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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.
Geographic Distribution and Mortality Risk Factors during the Cholera Outbreak in a Rural Region of Haiti, 2010-2011
Anne-Laure Page | Iza Ciglenecki | Ernest Robert Jasmin | Laurence Desvignes | Francesco Grandesso | Jonathan Polonsky | Sarala Nicholas | Kathryn P. Alberti | Klaudia Porten | Francisco J. Luquero | Edward T. Ryan
Date of Publication:
PLOS Neglected Tropical Diseases
In 2010 and 2011, Haiti was heavily affected by a large cholera outbreak that spread throughout the country. Although national health structure-based cholera surveillance was rapidly initiated, a substantial number of community cases might have been missed, particularly in remote areas. We conducted a community-based survey in a large rural, mountainous area across four districts of the Nord department including areas with good versus poor accessibility by road, and rapid versus delayed response to the outbreak to document the true cholera burden and assess geographic distribution and risk factors for cholera mortality.
A two-stage, household-based cluster survey was conducted in 138 clusters of 23 households in four districts of the Nord Department from April 22nd to May 13th 2011. A total of 3,187 households and 16,900 individuals were included in the survey, of whom 2,034 (12.0%) reported at least one episode of watery diarrhea since the beginning of the outbreak. The two more remote districts, Borgne and Pilate were most affected with attack rates up to 16.2%, and case fatality rates up to 15.2% as compared to the two more accessible districts. Care seeking was also less frequent in the more remote areas with as low as 61.6% of reported patients seeking care. Living in remote areas was found as a risk factor for mortality together with older age, greater severity of illness and not seeking care.
These results highlight important geographical disparities and demonstrate that the epidemic caused the highest burden both in terms of cases and deaths in the most remote areas, where up to 5% of the population may have died during the first months of the epidemic. Adapted strategies are needed to rapidly provide treatment as well as prevention measures in remote communities.