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Asantewaa AA, Odoom A, Owusu-Okyere G, Donkor ES. Cholera Outbreaks in Low- and Middle-Income Countries in the Last Decade: A Systematic Review and Meta-Analysis. Microorganisms 2024; 12:2504. [PMID: 39770707 PMCID: PMC11728267 DOI: 10.3390/microorganisms12122504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Revised: 11/14/2024] [Accepted: 11/19/2024] [Indexed: 01/16/2025] Open
Abstract
Cholera is linked to penury, making low- and middle-income countries (LMICs) particularly vulnerable to outbreaks. In this systematic review, we analyzed the drivers contributing to these outbreaks, focusing on the epidemiology of cholera in LMICs. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in PROSPERO (ID: CRD42024591613). We searched PubMed, Scopus, Web of Science, and Google Scholar to include studies on cholera outbreaks that occurred in LMICs from 1 January 2014 to 21 September 2024. Studies on outbreaks outside LMICs and focusing on sporadic cases were excluded. The risk of bias among included studies was assessed using a modified Downes et al. appraisal tool. Thematic analysis was used to synthesize the qualitative data, and meta-analyses to estimate the pooled prevalence. From 1662 records, 95 studies met inclusion criteria, primarily documenting outbreaks in Africa (74%) and Asia (26%). Contaminated water was the main route of disease transmission. The pooled fatality prevalence was 1.3% (95% CI: 1.1-1.6), and the detection rate among suspected cases was 57.8% (95% CI: 49.2-66.4). Vibrio cholerae O1 was the dominant serogroup while Ogawa was the dominant serotype. All studies reporting biotypes indicated El Tor. Although the isolates were 100% susceptible to ofloxacin, levofloxacin, norfloxacin, cefuroxime, and doxycycline, they were also fully resistant to amikacin, sulfamethoxazole, trimethoprim, and furazolidone. The persistence of cholera outbreaks in destitute areas with limited access to clean water and sanitation emphasizes the need for socioeconomic improvements, infrastructure development, and ongoing surveillance to support timely responses and achieve long-term prevention.
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Affiliation(s)
- Anastasia A. Asantewaa
- Department of Medical Microbiology, University of Ghana Medical School, Korle Bu, Accra P.O. Box KB 4236, Ghana; (A.A.A.); (A.O.)
| | - Alex Odoom
- Department of Medical Microbiology, University of Ghana Medical School, Korle Bu, Accra P.O. Box KB 4236, Ghana; (A.A.A.); (A.O.)
| | - Godfred Owusu-Okyere
- National Public Health & Reference Laboratory (NPHRL), Ghana Health Service-Korle Bu, Accra P.O. Box 300, Ghana;
| | - Eric S. Donkor
- Department of Medical Microbiology, University of Ghana Medical School, Korle Bu, Accra P.O. Box KB 4236, Ghana; (A.A.A.); (A.O.)
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Yallew WW, Fasil N, Abdelmenan S, Berhane HY, Tsegaye S, Wang D, Fawzi W, Demissie M, Worku A, Birhane Y. Household Sanitation and Crowding Status in Addis Health and Demographic Surveillance System (Addis-HDSS) in Addis Ababa, Ethiopia. Ethiop J Health Sci 2024; 34:84-90. [PMID: 39911640 PMCID: PMC11793117 DOI: 10.4314/ejhs.v34i2.3s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 10/13/2024] [Indexed: 02/07/2025] Open
Abstract
Background Access to sanitation and healthy housing conditions are essential for public health, reducing the spread of diseases and improving overall well-being. However, millions of people, particularly in low-income countries, still lack access to basic sanitation and housing facilities. This study assessed household sanitation and crowding status in a rapidly developing urban area of Addis Ababa. Methods Data were extracted from the household census conducted from December 2022 to January 2023 at the Addis-HDSS site. Availability of basic sanitation facilities was defined as the presence of privately owned sanitation facilities within the household. Household crowding was measured by the number of occupants per bedroom. Multivariable logistic regression was used to identify factors associated with access to sanitation facilities (STATA/SE 14.2). A p-value of <0.05 was considered statistically significant. Results The study included 30,533 households. Overall, 76.37% (95% CI: 74.86-77.2) lacked access to basic sanitation facilities. Most households (67.42%) lived in overcrowded housing. Educational status of the household head and household size were significantly associated with sanitation access. Households with college-educated heads were more likely to have access to basic sanitation (AOR 2.52, 95% CI: 2.27-2.79), while overcrowded households were less likely to have such access (AOR 0.06, 95% CI: 0.040-0.063). Conclusions A large proportion of households lacked basic sanitation facilities and lived in overcrowded housing, which increases the risk of infectious disease transmission. Improving sanitation and housing conditions is crucial for reducing health risks and improving public health outcomes.
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Affiliation(s)
- Walelegn W Yallew
- Department of Global Health and Health Policy, Addis Continental Institute of Public Health
| | - Nebiyou Fasil
- Department of Global Health and Health Policy, Addis Continental Institute of Public Health
| | - Semira Abdelmenan
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health
| | - Hanna Y Berhane
- Department of Nutrition and Behavioral Science, Addis Continental Institute of Public Health
| | - Sitota Tsegaye
- Department of Nutrition and Behavioral Science, Addis Continental Institute of Public Health
| | - Dongqing Wang
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia, United States of America
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Meaza Demissie
- Department of Global Health and Health Policy, Addis Continental Institute of Public Health
| | - Alemayehu Worku
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health
| | - Yemane Birhane
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health
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Figuereo S, Yoon I, Kaddu SS, Lubogo M, Baruch J, Hossain AA, Mohamed SI, Abubakar AHA, Mohamud KM, Malik SMMR. Cost of Cholera for Households and Health Facilities, Somalia. J Epidemiol Glob Health 2024; 14:1219-1230. [PMID: 39023718 PMCID: PMC11442814 DOI: 10.1007/s44197-024-00278-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024] Open
Abstract
INTRODUCTION Cholera remains a substantial public health challenge in Somalia. Ongoing droughts in the country have caused significant outbreaks which have negatively affected the lives of many individuals and overwhelmed health facilities. We aimed to estimate the costs associated with cholera cases for households and health facilities in Somalia. METHODS This cost-of-illness study was conducted in five cholera treatment centres in Somalia and 400 patients treated in these facilities. Data collection took place during October and November 2023. Given that a significant portion of the patients were children, we interviewed their caregivers to gather cost data. We interviewed staff at the centres and the patients. The data obtained from the household questionnaire covered direct (medical and non-medical) and indirect (lost wages) costs, while direct costs were estimated for the health facility (personnel salaries, drugs and consumables used to treat a patient, and utility expenses). All costs were calculated in US dollars (USD), using 2023 as the base year for the estimation. RESULTS The average total cost of a cholera episode for a household was US$ 33.94 (2023 USD), with 50.4% (US$ 17.12) being direct costs and 49.6% (US$ 16.82) indirect costs. The average total cost for a health facility to treat an episode of cholera was US$ 82.65. The overall average cost to households and health facilities was US$ 116.59. The average length of stay for a patient was 3.08 days. In the households, patients aged 41 years and older incurred the highest mean total cost (US$ 73.90) while patients younger than 5 years had the lowest cost (US$ 21.02). Additionally, 61.8% of households had to use family savings to cover the cost of the cholera episode, while 14.5% had to borrow money. Most patients (71.8%) were younger than 16 years- 45.3% were 5 years or younger- and 94.0% had never received a cholera vaccine. CONCLUSION Our study suggests that preventing one cholera episode in Somalia could avert substantial losses for both the households and cholera treatment centres. The findings shed light on the expenses associated with cholera that extend beyond healthcare, including substantial direct and indirect costs borne by households. Preventing cholera cases could lead to a decrease in this economic burden, consequently our study supports the need for preventive measures.
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Affiliation(s)
- Salvador Figuereo
- World Health Organization, Somalia Country Office, Mogadishu, Somalia.
| | - Ian Yoon
- World Health Organization, Headquarters, Geneva, Switzerland
| | | | - Mutaawe Lubogo
- World Health Organization, Somalia Country Office, Mogadishu, Somalia
| | - Joaquin Baruch
- World Health Organization, Somalia Country Office, Mogadishu, Somalia
| | - Asm Amjad Hossain
- World Health Organization, Somalia Country Office, Mogadishu, Somalia
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Bitew A, Gelaw A, Wondimeneh Y, Ayenew Z, Getie M, Tafere W, Gebre-Eyesus T, Yimer M, Beyene GT, Bitew M, Abayneh T, Abebe M, Mihret A, Yeshitela B, Teferi M, Gelaw B. Prevalence and antimicrobial susceptibility pattern of Vibrio cholerae isolates from cholera outbreak sites in Ethiopia. BMC Public Health 2024; 24:2071. [PMID: 39085873 PMCID: PMC11292863 DOI: 10.1186/s12889-024-19621-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 07/29/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Cholera is an acute infectious disease caused by ingestion of contaminated food or water with Vibrio cholerae. Cholera remains a global threat to public health and an indicator of inequity and lack of social development. The aim of this study was to assess the prevalence and antimicrobial susceptibility pattern of V. cholerae from cholera outbreak sites in Ethiopia. METHODS Across-sectional study was conducted from May 2022 to October 2023 across different regions in Ethiopia: Oromia National Regional State, Amhara National Regional State and Addis Ababa City Administration. A total of 415 fecal samples were collected from the three regions. Two milliliter fecal samples were collected from each study participants. The collected samples were cultured on Blood Agar, MacConkey Agar and Thiosulfate Citrate Bile Salt Sucrose Agar. A series of biochemical tests Oxidase test, String test, Motility, Indole, Citrate, Gas production, H2S production, Urease test were used to identify V. cholerae species. Both polyvalent and monovalent antisera were used for agglutination tests to identify and differentiate V. cholerae serogroup and serotypes. In addition, Kirby-Bauer Disk diffusion antibiotic susceptibility test method was done. Data were registered in epi-enfo version 7 and analyzed by Statistical Package for Social Science version 25. Descriptive statistics were used to determine the prevalence of Vibrio cholerae. Logistic regression model was fitted and p-value < 0.05 was considered as statically significant. RESULTS The prevalence of V. cholerae in the fecal samples was 30.1%. Majority of the isolates were from Oromia National Regional State 43.2% (n = 54) followed by Amhara National Regional State 31.2% (n = 39) and Addis Ababa City Administration 25.6% (n = 32). Most of the V. cholerae isolates were O1 serogroups 90.4% (n = 113) and Ogawa serotypes 86.4% (n = 108). Majority of the isolates were susceptible to ciprofloxacin 100% (n = 125), tetracycline 72% (n = 90) and gentamycin 68% (n = 85). More than half of the isolates were resistant to trimethoprim-sulfamethoxazole 62.4% (n = 78) and ampicillin 56.8% (n = 71). In this study, participants unable to read and write were about four times more at risk for V. cholerae infection (AOR: 3.8, 95% CI: 1.07-13.33). In addition, consumption of river water were about three times more at risk for V. cholerae infection (AOR: 2.8, 95% CI: 1.08-7.08). CONCLUSION our study revealed a high prevalence of V. cholerae from fecal samples. The predominant serogroups and serotypes were O1 and Ogawa, respectively. Fortunately, the isolates showed susceptible to most tested antibiotics. Drinking water from river were the identified associated risk factor for V. cholerae infection. Protecting the community from drinking of river water and provision of safe and treated water could reduce cholera outbreaks in the study areas.
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Affiliation(s)
- Abebaw Bitew
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
- Department of Medical Microbiology, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
| | - Aschalew Gelaw
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yitayih Wondimeneh
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zeleke Ayenew
- Department of Bacteriology, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Michael Getie
- Department of Medical Microbiology, Amhara National Regional State Public Health Institute, Bahir Dar, Ethiopia
| | - Wudu Tafere
- Department of Medical Microbiology, Amhara National Regional State Public Health Institute, Bahir Dar, Ethiopia
| | - Tsehaynesh Gebre-Eyesus
- Department of Medical Microbiology, Amhara National Regional State Public Health Institute, Bahir Dar, Ethiopia
| | - Marechign Yimer
- Bacterial and Viral Disease Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Getachew Tesfaye Beyene
- Bacterial and Viral Disease Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Molalegne Bitew
- Bio and Emerging Technology Institute of Ethiopia, Addis Ababa, Ethiopia
| | | | - Markos Abebe
- Bacterial and Viral Disease Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Adane Mihret
- Bacterial and Viral Disease Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Biruk Yeshitela
- Bacterial and Viral Disease Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Mekonnen Teferi
- Bacterial and Viral Disease Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Baye Gelaw
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Getahun T, Hailu D, Mogeni OD, Mesfin Getachew E, Yeshitela B, Jeon Y, Gedefaw A, Ayele Abebe S, Hundito E, Mukasa D, Jang GH, Pak GD, Kim DR, Worku Demlie Y, Hussen M, Teferi M, Park SE. Healthcare Seeking Behavior and Disease Perception Toward Cholera and Acute Diarrhea Among Populations Living in Cholera High-Priority Hotspots in Shashemene, Ethiopia. Clin Infect Dis 2024; 79:S43-S52. [PMID: 38996036 PMCID: PMC11244153 DOI: 10.1093/cid/ciae232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Healthcare seeking behavior (HSB) and community perception on cholera can influence its management. We conducted a cross-sectional survey to generate evidence on cholera associated HSB and disease perception in populations living in cholera hotspots in Ethiopia. METHODS A total of 870 randomly selected households (HHs) in Shashemene Town (ST) and Shashemene Woreda (SW) participated in our survey in January 2022. RESULTS Predominant HHs (91.0%; 792/870) responded "primary health center" as the nearest healthcare facility (HCF). Around 57.4% (247/430) of ST HHs traveled <30 minutes to the nearest HCF. In SW, 60.2% (265/440) of HHs travelled over 30 minutes and 25.9% (114/440) over 4 km. Two-thirds of all HHs paid CONCLUSIONS Variations in cholera prevention practices between rural and urban residents were shown. Addressing differences in HSB per age groups is needed for community engagement for early case detection and case management; critical in reducing cholera deaths and transmission.
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Affiliation(s)
- Tomas Getahun
- Clinical Trials Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Dejene Hailu
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
- School of Public Health, Hawassa University, Hawassa, Ethiopia
| | - Ondari D Mogeni
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
| | | | - Biruk Yeshitela
- Bacterial and Viral Disease Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Yeonji Jeon
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Abel Gedefaw
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Samuyel Ayele Abebe
- Statistics and Data Management Department, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Ermiyas Hundito
- Clinical Trials Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - David Mukasa
- Biostatistics and Data Management (BDM) Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Geun Hyeog Jang
- Biostatistics and Data Management (BDM) Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Gi Deok Pak
- Biostatistics and Data Management (BDM) Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Deok Ryun Kim
- Biostatistics and Data Management (BDM) Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Yeshambel Worku Demlie
- Public Health Emergency Management, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Mukemil Hussen
- Public Health Emergency Management, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Mekonnen Teferi
- Clinical Trials Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Se Eun Park
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
- Department of Global Health and Disease Control, Yonsei University Graduate School of Public Health, Seoul, Republic of Korea
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Braka F, Daniel EO, Okeibunor J, Rusibamayila NK, Conteh IN, Ramadan OPC, Byakika-Tusiime J, Yur CT, Ochien EM, Kagoli M, Chauma-Mwale A, Chamla D, Gueye AS. Effects of tropical cyclone Freddy on the social determinants of health: the narrative review of the experience in Malawi. BMJ PUBLIC HEALTH 2024; 2:e000512. [PMID: 40018254 PMCID: PMC11816094 DOI: 10.1136/bmjph-2023-000512] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/06/2024] [Indexed: 03/01/2025]
Abstract
Malawi-one of the low-income countries in Africa-has witnessed a series of flood-related disasters in many years. The recent tropical cyclone Freddy (TCF) has indispensable effects on the unequal distribution of the social determinants of health with tendencies for increased disease outbreaks across the districts of the country. This narrative study aimed at unravelling the consequences of the TCF and its possible relationship with the already existing cholera epidemic in the fourteen affected districts. Additionally, it aimed to document the immediate humanitarian responses in the acute phase of the disaster. We identified, used and extracted information and data from relevant documents available from the government records, WHO and other multiagency documents, which were summarised along with the humanitarian actions and the associated implications of the entire event. Areas of TCF's main effects included health, shelter, education, nutrition, water sanitation and hygiene, agriculture and livelihood, transport and logistics including food security. The notable immediate humanitarian responses are donations, camp creation for accommodations, emergency life-saving response and essential healthcare services. Nsanje and Chikwawa districts experienced an increase in cholera cases and deaths post-TCF. The highest proportion of the disaster-impacted and intervention beneficiaries were women and children. The effects of the TCF on the social determinants of health in the affected districts and the associated negative impacts should be considered by the government and disaster management experts in evidence-based policy-making towards disaster risk reduction in the flood-prone districts using an all-hazard approach. This step might be useful in improving the vulnerable population's standard of living and achievement of related Sustainable Development Goals in Malawi.
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Affiliation(s)
- Fiona Braka
- Emergency Preparedness and Response Programme, World Health Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Ebenezer Obi Daniel
- Emergency Preparedness and Response Programme, World Health Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Joseph Okeibunor
- Emergency Preparedness and Response Programme, World Health Health Organization Regional Office for Africa, Brazzaville, Congo
- Department of Sociology/Anthropology, University of Nigeria, Nsukka, Nigeria
| | | | - Ishata Nannie Conteh
- Emergency Preparedness and Response Programme, World Health Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Otim Patrick Cossy Ramadan
- Emergency Preparedness and Response Programme, World Health Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Jayne Byakika-Tusiime
- Emergency Preparedness and Response Programme, World Health Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Chol Thabo Yur
- Nairobi Hub Emergency Preparedness and Response Programme, World Health Organization, Nairobi, Kenya
| | | | | | | | - Dick Chamla
- Emergency Preparedness and Response Programme, World Health Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Abdou Salam Gueye
- Emergency Preparedness and Response Programme, World Health Health Organization Regional Office for Africa, Brazzaville, Congo
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Amisu BO, Okesanya OJ, Adigun OA, Manirambona E, Ukoaka BM, Lawal OA, Idris NB, Olaleke NO, Okon II, Ogaya JB, Prisno DEL. Cholera resurgence in Africa: assessing progress, challenges, and public health response towards the 2030 global elimination target. LE INFEZIONI IN MEDICINA 2024; 32:148-156. [PMID: 38827826 PMCID: PMC11142410 DOI: 10.53854/liim-3202-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/14/2024] [Indexed: 06/05/2024]
Abstract
Global efforts to combat epidemic cholera outbreaks have witnessed tremendous feats over the decades. However, sporadic outbreaks in regions, particularly across African states, mask these advancements. This regressive trend is frequently fuelled by factors retarding efforts towards optimal environmental sanitation and personal hygiene, which include ingesting infected food, drinking contaminated waters, and engaging in unhealthy environmental practices such as indiscriminate waste and sewage disposal and poor toilet practices. The ongoing efforts to achieve the Global Taskforce on Cholera Control (GTFCC) targets of a 90% reduction in cases and deaths by 2030, even in the wake of continuous outbreaks across various African regions, as reported by the World Health Organization (WHO) face a significant threat. One such effort, among others, is the AFRICHOL project, an enhanced cholera surveillance consortium launched in Africa over a decade ago as part of the GTFCC at WHO to monitor and fast-track the GTFCC's 2030 targets. It is tasked with supporting the implementation of research-based strategies for combating cholera in Africa. The prequalified oral cholera vaccines - Dukoral, Shanchol, and Euvichol - and those with recombinant DNA technology have also emerged as remarkable strides. In the face of this progress, challenges persist. Climate change, including extreme weather events and the lack of safe water, sanitation, and hygiene facilities, acts as a multiplier, amplifying existing challenges and hindering progress. Porous borders with inefficient disease surveillance networks among member states also facilitate the inter-territorial spread of the disease. Despite ongoing challenges, global targets are achievable provided strong institutional infrastructure and additional evidence-based public health initiatives are promulgated and enacted. The Global Roadmap to Ending Cholera Outbreaks by 2030 is a resourceful tool for advancing this fight and eradicating cholera.
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Affiliation(s)
- Blessing Olawunmi Amisu
- Department of Medical Laboratory Science, Uniosun Teaching Hospital, Osogbo, Osun state, Nigeria
| | - Olalekan John Okesanya
- Department of Public Health and Maritime Transport, University of Thessaly, Volos, Greece
| | | | - Emery Manirambona
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Okikiola Azeez Lawal
- Department of Medical Laboratory Sciences, Kwara State University, Kwara State, Nigeria
| | - Nimat Bola Idris
- Department of Public Health, Al-Hikmah University, Ilorin, Kwara State, Nigeria
| | - Noah Olabode Olaleke
- Department of Medical Laboratory Science, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Osun State, Nigeria
| | - Inibehe Ime Okon
- Department of Neurosurgery, Hospital of the Babcock University, Ogun State, Nigeria
| | | | - Don Eliseo Lucero Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Moore S, Worku Demlie Y, Muluneh D, Dunoyer J, Hussen M, Wossen M, Edosa M, Sudre B. Spatiotemporal dynamics of cholera epidemics in Ethiopia: 2015-2021. Sci Rep 2024; 14:7170. [PMID: 38570534 PMCID: PMC10991303 DOI: 10.1038/s41598-024-51324-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/03/2024] [Indexed: 04/05/2024] Open
Abstract
Since the onset of the seventh cholera pandemic, Ethiopia has been affected by recurrent epidemics. However, the epidemiology of cholera in this country remains poorly understood. This study aimed to describe cholera outbreak characteristics in Ethiopia from 2015 to 2021. During this period, Ethiopia experienced four epidemic waves. The first wave involved nationwide outbreaks during the second half of 2016 followed by outbreaks predominantly affecting Somali Region in 2017. The second wave primarily affected Tigray and Afar Regions. During the third wave, multiple smaller-scale outbreaks occurred during 2019. The fourth wave was limited to Bale Zone (Oromia Region) in 2021. Overall, a north to south shift was observed over the course of the study period. Major cholera transmission factors included limited access to safe water and sanitation facilities. Severe weather events (drought and flooding) appear to aggravate cholera diffusion. Cholera transmission between Ethiopia and nearby countries (Kenya and Somalia), likely plays a major role in regional cholera dynamics. Overall, this study provides the first understanding of recent spatiotemporal cholera dynamics in Ethiopia to inform cholera control and elimination strategies.
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Affiliation(s)
- Sandra Moore
- Prospective and Cooperation, 1 Place Gabriel Péri, Vieux Port, 13001, Marseille, France
| | - Yeshambel Worku Demlie
- Public Health Emergency Management, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia.
| | - Dereje Muluneh
- Health Section, UNICEF Ethiopia, UNECA Compound, Zambezi Building, Box 1169, Addis Ababa, Ethiopia
| | - Jessica Dunoyer
- Prospective and Cooperation, 1 Place Gabriel Péri, Vieux Port, 13001, Marseille, France
| | - Mukemil Hussen
- Public Health Emergency Management, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Mesfin Wossen
- Public Health Emergency Management, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Moti Edosa
- Public Health Emergency Management, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Bertrand Sudre
- Prospective and Cooperation, 1 Place Gabriel Péri, Vieux Port, 13001, Marseille, France
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Demlie YW, Moore S, Dunoyer J, Muluneh D, Hussen M, Wossen M, Edosa M, Sudre B. Comparison of analysis methods to classify cholera hotspots in Ethiopia from 2015 to 2021. Sci Rep 2024; 14:7377. [PMID: 38570545 PMCID: PMC10991413 DOI: 10.1038/s41598-024-56299-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/05/2024] [Indexed: 04/05/2024] Open
Abstract
Cholera continues to represent a major public health concern in Ethiopia. The country has developed a Multi-sectoral National Cholera Elimination Plan in 2022, which targets prevention and control interventions in cholera hotspots. Multiple methods to classify cholera hotspots have been used in several countries. Since 2014, a classification method developed by United Nations Children's Fund has been applied to guide water, sanitation and hygiene interventions throughout Sub-Saharan Africa based on three outbreak parameters: frequency, duration and standardized attack rate. In 2019, the Global Task Force on Cholera Control (GTFCC) proposed a method based on two parameters: average annual cholera incidence and persistence. In 2023, an updated GTFCC method for multisectoral interventions considers three epidemiological indicators (cumulative incidence, cumulative mortality and persistence,) and a cholera-case confirmation indicator. The current study aimed to classify cholera hotspots in Ethiopia at the woreda level (equivalent to district level) applying the three methods and comparing the results to optimize the hotspot targeting strategy. From 2015 to 2021, cholera hotspots were located along major routes between Addis Ababa and woredas adjacent to the Kenya and Somalia borders, throughout Tigray Region, around Lake Tana, and in Afar Region. The multi-method comparison enables decision makers to prioritize interventions according to a sub-classification of the highest-priority areas.
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Affiliation(s)
- Yeshambel Worku Demlie
- Public Health Emergency Management, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Sandra Moore
- Prospective and Cooperation, 1 place Gabriel Péri, Vieux port, 13001, Marseille, France
| | - Jessica Dunoyer
- Prospective and Cooperation, 1 place Gabriel Péri, Vieux port, 13001, Marseille, France
| | - Dereje Muluneh
- Health Section, UNICEF Ethiopia, UNECA Compound, Zambezi Building, Box 1169, Addis Ababa, Ethiopia
| | - Mukemil Hussen
- Public Health Emergency Management, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Mesfin Wossen
- Public Health Emergency Management, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Moti Edosa
- Public Health Emergency Management, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia.
| | - Bertrand Sudre
- Prospective and Cooperation, 1 place Gabriel Péri, Vieux port, 13001, Marseille, France
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10
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Olu OO, Usman A, Ameda IM, Ejiofor N, Mantchombe F, Chamla D, Nabyonga-Orem J. The Chronic Cholera Situation in Africa: Why Are African Countries Unable to Tame the Well-Known Lion? Health Serv Insights 2023; 16:11786329231211964. [PMID: 38028119 PMCID: PMC10647958 DOI: 10.1177/11786329231211964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Seven years to the Global Taskforce on Cholera Control's target of reducing cholera cases and deaths by 90% by 2030, Africa continues to experience a high incidence of the disease. In the last 20 years, more than 2.6 million cases and 60 000 deaths of the disease have been recorded, mostly in sub-Saharan Africa. Case Fatality Ratio remains consistently above the WHO-recommended 1% with a yearly average of 2.2%. Between 1 January 2022 and 16 July 2023, fourteen African countries reported 213 443 cases and 3951 deaths (CFR, 1.9%) of the disease. In this perspective article, based on available literature and the authors' field experiences in Africa, we discuss the underlying reasons for the sustained transmission of the disease. We posit that in addition to the well-known risk factors for the disease, the chronic cholera situation in Africa is due to the poor socioeconomic development status, weak household and community resilience, low literacy levels, weak capacity of African countries to implement the 2005 International Health Regulation and the pervasively weak health system on the continent. Stemming this tide requires good leadership, partnership, political commitment, and equity in access to health services, water, and sanitation. Therefore, we recommend that African governments and stakeholders recognize and approach cholera prevention and control from the long-term development lens and leverage the current cholera emergency preparedness and response efforts on the continent to strengthen the affected countries' health, water, and sanitation systems. We call on international organizations such as WHO and the Africa Centres for Diseases Control to support African governments in scaling up research and innovations aimed at better characterizing the epidemiology of cholera and developing evidence-based, context-specific, and innovative strategies for its prevention and control. These recommendations require long-term multisectoral and multidisciplinary approaches.
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Affiliation(s)
| | - Abdulmumini Usman
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Ida Marie Ameda
- United Nations Children Fund Eastern and Southern African Regional Office, Nairobi, Kenya
| | - Nonso Ejiofor
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Freddie Mantchombe
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Dick Chamla
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Juliet Nabyonga-Orem
- World Health Organization Regional Office for Africa, Brazzaville, Congo
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom Campus, South Africa
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11
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Malaeb D, Sallam M, Younes S, Mourad N, Sarray El Dine A, Obeid S, Hallit S, Hallit R. Knowledge, Attitude, and Practice in a Sample of the Lebanese Population Regarding Cholera. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16243. [PMID: 36498316 PMCID: PMC9735709 DOI: 10.3390/ijerph192316243] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 05/12/2023]
Abstract
The evaluation of knowledge, attitude, and practices towards an emerging disease is an essential component of public health preventive measures during an outbreak. In October 2022, an outbreak of cholera was reported in Lebanon, which is the first to be reported in the Middle Eastern country for 30 years. This study aimed to explore the level of knowledge as well as attitude and practice of the general public in Lebanon towards cholera. A self-administered structured questionnaire was distributed via an online link to individuals living in Lebanon during October-November 2022. The survey instrument comprised items to assess the sociodemographic data; questions on knowledge about cholera symptoms, transmission, and prevention; as well as attitude and practice questions. Our study involved 553 participants, with a median age of 24 years and a majority of females (72.5%). The results showed that the majority of respondents correctly identified diarrhea as a symptom of cholera and recognized the spread via contaminated water and food. Having a university level education compared with secondary school or less (adjusted odds ratio (aOR) = 2.09), being married compared with single (aOR = 1.67), and working in the medical field compared with unemployed (aOR = 4.19) were significantly associated with higher odds of having good cholera knowledge. Having good knowledge compared with having a poor level of cholera knowledge (aOR = 1.83) and older age (aOR = 1.03) were significantly associated with higher odds of having a good attitude towards cholera. The current study showed an overall high knowledge score on cholera among the Lebanese population. Nevertheless, gaps in cholera knowledge were identified and should be addressed, particularly among workers in the medical field. Thus, we recommend targeted health education to the general population that aims to strengthen the health resilience in the community.
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Affiliation(s)
- Diana Malaeb
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman P.O. Box 4184, United Arab Emirates
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
- Department of Translational Medicine, Faculty of Medicine, Lund University, 22184 Malmö, Sweden
| | - Samar Younes
- Department of Biomedical Sciences, School of Pharmacy, Lebanese International University, Bekaa, Lebanon
| | - Nisreen Mourad
- Pharmaceutical Sciences Department, School of Pharmacy, Lebanese International University, Bekaa, Lebanon
| | - Abir Sarray El Dine
- Department of Biomedical Sciences, School of Arts and Sciences, Lebanese International University, Beirut P.O. Box 146404, Lebanon
| | - Sahar Obeid
- Department of Social and Education Sciences, School of Arts and Sciences, Lebanese American University, Byblos, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh P.O. Box 446, Lebanon
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman 11931, Jordan
| | - Rabih Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh P.O. Box 446, Lebanon
- Department of Infectious Disease, Bellevue Medical Center, Mansourieh, Lebanon
- Department of Infectious Disease, Notre Dame des Secours, University Hospital Center, Byblos, Lebanon
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