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Cholera hotspots and surveillance constraints contributing to recurrent epidemics in Tanzania
Yaovi M. G. Hounmanou | Kåre Mølbak | Jonas Kähler | Robinson H. Mdegela | John E. Olsen | Anders Dalsgaard
Date of Publication:
BMC Research Notes
We described the dynamics of cholera in Tanzania between 2007 and 2017 and assessed the weaknesses of the current surveillance system in providing necessary data in achieving the global roadmap to 2030 for cholera control. The Poisson-based spatial scan identified cholera hotspots in mainland Tanzania. A zero-inflated Poisson regression investigated the relationship between the incidence of cholera and available demographic, socio-economic and climatic exposure variables. Four cholera hotspots were detected covering 17 regions, home to 28 million people, including the central regions and those surrounding the Lakes Victoria, Tanganyika and Nyaza. The risk of experiencing cholera in these regions was up to 2.9 times higher than elsewhere in the country. Regression analyses revealed that every 100 km of water perimeter in a region increased the cholera incidence by 1.5%. Due to the compilation of surveillance data at regional level rather than at district, we were unable to reliably identify any other significant risk factors and specific hotspots. Cholera high-risk populations in Tanzania include those living near lakes and central regions. Successful surveillance require disaggregated data available weekly and at district levels in order to serve as data for action to support the roadmap for cholera control.
Cholera prevention and control in refugee settings: Successes and continued challenges
Kerry Shannon | Marisa Hast | Andrew S. Azman | Dominique Legros | Heather McKay | Justin Lessler
Date of Publication:
PLoS Neglected Tropical Diseases
Cholera has long been viewed as a serious threat for refugee populations. In the 1980s and 90s, refugee camps proliferated in Africa and Asia as a result of large civil wars and environmental disasters. These camps experienced large-scale cholera outbreaks with regularity because of overcrowding, scarce clean water, and poor sanitation and hygiene practices. Death rates were often high because of preexisting malnutrition, comorbidities, and limited access to medical care. Mobilization around these issues was greatly accelerated in 1994, when a particularly massive outbreak occurred among Rwandan refugees in the Lake Kivu region of Zaire (present-day Democratic Republic of the Congo), and approximately 42,000 people died. In response to this unprecedented tragedy, the humanitarian community developed and adopted the Sphere standards for the minimum acceptable living conditions and availability of health services in refugee camps and other humanitarian responses. Although refugee camps continue to experience many vulnerabilities, the increased focus on improved camp coordination, preparedness, timely multisectoral response, and adherence to minimum standards has resulted in a notable decrease in the number and size of camp-based cholera outbreaks and associated mortality.
The Epidemiology of Cholera in Zanzibar: Implications for the Zanzibar Comprehensive Cholera Elimination Plan
Qifang Bi | Fadhil M Abdalla | Salma Masauni | Rita Reyburn | Marko Msambazi | Carole Deglise | Lorenz von Seidlein | Jacqueline Deen | Mohamed Saleh Jiddawi | David Olson | Iriya Nemes | Jamala Adam Taib | Justin Lessler | Ghirmay Redae Andemichael | Andrew S Azman
Date of Publication:
The Journal of Infectious Diseases
Cholera poses a public health and economic threat to Zanzibar. Detailed epidemiologic analyses are needed to inform a multisectoral cholera elimination plan currently under development. We collated passive surveillance data from 1997 to 2017 and calculated the outbreak-specific and cumulative incidence of suspected cholera per shehia (neighborhood). We explored the variability in shehia-specific relative cholera risk and explored the predictive power of targeting intervention at shehias based on historical incidence. Using flexible regression models, we estimated cholera’s seasonality and the relationship between rainfall and cholera transmission.
From 1997 and 2017, 11921 suspected cholera cases were reported across 87% of Zanzibar’s shehias, representing an average incidence rate of 4.4 per 10,000/year. The geographic distribution of cases across outbreaks was variable, although a number of high-burden areas were identified. Outbreaks were highly seasonal with two high-risk periods corresponding to the annual rainy seasons.
In conclusion, shehia-targeted interventions should be complemented with island-wide cholera prevention activities given the spatial variability in cholera risk from outbreak to outbreak. In-depth risk factor analyses should be conducted in the high-burden shehias. The seasonal nature of cholera provides annual windows of opportunity for cholera preparedness activities.