indexed: 12/21/2022] Open
Abstract
Globally, approximately 2 billion people lack microbiologically safe drinking water. Boiling is the most prevalent household water treatment method, yet evidence of its health impact is limited. To conduct this systematic review, we searched four online databases with no limitations on language or publication date. Studies were eligible if health outcomes were measured for participants who reported consuming boiled and untreated water. We used reported and calculated odds ratios (ORs) and random-effects meta-analysis to estimate pathogen-specific and pooled effects by organism group and nonspecific diarrhea. Heterogeneity and publication bias were assessed using I2, meta-regression, and funnel plots; study quality was also assessed. Of the 1,998 records identified, 27 met inclusion criteria and reported extractable data. We found evidence of a significant protective effect of boiling for Vibrio cholerae infections (OR = 0.31, 95% confidence interval [CI] = 0.13-0.79, N = 4 studies), Blastocystis (OR = 0.35, 95% CI = 0.17-0.69, N = 3), protozoal infections overall (pooled OR = 0.61, 95% CI = 0.43-0.86, N = 11), viral infections overall (pooled OR = 0.83, 95% CI = 0.7-0.98, N = 4), and nonspecific diarrheal outcomes (OR = 0.58, 95% CI = 0.45-0.77, N = 7). We found no evidence of a protective effect for helminthic infections. Although our study was limited by the use of self-reported boiling and non-experimental designs, the evidence suggests that boiling provides measureable health benefits for pathogens whose transmission routes are primarily water based. Consequently, we believe a randomized controlled trial of boiling adherence and health outcomes is needed.
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Affiliation(s)
- Alasdair Cohen
- Division of Epidemiology, School of Public Health, University of California at Berkeley, Berkeley, California
- Department of Environmental Science, Policy and Management, University of California at Berkeley, Berkeley, California
| | - John M. Colford
- Division of Epidemiology, School of Public Health, University of California at Berkeley, Berkeley, California
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22
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Rinaldo A, Bertuzzo E, Blokesch M, Mari L, Gatto M. Modeling Key Drivers of Cholera Transmission Dynamics Provides New Perspectives for Parasitology. Trends Parasitol 2017; 33:587-599. [PMID: 28483382 DOI: 10.1016/j.pt.2017.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 04/01/2017] [Accepted: 04/10/2017] [Indexed: 11/15/2022]
Abstract
Hydroclimatological and anthropogenic factors are key drivers of waterborne disease transmission. Information on human settlements and host mobility on waterways along which pathogens and hosts disperse, and relevant hydroclimatological processes, can be acquired remotely and included in spatially explicit mathematical models of disease transmission. In the case of epidemic cholera, such models allowed the description of complex disease patterns and provided insight into the course of ongoing epidemics. The inclusion of spatial information in models of disease transmission can aid in emergency management and the assessment of alternative interventions. Here, we review the study of drivers of transmission via spatially explicit approaches and argue that, because many parasitic waterborne diseases share the same drivers as cholera, similar principles may apply.
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Affiliation(s)
- Andrea Rinaldo
- Laboratory of Ecohydrology, School of Architecture, Civil and Environmental Engineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; Dipartimento ICEA, Università di Padova, Padova, Italy.
| | - Enrico Bertuzzo
- Laboratory of Ecohydrology, School of Architecture, Civil and Environmental Engineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; Department of Environmental Sciences, Informatics and Statistics, University Cà Foscari Venice, Venezia Mestre, Italy
| | - Melanie Blokesch
- Laboratory of Molecular Microbiology, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Lorenzo Mari
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - Marino Gatto
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
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Nsagha DS, Atashili J, Fon PN, Tanue EA, Ayima CW, Kibu OD. Assessing the risk factors of cholera epidemic in the Buea Health District of Cameroon. BMC Public Health 2015; 15:1128. [PMID: 26577770 PMCID: PMC4650512 DOI: 10.1186/s12889-015-2485-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 11/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cholera is an acute diarrheal disease caused by the bacterium, Vibrio cholerae. A cholera epidemic occurred in Cameroon in 2010. After a cholera-free period at the end of 2010, new cases started appearing in early 2011. The disease affected 23,152 people and killed 843, with the South West Region registering 336 cases and 13 deaths. Hence, we assessed the risk factors of cholera epidemic in the Buea Health District to provide evidence-based cholera guidelines. METHODS We conducted an unmatched case-control study. Cases were identified from health facility records and controls were neighbours of the cases in the same community. We interviewed 135 participants on socio-economic, household hygiene, food and water exposures practices using a semi-structured questionnaire. Data was analyzed using STATA. Fisher exact test and logistic regression were computed. P < 0.05 was considered to be statistically significant. RESULTS The 135 participants included 34 (25.2 %) cholera cases and 101 (74.8 %) controls. More females [78 (57.8 %)] participated in the study. Ages ranged from 1 year 3 months to 72 years; with a mean of 29.86 (±14.51) years. The cholera attack rate was 0.03 % with no fatality. Most participants [129 (99.2 %)] had heard of cholera. Poor hygienic practices [77 (59.2 %)] and contaminated water sources [54 (41.5 %)] were the main reported transmission routes of cholera. Good hygienic practices [108 (83.1 %)] were the main preventive methods of cholera in both cases [23 (76.6 %)] and controls [85 (85.0 %)]. Logistic regression analysis showed age below 21 years (OR = 1.72, 95 % CI: 0.73-4.06, p = 0.251), eating outside the home (OR = 1.06, CI: 0.46-2.43, p = 1.00) and poor food preservation method (OR = 9.20, CI: 3.67-23.08, p < 0.0001) were independent risk factors of cholera. Also, irregular water supply (OR = 0.66, 95 % CI: 0.30-1.43, p = 0.320), poor kitchen facility (OR = 0.60, CI: 0.16-2.23, p = 0.560), lack of home toilet (OR = 0.69, CI: 0.25-1.86, p = 0.490), and education below tertiary (OR = 0.87, 95 % CI: 0.36-2.11, p = 0.818) were independent protective factors for the occurrence of cholera. CONCLUSION There was a good knowledge of cholera among participants. Poor food preservation method was a significant independent risk factor of cholera. Improvement in hygiene and sanitation conditions and water infrastructural development is crucial to combating the epidemic.
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Affiliation(s)
- Dickson Shey Nsagha
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O Box 12, Buea, Cameroon.
| | - Julius Atashili
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O Box 12, Buea, Cameroon.
| | - Peter Nde Fon
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O Box 12, Buea, Cameroon.
| | - Elvis Asangbeng Tanue
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, P.O Box 12, Buea, Cameroon.
| | - Charlotte Wenze Ayima
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, P.O Box 12, Buea, Cameroon.
| | - Odette Dzemo Kibu
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, P.O Box 12, Buea, Cameroon.
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Innocent AOU, Francisca N, Adeniyi A, David O, Tajudeen B, Sola M, Kehinde A, Jerry I, Mike O, Stella S, Innocent AOU, Francisca N, Adeniyi A, David O, Tajudeen B, Sola M, Kehinde A, Jerry I, Mike O, Stella S. A review of perception and myth on causes of cholera infection in endemic areas of Nigeria. ACTA ACUST UNITED AC 2015. [DOI: 10.5897/ajmr2015.7362] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Colombara DV, Faruque ASG, Cowgill KD, Mayer JD. Risk factors for diarrhea hospitalization in Bangladesh, 2000-2008: a case-case study of cholera and shigellosis. BMC Infect Dis 2014; 14:440. [PMID: 25127553 PMCID: PMC4141120 DOI: 10.1186/1471-2334-14-440] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 08/12/2014] [Indexed: 02/05/2023] Open
Abstract
Background Cholera and shigellosis are endemic on the Indian subcontinent. Our objective was to identify cholera-specific risk factors distinct from shigellosis risk factors. Methods We conducted a case-case study among hospitalized diarrheal patients, comparing those with cholera and shigellosis in International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) hospitals in Matlab (rural) and Dhaka (urban) between January 1, 2000 and December 31, 2008. Results Multivariable Poisson regression models revealed that having more than nine years of education, compared to no education, was associated with a 39% (adjusted Risk Ratio [aRR] = 0.61, 95% confidence interval [CI]: 0.40-0.93) decreased risk for cholera hospitalization in Matlab and a 16% (aRR = 0.84, 95% CI: 0.75-0.94) decreased risk in Dhaka. Having a family member with diarrhea in the past seven days increased cholera hospitalization risk by 17% (aRR = 1.17, 95% CI: 1.09-1.26) in Matlab. Conclusions Further studies are needed to elucidate the pathway through which education impacts cholera risk in order to create targeted interventions in cholera-endemic areas. Interventions seeking to reduce transmission and facilitate hygienic practices among family members of index cases with diarrhea should be considered, especially in rural cholera endemic settings.
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Affiliation(s)
- Danny V Colombara
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
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Charles M, Delva GG, Boutin J, Severe K, Peck M, Mabou MM, Wright PF, Pape JW. Importance of cholera and other etiologies of acute diarrhea in post-earthquake Port-au-Prince, Haiti. Am J Trop Med Hyg 2014; 90:511-7. [PMID: 24445205 DOI: 10.4269/ajtmh.13-0514] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We estimated the proportion of diarrhea attributable to cholera and other pathogens during the rainy and dry seasons in patients seen in two urban health settings: a cholera treatment center (CTC) and oral rehydration points (ORPs). During April 1, 2011-November 30, 2012, stool samples were collected from 1,206 of 10,845 patients who came to the GHESKIO CTC or to the community ORPs with acute diarrhea, cultured for Vibrio cholerae, and tested by multiplex polymerase reaction. Vibrio cholerae was isolated from 409 (41.8%, 95% confidence interval [CI] = 38.7-44.9%) of the 979 specimens from the CTC and in 45 (19.8%, 95% CI = 14.8-25.6%) of the 227 specimens from the ORPs. Frequencies varied from 21.4% (95% CI = 16.6-26.7%) during the dry season to 46.8% (95% CI = 42.9-50.7%) in the rainy season. Shigella, enterotoxigenic Escherichia coli, rotavirus, and Cryptosporidium were frequent causes of diarrhea in children less than five years of age.
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Affiliation(s)
- Macarthur Charles
- Les Centres GHESKIO, Port-au-Prince, Haiti; Division of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Division of Infectious Diseases, Center for Global Health, Weill Cornell Medical College, New York, New York
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Loharikar A, Briere E, Ope M, Langat D, Njeru I, Gathigi L, Makayotto L, Ismail AM, Thuranira M, Abade A, Amwayi S, Omolo J, Oundo J, De Cock KM, Breiman RF, Ayers T, Mintz E, O'Reilly CE. A national cholera epidemic with high case fatality rates--Kenya 2009. J Infect Dis 2013; 208 Suppl 1:S69-77. [PMID: 24101648 DOI: 10.1093/infdis/jit220] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cholera remains endemic in sub-Saharan Africa. We characterized the 2009 cholera outbreaks in Kenya and evaluated the response. METHODS We analyzed surveillance data and estimated case fatality rates (CFRs). Households in 2 districts, East Pokot (224 cases; CFR = 11.7%) and Turkana South (1493 cases; CFR = 1.0%), were surveyed. We randomly selected 15 villages and 8 households per village in each district. Healthcare workers at 27 health facilities (HFs) were surveyed in both districts. RESULTS In 2009, cholera outbreaks caused a reported 11 425 cases and 264 deaths in Kenya. Data were available from 44 districts for 6893 (60%) cases. District CFRs ranged from 0% to 14.3%. Surveyed household respondents (n = 240) were aware of cholera (97.5%) and oral rehydration solution (ORS) (87.9%). Cholera deaths were reported more frequently from East Pokot (n = 120) than Turkana South (n = 120) households (20.7% vs. 12.3%). The average travel time to a HF was 31 hours in East Pokot compared with 2 hours in Turkana South. Fewer respondents in East Pokot (9.8%) than in Turkana South (33.9%) stated that ORS was available in their village. ORS or intravenous fluid shortages occurred in 20 (76.9%) surveyed HFs. CONCLUSIONS High CFRs in Kenya are related to healthcare access disparities, including availability of rehydration supplies.
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Affiliation(s)
- Anagha Loharikar
- Epidemic Intelligence Service, Office of Workforce and Career Development
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Valcin CL, Severe K, Riche CT, Anglade BS, Moise CG, Woodworth M, Charles M, Li Z, Joseph P, Pape JW, Wright PF. Predictors of disease severity in patients admitted to a cholera treatment center in urban Haiti. Am J Trop Med Hyg 2013; 89:625-632. [PMID: 24106188 PMCID: PMC3795091 DOI: 10.4269/ajtmh.13-0170] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cholera, previously unrecognized in Haiti, spread through the country in the fall of 2010. An analysis was performed to understand the epidemiological characteristics, clinical management, and risk factors for disease severity in a population seen at the GHESKIO Cholera Treatment Center in Port-au-Prince. A comprehensive review of the medical records of patients admitted during the period of October 28, 2010–July 10, 2011 was conducted. Disease severity on admission was directly correlated with older age, more prolonged length of stay, and presentation during the two epidemic waves seen in the observation period. Although there was a high seroprevalence of human immunodeficiency virus (HIV), severity of cholera was not greater with HIV infection. This study documents the correlation of cholera waves with rainfall and its reduction in settings with improved sanitary conditions and potable water when newly introduced cholera affects all ages equally so that interventions must be directed throughout the population.
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Affiliation(s)
- Claude-Lyne Valcin
- *Address correspondence to Claude-Lyne Valcin, Dartmouth Medical School, Division of Infectious Diseases and International Health, 1 Medical Center Drive, Lebanon, NH 03756. E-mail:
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Eisenberg MC, Kujbida G, Tuite AR, Fisman DN, Tien JH. Examining rainfall and cholera dynamics in Haiti using statistical and dynamic modeling approaches. Epidemics 2013; 5:197-207. [PMID: 24267876 DOI: 10.1016/j.epidem.2013.09.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 09/24/2013] [Accepted: 09/26/2013] [Indexed: 10/26/2022] Open
Abstract
Haiti has been in the midst of a cholera epidemic since October 2010. Rainfall is thought to be associated with cholera here, but this relationship has only begun to be quantitatively examined. In this paper, we quantitatively examine the link between rainfall and cholera in Haiti for several different settings (including urban, rural, and displaced person camps) and spatial scales, using a combination of statistical and dynamic models. Statistical analysis of the lagged relationship between rainfall and cholera incidence was conducted using case crossover analysis and distributed lag nonlinear models. Dynamic models consisted of compartmental differential equation models including direct (fast) and indirect (delayed) disease transmission, where indirect transmission was forced by empirical rainfall data. Data sources include cholera case and hospitalization time series from the Haitian Ministry of Public Health, the United Nations Water, Sanitation and Health Cluster, International Organization for Migration, and Hôpital Albert Schweitzer. Rainfall data was obtained from rain gauges from the U.S. Geological Survey and Haiti Regeneration Initiative, and remote sensing rainfall data from the National Aeronautics and Space Administration Tropical Rainfall Measuring Mission. A strong relationship between rainfall and cholera was found for all spatial scales and locations examined. Increased rainfall was significantly correlated with increased cholera incidence 4-7 days later. Forcing the dynamic models with rainfall data resulted in good fits to the cholera case data, and rainfall-based predictions from the dynamic models closely matched observed cholera cases. These models provide a tool for planning and managing the epidemic as it continues.
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Affiliation(s)
- Marisa C Eisenberg
- Mathematical Biosciences Institute, The Ohio State University, United States; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, United States; Department of Mathematics, University of Michigan, Ann Arbor, United States.
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Luquero FJ, Grout L, Ciglenecki I, Sakoba K, Traore B, Heile M, Dialo AA, Itama C, Serafini M, Legros D, Grais RF. First outbreak response using an oral cholera vaccine in Africa: vaccine coverage, acceptability and surveillance of adverse events, Guinea, 2012. PLoS Negl Trop Dis 2013; 7:e2465. [PMID: 24147164 PMCID: PMC3798604 DOI: 10.1371/journal.pntd.0002465] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/21/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Despite World Health Organization (WHO) prequalification of two safe and effective oral cholera vaccines (OCV), concerns about the acceptability, potential diversion of resources, cost and feasibility of implementing timely campaigns has discouraged their use. In 2012, the Ministry of Health of Guinea, with the support of Médecins Sans Frontières organized the first mass vaccination campaign using a two-dose OCV (Shanchol) as an additional control measure to respond to the on-going nationwide epidemic. Overall, 316,250 vaccines were delivered. Here, we present the results of vaccination coverage, acceptability and surveillance of adverse events. METHODOLOGY/PRINCIPAL FINDINGS We performed a cross-sectional cluster survey and implemented adverse event surveillance. The study population included individuals older than 12 months, eligible for vaccination, and residing in the areas targeted for vaccination (Forécariah and Boffa, Guinea). Data sources were household interviews with verification by vaccination card and notifications of adverse events from surveillance at vaccination posts and health centres. In total 5,248 people were included in the survey, 3,993 in Boffa and 1,255 in Forécariah. Overall, 89.4% [95%CI:86.4-91.8%] and 87.7% [95%CI:84.2-90.6%] were vaccinated during the first round and 79.8% [95%CI:75.6-83.4%] and 82.9% [95%CI:76.6-87.7%] during the second round in Boffa and Forécariah respectively. The two dose vaccine coverage (including card and oral reporting) was 75.8% [95%CI: 71.2-75.9%] in Boffa and 75.9% [95%CI: 69.8-80.9%] in Forécariah respectively. Vaccination coverage was higher in children. The main reason for non-vaccination was absence. No severe adverse events were notified. CONCLUSIONS/SIGNIFICANCE The well-accepted mass vaccination campaign reached high coverage in a remote area with a mobile population. Although OCV should not be foreseen as the long-term solution for global cholera control, they should be integrated as an additional tool into the response.
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Affiliation(s)
| | - Lise Grout
- Epicentre, Paris, France
- Médecins sans Frontières, Geneva, Switzerland
| | | | - Keita Sakoba
- Ministry of Health, Conakry, Guinea
- African Cholera Surveillance Network, Paris, France
| | - Bala Traore
- Direction Préfectorale de la Santé, Ministry of Health, Conakry, Guinea
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Risk factors for cholera transmission in Haiti during inter-peak periods: insights to improve current control strategies from two case-control studies. Epidemiol Infect 2013; 142:1625-35. [PMID: 24112364 DOI: 10.1017/s0950268813002562] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Two community-based density case-control studies were performed to assess risk factors for cholera transmission during inter-peak periods of the ongoing epidemic in two Haitian urban settings, Gonaives and Carrefour. The strongest associations were: close contact with cholera patients (sharing latrines, visiting cholera patients, helping someone with diarrhoea), eating food from street vendors and washing dishes with untreated water. Protective factors were: drinking chlorinated water, receiving prevention messages via television, church or training sessions, and high household socioeconomic level. These findings suggest that, in addition to contaminated water, factors related to direct and indirect inter-human contact play an important role in cholera transmission during inter-peak periods. In order to reduce cholera transmission in Haiti intensive preventive measures such as hygiene promotion and awareness campaigns should be implemented during inter-peak lulls, when prevention activities are typically scaled back.
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Rosewell A, Clark G, Mabong P, Ropa B, Posanai E, Man NWY, Dutta SR, Wickramasinghe W, Qi L, Ng JC, Mola G, Zwi AB, MacIntyre CR. Concurrent outbreaks of cholera and peripheral neuropathy associated with high mortality among persons internally displaced by a volcanic eruption. PLoS One 2013; 8:e72566. [PMID: 24023752 PMCID: PMC3759368 DOI: 10.1371/journal.pone.0072566] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 07/10/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In October 2004, Manam Island volcano in Papua New Guinea erupted, causing over 10 000 villagers to flee to internally displaced person (IDP) camps, including 550 from Dugulaba village. Following violence over land access in March 2010, the IDPs fled the camps, and four months later concurrent outbreaks of acute watery diarrhea and unusual neurological complaints were reported in this population. MATERIALS AND METHODS A retrospective case-control study was conducted to identify the risk factors for peripheral neuropathy. Rectal swabs were collected from cases of acute watery diarrhea. Hair and serum metals and metalloids were analyzed by Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). RESULTS There were 17 deaths among the 550 village inhabitants during the outbreak period at a crude mortality rate 21-fold that of a humanitarian crisis. Vibrio cholerae O1 El Tor Ogawa was confirmed among the population. Access to community-level rehydration was crucial to mortality. Peripheral neuropathy was diagnosed among cases with neurological symptoms. A balanced diet was significantly protective against neuropathy. A dose-response relationship was seen between peripheral neuropathy and a decreasing number of micronutrient- rich foods in the diet. Deficiencies in copper, iron, selenium and zinc were identified among the cases of peripheral neuropathy. CONCLUSIONS Cholera likely caused the mostly preventable excess mortality. Peripheral neuropathy was not caused by cholera, but cholera may worsen existing nutritional deficiencies. The peripheral neuropathy was likely caused by complex micronutrient deficiencies linked to non-diversified diets that potentially increased the vulnerability of this population, however a new zinc-associated neuropathy could not be ruled out. Reoccurrence can be prevented by addressing the root cause of displacement and ensuring access to arable land and timely resettlement.
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Affiliation(s)
- Alexander Rosewell
- World Health Organization, Port Moresby, National Capital District (NCD), Papua New Guinea
- School of Public Health and Community Medicine, The University of New South Wales, New South Wales, Sydney, NSW, Australia
- * E-mail:
| | - Geoff Clark
- World Health Organization, Port Moresby, National Capital District (NCD), Papua New Guinea
| | - Paul Mabong
- Provincial Health Office, Madang, Madang Province, Papua New Guinea
| | - Berry Ropa
- National Department of Health, Port Moresby, NCD, Papua New Guinea
| | - Enoch Posanai
- National Department of Health, Port Moresby, NCD, Papua New Guinea
| | - Nicola W. Y. Man
- School of Public Health and Community Medicine, The University of New South Wales, New South Wales, Sydney, NSW, Australia
| | - Samir R. Dutta
- Pathology Department, Port Moresby General Hospital, Port Moresby, NCD, Papua New Guinea
| | - Wasa Wickramasinghe
- The University of Queensland, National Research Centre for Environmental Toxicology, Coopers Plains, Queensland, Australia
| | - Lixia Qi
- The University of Queensland, National Research Centre for Environmental Toxicology, Coopers Plains, Queensland, Australia
| | - Jack C. Ng
- The University of Queensland, National Research Centre for Environmental Toxicology, Coopers Plains, Queensland, Australia
| | - Glen Mola
- University of Papua New Guinea, Port Moresby, NCD, Papua New Guinea
| | - Anthony B. Zwi
- School of Public Health and Community Medicine, The University of New South Wales, New South Wales, Sydney, NSW, Australia
| | - C. Raina MacIntyre
- School of Public Health and Community Medicine, The University of New South Wales, New South Wales, Sydney, NSW, Australia
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Bias TE, Davanos E, Rahman SM, Venugopalan V. Impact of Gastric Acidity on the Acquisition of Cholera Post Gastric Bypass. Bariatr Surg Pract Patient Care 2013. [DOI: 10.1089/bari.2013.9977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tiffany E. Bias
- Department of Pharmacy, Hahnemann University Hospital, Philadelphia, Pennsylvania
| | - Evangelia Davanos
- Department of Clinical Pharmacotherapy, The Brooklyn Hospital Center, Brooklyn, New York
| | - Shafiqur M. Rahman
- Division of Infectious Diseases, The Brooklyn Hospital Center, Brooklyn, New York
| | - Veena Venugopalan
- Department of Clinical Pharmacotherapy, The Brooklyn Hospital Center, Brooklyn, New York
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Azman AS, Rudolph KE, Cummings DA, Lessler J. The incubation period of cholera: a systematic review. J Infect 2013; 66:432-8. [PMID: 23201968 PMCID: PMC3677557 DOI: 10.1016/j.jinf.2012.11.013] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 11/23/2012] [Accepted: 11/26/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Recent large cholera outbreaks highlight the need for improved understanding of the pathogenesis and epidemiology of cholera. The incubation period of cholera has important implications for clinical and public health decision-making, yet statements of the incubation period of cholera are often imprecise. Here we characterize the distribution of cholera's incubation period. METHODS We conducted a systematic review of the literature for statements of the incubation period of cholera and data that might aid in its estimation. We extracted individual-level data, parametrically estimated the distribution of toxigenic cholera's incubation period, and evaluated evidence for differences between strains. RESULTS The incubation period did not differ by a clinically significant margin between strains (except O1 El Tor Ogawa). We estimate the median incubation period of toxigenic cholera to be 1.4 days (95% CI, 1.3-1.6). Five percent of cholera cases will develop symptoms by 0.5 days (95% CI 0.4-0.5), and 95% by 4.4 days (95% CI 3.9-5.0) after infection. CONCLUSIONS We recommend that cholera investigations use a recall period of at least five days to capture relevant exposures; significantly longer than recent risk factor studies from the Haitian epidemic. This characterization of cholera's incubation period can help improve clinical and public health practice and advance epidemiologic research.
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Affiliation(s)
- Andrew S. Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Kara E. Rudolph
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Derek A.T. Cummings
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
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Rosewell A, Addy B, Komnapi L, Makanda F, Ropa B, Posanai E, Dutta S, Mola G, Man WYN, Zwi A, MacIntyre CR. Cholera risk factors, Papua New Guinea, 2010. BMC Infect Dis 2012; 12:287. [PMID: 23126504 PMCID: PMC3531249 DOI: 10.1186/1471-2334-12-287] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 11/01/2012] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cholera is newly emergent in Papua New Guinea but may soon become endemic. Identifying the risk factors for cholera provides evidence for targeted prevention and control measures. METHODS We conducted a hospital-based case-control study to identify cholera risk factors. Using stool culture as the standard, we evaluated a cholera point of care test in the field. RESULTS 176 participants were recruited: 54 cases and 122 controls. Independent risk factors for cholera were: being over 20 years of age (aOR 2.5; 95%CI 1.1, 5.4), defecating in the open air (or river) (aOR 4.5; 95% CI 1.4, 14.4) and knowing someone who travelled to a cholera affected area (aOR 4.1; 95%CI 1.6, 10.7); while the availability of soap for handwashing at home was protective (aOR 0.41; 95%CI 0.19, 0.87). Those reporting access to a piped water distribution system in the home were twice as likely to report the availability of soap for handwashing. The sensitivity and specificity of the rapid test were 72% (95% CI 47-90) and 71% (95%CI 44-90%). CONCLUSIONS Improving population access to the piped water distribution system and sanitation will likely reduce transmission by enabling enhanced hygiene and limiting the contamination of water sources. The One step V. cholerae O1/O139 Antigen Test is of limited utility for clinical decision making in a hospital setting with access to traditional laboratory methods. Settlement dwellers and mobile populations of all age groups should be targeted for interventions in Papua New Guinea.
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