Investigation of the public health event in the Cafunfu town, Lunda-norte, Angola in December 2017

  • Public health surveillance
  • Vector-borne
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Background:
On November 22nd , 2017, the people from Cafunfu municipality in Lunda-Norte Province, alerted through the media, “the occurrence of unidentified disease, manifested mainly by high fevers, among other symptoms”. After verifica- tion of the alert, a multidisciplinary outbreak investigation team was sent to the town in December to investigate this public health event and determine the causal agent.
Methods:
In order to investigate the etiology of this public health event, 370 febrile children were randomly selected for testing with rapid diagnostic tests (RDT) for malaria. Further, 25 RDT for dengue and chikungunya were performed. After confirmation of the etiology of the event a 1:2 age-matched case-control study was conducted in the neighborhoods of Elevação and Bala bala to evaluate for risk factors. The target population were children under 15 years old. The sample size was calculated using the EPI Info Calculator: 60 cases and 120 controls were recruited. Significance level was set at p<0.05 for all hypothesis tests.
Results:
The RDT positivity rate was 70% for malaria, 9 RDTs were positive for Dengue and 3 for chikungunya. Of the 60 cases analyzed, 39 (65%) were male; 34 (57%)> 5 years, 36 (60%) lived in Bala bala .The epidemic curve was typi- cal of vector-borne disease and revealed significant under-reporting prior to the arrival of the external outbreak investigation teams. Logistic regression identified the following malaria infection associated factors: having an open dump close to home, OR of 11.3 [4.54-28.32] (p<0.001); not sleeping under mosquito net, OR = 16.3 [6.23-42.49] (p<0.001).
Conclusion
The upsurge in malaria cases was the trigger for the rumor that circulated through the media by the population of Cafunfu. Our study also showed co-circulation of Dengue and chikungunya. Control measures taken included: distribution of LLITNs; vector control strategies, improved case management. It was further recommended that local health authorities strengthen epidemiological surveillance system and vector control activities, improve basic sanitation, and develop risk communication strategies.

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