Risk Factors and Evaluation of Response during an outbreak of Cholera –Busia, Kenya, 2018.

  • Water or foodborne
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Background:
Between January 2018─April 2018, Busia County reported two confirmed cholera cases and six deaths as of 17th April 2018. We aimed to identify more cases, risk factors and evaluate preparedness and response during the outbreak.
Methods:
We conducted active case search, case-control study and a preparedness and response evaluation. Cases were de- fined as ≥2 watery diarrhea episodes in person’s ≥ 2 years old residing in Busia-county between January 2018─April 2018. Controls were defined as absence of watery diarrhea in any person of the same age group in same period. Cases were selected by simple random sampling from outbreak line-list. Controls were selected from the villages the cases resided using systematic random sampling, matched to cases by age ±2 years at a ratio 1:1. Socio-demographic characteristics, clinical, risk factors were collected using a structured questionnaire. Five health officials were inter- viewed to evaluate preparedness and response. Strengths and weaknesses in the cholera preparedness and during response were summarized. We calculated descriptive and analytic statistics; Odds-Ratios (OR) were calculated and variables with p-value ≤0.2 at bivariate were included in logistic regression model and variables with p<0.05 in final model were considered significant.
Results:
We line-listed 201 cases; 4 (2.0%) confirmed cases and six deaths (CFR=3.0%). Median age was 22 years (IQR 37), 104 (51.7%) were female, 48 (30.4%) cases were aged <5 years and 151 (75.1%) admitted patients. Dirty latrines (aOR=10.6, CI 1.9-58.8) and drinking untreated water (aOR=2.7, CI 1.1-6.8) were risk factors of being a case. Use of treated borehole water (aOR=0.2, CI 0.07-0.5) and treated protected shallow well water (aOR=0.08, CI 0.02-0.3) were protective factors. Cholera treatment units (CTUs) were not decentralized for patients to avoid transporta- tion. The CTUs lacked proper documentation of cholera response activities, case management flow charts, infection prevention and control protocols and cholera case definition materials. The outbreak response activities were not multisectoral since response was by the department of health only.
Conclusion
Poor latrine hygiene, untreated drinking water and unpreparedness were the main drivers of the outbreak. We recommend health education on latrine hygiene, treatment of drinking water and coordinated multisectoral approach in responding to future cholera outbreaks.

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