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A cholera outbreak in a rural north central Nigerian community: an unmatched case-control study
Chioma Cindy Dan-Nwafor | Uzoma Ogbonna | Pamela Onyiah | Saheed Gidado | Bashorun Adebobola | Patrick Nguku | Peter Nsubuga
Date of Publication:
BMC Public Health
Cholera remains a disease of public health importance in Nigeria associated with high morbidity and mortality. In November 2014, the Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP) was notified of an increase in suspected cholera cases in Gomani, Kwali Local Government Area. NFELTP residents were deployed to investigate the outbreak with the objectives of verifying the diagnosis, identifying risk factors and instituting appropriate control measures to control the outbreak. We conducted an unmatched case-control study. We defined a cholera case as any person aged ≥5 years with acute watery diarrhea in Gomani community. We identified community controls. A total of 43 cases and 68 controls were recruited. Structured questionnaires were administered to both cases and controls. Four stool samples from case-patients and two water samples from the community water source were collected for laboratory investigation. We performed univariate and bivariate analysis using Epi-Info version 126.96.36.199. The mean age of cases and controls was 20.3 years and 25.4 respectively (p value 0.09). Females constituted 58.1% (cases) and 51.5% (controls). The attack rate was 4.3% with a case fatality rate of 13%. Four stool (100%) specimen tested positive for Vibrio cholerae. The water source and environment were polluted by indiscriminate defecation. Compared to controls, cases were more likely to have drank from Zamani River (OR 14.2, 95% CI: 5.5–36.8) and living in households (HH) with more than 5 persons/HH (OR 5.9, 95% CI: 1.3–27.2). Good hand hygiene was found to be protective (OR 0.3, 95% CI: 0.1–0.7). Vibrio cholerae was the cause of the outbreak in Gomani. Drinking water from Zamani River, living in overcrowded HH and poor hand hygiene were significantly associated with the outbreak. We initiated hand hygiene and water treatment to control the outbreak.
Cholera outbreak in a naïve rural community in Northern Nigeria: the importance of hand washing with soap, September 2010
Saheed Gidado | Emmanuel Awosanya | Suleiman Haladu | Halimatu Bolatito Ayanleke | Suleman Idris | Ismaila Mamuda | Abdulaziz Mohammed | Charles Akataobi Michael | Ndadilnasiya Endie Waziri | Patrick Nguku
Date of Publication:
The Pan African Medical Journal
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. We conducted an unmatched case-control study. 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. Unhygienic handwashing practices was the key risk factor in this outbreak. We educated the community on personal hygiene focusing on the importance of handwashing with soap.