Geographic Mapping of Cholera Hotspots in Tanzania, 2010-2018: A Tool for Identifying Priority Areas for Intervention

  • Water or foodborne
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Background:
In the past 10 years Tanzania has experienced several waves of cholera outbreak affecting all the 26 regions of the country. To address this in the year 2010-2018, the Government of Tanzania was committed to develop a road map to eliminate cholera by 2030. However for elimination to be successful cholera hotspots must be identified and specifically targeted for interventions. We used mapping to identify cholera hotspots in Tanzania and guide the development of the elimination roadmap.
Methods:
Cases are defined in the surveillance system as confirmed. Weekly cholera case counts by district were obtained from integrated disease surveillance and response weekly ending reports (IDWE) for the period from January 2010 through June 2018. Annual population estimates by district were extrapolated from 2012 Census estimates and 2016 and 2017 projections from the Tanzania National Bureau of Statistics. Three ranking criteria including mean annual incidence, maximum annual incidence and stability were employed and converted into scores to capture multiple facets of disease burden.
Results:
In total, 29053 cases and 380 deaths (Case Fatality Rate 1.3) of cholera were reported during 2010 and 2018. The mean annual incidence ranged from 0.00-0.70 cases/1000 persons /year, while the maximum annual district specific incidence ranged from 0.00-4.7x cases/1000/yr . Stability ranged 0.00-1.65 cases/1000. Of the 184 districts in Tanzania 45 were identified as priority/hotspot areas based on the three criteria. Approximately 29% of the population of Tanzania lives in these districts.
Conclusion
We identified cholera hotspots in Tanzania and estimated the population at risk in hotspot districts. Selecting the right areas within the hotspots for targeting interventions followed by impact assessments of the interventions could eliminate cholera in these areas of Tanzania.

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