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Cholera Epidemic in Guinea-Bissau (2008): The Importance of “Place”
Francisco J. Luquero | Cunhate Na Banga | Daniel Remartínez | Pedro Pablo Palma | Emanuel Baron | Rebeca F. Grais | Frank Tanser
Date of Publication:
As resources are limited when responding to cholera outbreaks, knowledge about where to orient interventions is crucial. We describe the cholera epidemic affecting Guinea-Bissau in 2008 focusing on the geographical spread in order to guide prevention and control activities.
We conducted two studies: 1) a descriptive analysis of the cholera epidemic in Guinea-Bissau focusing on its geographical spread (country level and within the capital); and 2) a cross-sectional study to measure the prevalence of houses with at least one cholera case in the most affected neighbourhood of the capital (Bairro Bandim) to detect clustering of households with cases (cluster analysis). All cholera cases attending the cholera treatment centres in Guinea-Bissau who fulfilled a modified World Health Organization clinical case definition during the epidemic were included in the descriptive study. For the cluster analysis, a sample of houses was selected from a satellite photo (Google Earth™); 140 houses (and the four closest houses) were assessed from the 2,202 identified structures. We applied K-functions and Kernel smoothing to detect clustering. We confirmed the clustering using Kulldorff's spatial scan statistic. A total of 14,222 cases and 225 deaths were reported in the country (AR = 0.94%, CFR = 1.64%). The more affected regions were Biombo, Bijagos and Bissau (the capital). Bairro Bandim was the most affected neighborhood of the capital (AR = 4.0). We found at least one case in 22.7% of the houses (95%CI: 19.5–26.2) in this neighborhood. The cluster analysis identified two areas within Bairro Bandim at highest risk: a market and an intersection where runoff accumulates waste (p<0.001).
Our analysis allowed for the identification of the most affected regions in Guinea-Bissau during the 2008 cholera outbreak, and the most affected areas within the capital. This information was essential for making decisions on where to reinforce treatment and to guide control and prevention activities.
Health education and cholera in rural Guinea-Bissau
Jónína Einarsdóttir | Alberto Passa | Geir Gunnlaugsson
Date of Publication:
International journal of infectious diseases
The study was undertaken to explore local ideas about cholera and the diffusion of official health educational messages for cholera prevention and to assess whether such messages contributed to changed behavior in the population.
During the ongoing cholera epidemic in 1994 in Guinea-Bissau, West Africa, a roster of all adult residents in a rural community was established. From this roster of 458 adults, 53 of 60 randomly chosen residents were interviewed for qualitative data on cholera and its prevention.
Local preventive rituals performed contributed to high awareness of the epidemic. Radio and word-of-mouth communication were the most important sources of information on cholera, whereas posters and television did not effectively reach the population. All persons with cholera rapidly sought care. Thirty-four (64%) of 53 participants recalled at least one preventive measure; specifically, treatment of water with lemon was mentioned by 21 (40%) of respondents. None of the respondents could explain how cholera is transmitted to humans.
To improve compliance with recommended preventive measures, these should take local conceptions of diseases into account and be few in number, practical, and effective. The impact of the radio could be increased if those who hear the message are urged to spread the recommendation, especially to women who take care of food, water, and general hygiene in the household.
Funerals during the 1994 cholera epidemic in Guinea-Bissau, West Africa: The need for disinfection of bodies of persons dying of cholera
G. Gunnlaugsson | J. Einarsdottir | F. J. Angulo | S. A. Mentambanar | A. Passa | R. V. Tauxe
Date of Publication:
Epidemiology and infection
The 1994 cholera epidemic in Guinea-Bissau resulted in 15878 reported cases and 306 deaths. Early in the epidemic, although the health ministry mandated that the bodies of persons dying of cholera be disinfected, outbreaks occurred in several villages following funerals in the region of Biombo. To determine the influence of disinfection and funeral activities on cholera transmission, we analysed surveillance data and conducted a case-control study following a funeral. The attack rate during the week following funerals was higher in villages where bodies were not disinfected (risk ratio = 2•6, 95% confidence interval [CI] 1•9–3•8). Cholera was strongly associated with eating at a funeral with a non-disinfected corpse (odds ratio [OR] = 14•5, 95% CI 0•9–786) and with touching (i.e., transporting, washing) the body (OR = 36•2, 95% CI 2•6–1769). During cholera epidemics, in addition to other cholera prevention activities, health officials should inform community leaders about the risk of cholera transmission during funerals, meals should not be served at funerals, and bodies of persons dying of cholera should be disinfected.