scholarly journals Cholera outbreak caused by drinking unprotected well water contaminated with faeces from an open storm water drainage: Kampala City, Uganda, January 2019

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel Eurien ◽  
Bernadette Basuta Mirembe ◽  
Angella Musewa ◽  
Esther Kisaakye ◽  
Benon Kwesiga ◽  
...  
Keyword(s):  
Drinking Water ◽  
Environmental Assessment ◽  
Case Fatality ◽  
Watery Diarrhoea ◽  
Suspected Case ◽  
Water Drainage ◽  
Cholera Outbreak ◽  
Local Council ◽  
Epidemic Curve ◽  
Kampala City

Abstract Background Kampala city slums, with one million dwellers living in poor sanitary conditions, frequently experience cholera outbreaks. On 6 January 2019, Rubaga Division notified the Uganda Ministry of Health of a suspected cholera outbreak in Sembule village. We investigated to identify the source and mode of transmission, and recommended evidence-based interventions. Methods We defined a suspected case as onset of profuse, painless, acute watery diarrhoea in a Kampala City resident (≥ 2 years) from 28 December 2018 to 11 February 2019. A confirmed case was a suspected case with Vibrio cholerae identified from the patient’s stool specimen by culture. We found cases by record review and active community case-finding. We conducted a case–control study in Sembule village, the epi-center of this outbreak, to compare exposures between confirmed case-persons and asymptomatic controls, individually matched by age group. We overlaid rainfall data with the epidemic curve to identify temporal patterns between rain and illnesses. We conducted an environmental assessment, interviewed village local council members, and tested water samples from randomly-selected households and water sources using culture and PCR to identify V. cholerae. Results We identified 50 suspected case-patients, with three deaths (case-fatality rate: 6.0%). Of 45 case-patients with stool samples tested, 22 were confirmed positive for V. cholerae O1, serotype Ogawa. All age groups were affected; persons aged 5–14 years had the highest attack rate (AR) (8.2/100,000). The epidemic curve showed several point-source outbreaks; cases repeatedly spiked immediately following rainfall. Sembule village had a token-operated water tap, which had broken down 1 month before the outbreak, forcing residents to obtain water from one of three wells (Wells A, B, C) or a public tap. Environmental assessment showed that residents emptied their feces into a drainage channel connected to Well C. Drinking water from Well C was associated with illness (ORM–H = 21, 95% CI 4.6–93). Drinking water from a public tap (ORM–H = 0.07, 95% CI 0.014–0.304) was protective. Water from a container in one of eight households sampled tested positive for V. cholerae; water from Well C had coliform counts ˃ 900/100 ml. Conclusions Drinking contaminated water from an unprotected well was associated with this cholera outbreak. We recommended emergency chlorination of drinking water, fixing the broken token tap, and closure of Well C.

scholarly journals Cholera Outbreak Caused by Drinking Unprotected Well Water Contaminated with Feces from an Open Storm Water Drainage — Kampala City, Uganda, January 2019

2020 ◽  
Author(s):  
Daniel Eurien ◽  
Bernadette Basuta Mirembe ◽  
Angella Musewa ◽  
Esther Kisaakye ◽  
Benon Kwesiga ◽  
...  
Keyword(s):  
Drinking Water ◽  
Environmental Assessment ◽  
Case Fatality ◽  
Watery Diarrhoea ◽  
Suspected Case ◽  
Water Drainage ◽  
Cholera Outbreak ◽  
Local Council ◽  
Epidemic Curve ◽  
Kampala City

Abstract Background: Kampala city slums, with one million dwellers living in poor sanitary conditions, frequently experience cholera outbreaks. On 6 January 2019, Lubaga Division notified the Uganda Ministry of Health of a suspected cholera outbreak in Sembule village. We investigated to identify the source and mode of transmission, and recommend evidence-based interventions.Methods: We defined a suspected case as onset of profuse, painless, acute watery diarrhoea in a Kampala City resident (≥2 years) from 28 December 2018 to 11 February 2019. A confirmed case was a suspected case with Vibrio cholerae identified from the patient’s stool specimen by culture or Polymerase Chain Reaction (PCR). We found cases by record review and active community case-finding. We conducted a case-control study in Sembule village, the epi-center of this outbreak, to compare exposures between confirmed case-persons and asymptomatic controls, individually matched by age group. We overlaid rainfall data with the epidemic curve to identify temporal patterns between rain and illnesses. We conducted an environmental assessment, interviewed village local council members, and tested water samples from randomly-selected households and water sources using culture and PCR to identify V. cholerae.Results: We identified 50 suspected case-patients, with three deaths (case-fatality rate: 6.0%). Of 45 case-patients with stool samples tested, 22 were confirmed positive for V. cholerae O1, serotype Ogawa. All age groups were affected; persons aged 5-14 years had the highest attack rate (AR) (8.2/100,000). The epidemic curve showed several point-source outbreaks; cases repeatedly spiked immediately following rainfall. Sembule village had a token-operated water tap, which had broken down one month before the outbreak, forcing residents to obtain water from one of three wells (Wells A, B, C) or a public tap. Environmental assessment showed that residents emptied their feces into a drainage channel connected to Well C. Drinking water from Well C was associated with illness (ORM-H=21, 95% CI: 4.6–93). Drinking water from a public tap (ORM-H=0.33, 95% CI: 0.13–0.86) and drinking boiled water (ORM-H=0.15, 95% CI: 0.036-0.59) were protective. Water from a container in one of eight households sampled tested positive for V. cholerae; water from Well C had coliform counts ˃900/100ml.Conclusions: Drinking contaminated water from an unprotected well was associated with this cholera outbreak. We recommended emergency chlorination of drinking water, fixing the broken token tap, and closure of Well C.

scholarly journals A prolonged cholera outbreak caused by drinking contaminated stream water, Kyangwali refugee settlement, Hoima District, Western Uganda: 2018

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Fred Monje ◽  
Alex Riolexus Ario ◽  
Angella Musewa ◽  
Kenneth Bainomugisha ◽  
Bernadette Basuta Mirembe ◽  
...  
Keyword(s):  
Environmental Assessment ◽  
Stream Water ◽  
Case Fatality ◽  
Fecal Coliforms ◽  
Watery Diarrhoea ◽  
Suspected Case ◽  
Water Tank ◽  
Cholera Outbreak ◽  
Republic Of Congo ◽  
Tank Water

Abstract Background On 23 February 2018, the Uganda Ministry of Health (MOH) declared a cholera outbreak affecting more than 60 persons in Kyangwali Refugee Settlement, Hoima District, bordering the Democratic Republic of Congo (DRC). We investigated to determine the outbreak scope and risk factors for transmission, and recommend evidence-based control measures. Methods We defined a suspected case as sudden onset of watery diarrhoea in any person aged ≥ 2 years in Hoima District, 1 February–9 May 2018. A confirmed case was a suspected case with Vibrio cholerae cultured from a stool sample. We found cases by active community search and record reviews at Cholera Treatment Centres. We calculated case-fatality rates (CFR) and attack rates (AR) by sub-county and nationality. In a case-control study, we compared exposure factors among case- and control-households. We estimated the association between the exposures and outcome using Mantel-Haenszel method. We conducted an environmental assessment in the refugee settlement, including testing samples of stream water, tank water, and spring water for presence of fecal coliforms. We tested suspected cholera cases using cholera rapid diagnostic test (RDT) kits followed by culture for confirmation. Results We identified 2122 case-patients and 44 deaths (CFR = 2.1%). Case-patients originating from Demographic Republic of Congo were the most affected (AR = 15/1000). The overall attack rate in Hoima District was 3.2/1000, with Kyangwali sub-county being the most affected (AR = 13/1000). The outbreak lasted 4 months, which was a multiple point-source. Environmental assessment showed that a stream separating two villages in Kyangwali Refugee Settlement was a site of open defecation for refugees. Among three water sources tested, only stream water was feacally-contaminated, yielding > 100 CFU/100 ml. Of 130 stool samples tested, 124 (95%) yielded V. cholerae by culture. Stream water was most strongly associated with illness (odds ratio [OR] = 14.2, 95% CI: 1.5–133), although tank water also appeared to be independently associated with illness (OR = 11.6, 95% CI: 1.4–94). Persons who drank tank and stream water had a 17-fold higher odds of illness compared with persons who drank from other sources (OR = 17.3, 95% CI: 2.2–137). Conclusions Our investigation demonstrated that this was a prolonged cholera outbreak that affected four sub-counties and two divisions in Hoima District, and was associated with drinking of contaminated stream water. In addition, tank water also appears to be unsafe. We recommended boiling drinking water, increasing latrine coverage, and provision of safe water by the District and entire High Commission for refugees.

scholarly journals A prolonged cholera outbreak caused by drinking contaminated stream water, Kyangwali Refugee Settlement, Hoima District, Western Uganda: 2018

2020 ◽  
Author(s):  
Fred Monje ◽  
Alex Riolexus Ario ◽  
Angella Musewa ◽  
Kenneth Bainomugisha ◽  
Bernadette Basuta Mirembe ◽  
...  
Keyword(s):  
Environmental Assessment ◽  
Stream Water ◽  
Case Fatality ◽  
Control Measures ◽  
Fecal Coliforms ◽  
Watery Diarrhoea ◽  
Suspected Case ◽  
Water Tank ◽  
Cholera Outbreak ◽  
Tank Water

Abstract Background: On 23 February 2018, the Uganda Ministry of Health (MOH) declared a cholera outbreak affecting more than 60 persons in Kyangwali Refugee Settlement, Hoima District, bordering the Democratic Republic of Congo (DRC). We investigated to determine the outbreak scope and risk factors for transmission, and recommend evidence-based control measures.Methods: We defined a suspected case as sudden onset of watery diarrhoea in any person aged ≥ 2 years in Hoima District, 1 February–9 May 2018. A confirmed case was a suspected case with Vibrio cholerae cultured from a stool sample. We found cases by active community search and record reviews at Cholera Treatment Centres. We calculated case-fatality rates (CFR) and attack rates (AR) by sub-county and nationality. In a case-control study, we compared exposure factors among case- and control-households. We estimated the association between the exposures and outcome using Mantel-Haenszel method. We conducted an environmental assessment in the refugee settlement, including testing samples of stream water, tank water, and spring water for presence of fecal coliforms. We tested suspected cholera cases using cholera Rapid Diagnostic Test (RDT) kits followed by culture for confirmation. Results: We identified 2122 case-patients and 44 deaths (CFR = 2.1%). Case-patients originating from DRC were the most affected (AR = 15/1000). The overall attack rate in Hoima District was 3.2/1000, with Kyangwali sub-county being the most affected (AR = 13/1000). The outbreak lasted four months, which was a multiple point-source. Environmental assessment showed that a stream separating two villages in Kyangwali Refugee Settlement was a site of open defecation for refugees. Among three water sources tested, only stream water was feacally-contaminated, yielding >100 CFU/100 ml. Of 130 stool samples tested, 124 (95%) yielded V. cholerae by culture. Stream water was most strongly associated with illness (OR = 14.2; 95%CI=1.5-133), although tank water also appeared to be independently associated with illness (OR = 11.6; 95%CI = 1.4–94). Persons who drank tank and stream water had a 17-fold higher odds of illness compared with persons who drank from other sources (OR = 17.3, 95%CI = 2.2–137). Conclusions: Our investigation demonstrated that this was a prolonged cholera outbreak that affected four sub-counties and two divisions in Hoima District, and was associated with drinking of contaminated stream water. In addition, tank water also appears to be unsafe. We recommended boiling drinking water, increasing latrine coverage, and provision of safe water by the District and entire High Commission for refugees.

scholarly journals A Prolonged Cholera Outbreak Caused by Drinking Contaminated Water from a Stream, Kyangwali Refugee Settlement, Hoima District, Western Uganda: February-May 2018

2020 ◽  
Author(s):  
Fred Monje ◽  
Alex Riolexus Ario ◽  
Angella Musewa ◽  
Kenneth Bainomugisha ◽  
Bernadette Basuta Mirembe ◽  
...  
Keyword(s):  
Environmental Assessment ◽  
Stream Water ◽  
Case Fatality ◽  
Control Measures ◽  
Fecal Coliforms ◽  
Watery Diarrhoea ◽  
Suspected Case ◽  
Water Tank ◽  
Cholera Outbreak ◽  
Tank Water

Abstract Background: On 23 February 2018, the Uganda Ministry of Health (MOH) declared a cholera outbreak affecting more than 60 persons in Kyangwali Refugee Settlement, Hoima District, bordering the Democratic Republic of Congo (DRC). We investigated to determine the outbreak scope and risk factors for transmission, and recommend evidence-based control measures.Methods: We defined a suspected case as sudden onset of watery diarrhoea in a person aged ≥2 years in Hoima District, 1 February-9 May 2018. A confirmed case was a suspected case with V. cholerae cultured from a stool sample. We found cases by active community search and record reviews at Cholera Treatment Centres. We calculated case-fatality rates (CFR) and attack rates (AR) by sub-county and nationality. In a case-control study, we compared exposure factors among case- and control-households. We conducted an environmental assessment in the refugee settlement, including testing samples of stream water, tank water, and spring water for presence of fecal coliforms. We tested suspected cholera cases using cholera Rapid Diagnostic Test (RDT) kits followed by culture for confirmation. Results: We identified 2,122 case-patients and 44 deaths (CFR=2.1%). Case-patients originating from DRC were the most affected (AR=15/1000). The overall attack rate in Hoima District was 3.2/1,000, with Kyangwali sub-county being the most affected (AR=13/1,000). The outbreak lasted 4 months, which was a multiple point-source. Environmental assessment showed that a stream separating two villages in Kyangwali Refugee Settlement was a site of open defecation for refugees. Among three water sources tested, only stream water was feacally-contaminated, yielding >100 CFU/100ml. Of 130 stool samples tested, 124 (95%) yielded V. cholerae by culture. Stream water was most strongly associated with illness (OR=14.2; CI=1.5-133), although tank water also appeared to be independently associated with illness (OR=11.6; CI=1.4-94). Persons who drank tank and stream water had a 17-fold higher odds of illness compared with persons who drank from other sources (OR=17.3, CI=2.2-137). Conclusions: Our investigation demonstrated that this was a prolonged cholera outbreak that affected 4 sub-counties and 2 divisions in Hoima District and was associated with drinking of contaminated stream water. In addition, tank water also appears to be unsafe. We recommended boiling drinking water, increasing latrine coverage, and provision of safe water by the District and entire High Commission for refugees.

scholarly journals A Prolonged Cholera Outbreak Caused by Drinking Contaminated Water from a Stream, Kyangwali Refugee Settlement, Hoima District, Western Uganda: February-May 2018

2020 ◽  
Author(s):  
Fred Monje ◽  
Alex Riolexus Ario ◽  
Angella Musewa ◽  
Kenneth Bainomugisha ◽  
Bernadette Basuta Mirembe ◽  
...  
Keyword(s):  
Environmental Assessment ◽  
Stream Water ◽  
Case Fatality ◽  
Control Measures ◽  
Fecal Coliforms ◽  
Watery Diarrhoea ◽  
Suspected Case ◽  
Water Tank ◽  
Cholera Outbreak ◽  
Tank Water

Abstract Background: On 23 February 2018, the Uganda Ministry of Health (MOH) declared a cholera outbreak affecting more than 60 persons in Kyangwali Refugee Settlement, Hoima District, bordering the Democratic Republic of Congo (DRC). We investigated to determine the outbreak scope and risk factors for transmission, and recommend evidence-based control measures.Methods: We defined a suspected case as sudden onset of watery diarrhoea in a person aged ≥2 years in Hoima District, 1 February-9 May 2018. A confirmed case was a suspected case with V. cholerae cultured from a stool sample. We found cases by active community search and record reviews at Cholera Treatment Centres. We calculated case-fatality rates (CFR) and attack rates (AR) by sub-county and nationality. In a case-control study, we compared exposure factors among case- and control-households. We conducted an environmental assessment in the refugee settlement, including testing of water samples from stream water, tank water, and spring water for presence of fecal coliforms. We tested suspected cholera cases using cholera Rapid Diagnostic Test (RDT) kits followed by culture for confirmation. Results: We identified 2,122 case-patients and 44 deaths (CFR=2.1%). Case-patients originating from DRC were the most affected (AR=15/1000). The overall attack rate in Hoima District was 3.2/1,000, with Kyangwali sub-county being the most affected (AR=13/1,000). The outbreak lasted 4 months, which was a multiple point-source. Environmental assessment showed that a stream separating two villages in Kyangwali Refugee Settlement was a site of open defecation for refugees. Among three water sources tested, only stream water was fecally-contaminated, yielding >100 CFU/100ml. Of 130 stool samples tested, 124 (95%) yielded V. cholerae by culture. Stream water was most strongly associated with illness (OR=14.2; CI=1.5-133), although tank water also appeared to be independently associated with illness (OR=11.6; CI=1.4-94). Persons who drank tank and stream water had a 17-fold higher odds of illness compared with persons who drank from other sources (OR=17.3, CI=2.2-137). Conclusions: Drinking contaminated stream water was associated with cholera outbreak. We recommended boiling drinking water, increasing latrine coverage, and provision of safe water by the District and United Nations High Commissioner for Refugees.

scholarly journals Descriptive epidemiology of cholera outbreak in Nigeria, January–November, 2018: implications for the global roadmap strategy

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kelly Osezele Elimian ◽  
Anwar Musah ◽  
Somto Mezue ◽  
Oyeronke Oyebanji ◽  
Sebastian Yennan ◽  
...  
Keyword(s):  
Public Health ◽  
Case Fatality ◽  
Northern Region ◽  
Watery Diarrhoea ◽  
Cholera Outbreak ◽  
North West ◽  
Design And Implementation ◽  
North East ◽  
The North ◽  
Outbreak Period

Abstract Background The cholera outbreak in 2018 in Nigeria reaffirms its public health threat to the country. Evidence on the current epidemiology of cholera required for the design and implementation of appropriate interventions towards attaining the global roadmap strategic goals for cholera elimination however seems lacking. Thus, this study aimed at addressing this gap by describing the epidemiology of the 2018 cholera outbreak in Nigeria. Methods This was a retrospective analysis of surveillance data collected between January 1st and November 19th, 2018. A cholera case was defined as an individual aged 2 years or older presenting with acute watery diarrhoea and severe dehydration or dying from acute watery diarrhoea. Descriptive analyses were performed and presented with respect to person, time and place using appropriate statistics. Results There were 43,996 cholera cases and 836 cholera deaths across 20 states in Nigeria during the outbreak period, with an attack rate (AR) of 127.43/100,000 population and a case fatality rate (CFR) of 1.90%. Individuals aged 15 years or older (47.76%) were the most affected age group, but the proportion of affected males and females was about the same (49.00 and 51.00% respectively). The outbreak was characterised by four distinct epidemic waves, with higher number of deaths recorded in the third and fourth waves. States from the north-west and north-east regions of the country recorded the highest ARs while those from the north-central recorded the highest CFRs. Conclusion The severity and wide-geographical distribution of cholera cases and deaths during the 2018 outbreak are indicative of an elevated burden, which was more notable in the northern region of the country. Overall, the findings reaffirm the strategic role of a multi-sectoral approach in the design and implementation of public health interventions aimed at preventing and controlling cholera in Nigeria.

scholarly journals A prolonged, community-wide cholera outbreak associated with drinking water contaminated by sewage in Kasese District, western Uganda

2017 ◽  
Vol 18 (1) ◽  
Author(s):  
Benon Kwesiga ◽  
Gerald Pande ◽  
Alex Riolexus Ario ◽  
Nazarius Mbona Tumwesigye ◽  
Joseph K. B. Matovu ◽  
...  
Keyword(s):  
Drinking Water ◽  
Cholera Outbreak ◽  
Western Uganda

scholarly journals High case fatality cholera outbreak in Western Kenya, August 2010

2013 ◽  
Vol 15 ◽  
Author(s):  
Dickens Onyango ◽  
Shirley Karambu ◽  
Ahmed Abade ◽  
Samuel Amwayi ◽  
Jared Omolo
Keyword(s):  
Case Fatality ◽  
Cholera Outbreak ◽  
Western Kenya

scholarly journals Evaluation of surveillance system for pneumonia in children below five years, Tema Metropolis, Ghana, 2012 – 2016

2020 ◽  
Vol 54 (2) ◽  
pp. 11-17
Author(s):  
Dora Dadzie ◽  
Adolphina Addo-Lartey ◽  
Nana Peprah ◽  
Ernest Kenu
Keyword(s):  
Surveillance System ◽  
Laboratory Data ◽  
Case Fatality ◽  
Information Management System ◽  
Case Definition ◽  
Health Staff ◽  
Suspected Case ◽  
Surveillance Systems ◽  
District Health ◽  
Under Five

Background: We evaluated the pneumonia surveillance system in Tema Metropolis to determine whether it is meeting its objectives and to assess its attributes.Design: Descriptive primary and secondary data analysisData Source: We interviewed health staff on the system’s operation and resources. We also extracted 2012-2016 surveillance dataset for under-five pneumonia cases and deaths from the District Health Information Management System for review.Participants: Health staffIntervention: The Centers for Disease Control (CDC) updated guidelines for evaluating surveillance systems was used to assess system attributes. Main outcome measure: state of the pneumonia surveillance system in TemaResults: A suspected case was defined as fast breathing in any child < 5 years old. The case definition was easy to apply, even at the community level. From 2012 to 2016, a total of 3,337 cases and 54 deaths (case fatality rate 1.6%) was recorded from 13 (23.6%) of 55 health facilities. Two epidemics were missed by the district because data were not being analysed. There were no laboratory data on antimicrobial resistance. Although reporting timeliness increased from 28.1% in 2012 to 83% in 2016, data inconsistencies existed between reporting levels.Conclusion: The surveillance system for under-five pneumonia in Tema Metropolis is simple, stable, flexible, timely,but of low sensitivity and acceptability, and only partly meeting its objectives. Major shortcomings are lack of laboratory data, non-use of data and low representativeness.Keywords: Under-five Pneumonia, Surveillance System Evaluation, Tema, GhanaFunding: The study was supported by a grant to author DB by the President’s Malaria Initiative (PMI) -CDC CoAg 6NU2GGH001876

scholarly journals Contaminated Pond Water Favors Cholera Outbreak at Haibatpur Village, Purba Medinipur District, West Bengal, India

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Dilip Kumar Biswas ◽  
Rama Bhunia ◽  
Dipankar Maji ◽  
Palash Das
Keyword(s):  
Risk Factors ◽  
Attack Rate ◽  
Stool Specimen ◽  
West Bengal ◽  
Health Workers ◽  
Pond Water ◽  
Underground Water ◽  
Control Measures ◽  
Cholera Outbreak ◽  
Epidemic Curve

Health workers reported an increased number of diarrhea cases at Haibatpur village on June 17, 2012. This outbreak was investigated with the followingobjectives: to confirm the existence of diarrhea outbreak, to find out the risk factors, and propose control measures. Cases were listed; spot map and epidemic curve were drawn. Attack rate was calculated by age and sex and risk factors were found out by calculating odds ratio (OR) with 95% confidence interval (CI). Rectal swabs were taken and water specimens were collected for laboratory test. Forty-one cases of patients were identified with overall attack rate (AR) was 5% (41/780). AR among men was higher 6% (25/404) than women. There was no death.V. cholerae01 Eltor Ogawa was isolated from one (1/4) stool specimen. Spot map showed cases clustered around two ponds which were contaminated with coliform organisms. The underground water was a bit saline in nature. Using pond water for preparation of fermented rice (Panta Bhat) (OR 4.73, 95% CI 1.69–13.51), washing utensil in pond water (OR 7.31, 95% CI 1.77–42.29) were associated with cholera outbreak. Health education was done to villagers. Disinfection of two ponds with bleaching powder was done. We proposed supplying of safe drinking water and repairing defective deep tube well to village.

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