Abstract
Introductionin February 2015, an outbreak of acute watery diarrhea was reported in two sub counties in western Kenya. Vibrio cholerae 01 serotype Ogawa was isolated from 26 cases and from water samples collected from a river mainly used by residents of the two sub-counties for domestic purposes. We carried out an investigation to determine factors associated with the outbreak.Methodswe conducted a frequency matched case control study in the community. We defined cases as episodes of watery diarrhea (at least three motions in 24 hours) in persons ≥ 2 years who were residents of Rongo or Ndhiwa sub-counties from January 23-February 25, 2015. Cases were systematically recruited from a cholera line list and matched to two controls (persons without diarrhea since January 23, 2015) by age category and residence. A structured questionnaire was administered to evaluate exposures in cases and controls and multivariable logistic regression done to determine independent factors associated with the outbreak.Resultswe recruited 52 cases and 104 controls. Females constituted 61% (95/156) of all participants. Overall latrine coverage was 58% (90/156). Latrine coverage was 44% (23/52) for cases and 64% (67/104) for controls. Having no latrine at home (aOR = 10.9; 95% CI: 3.02-39.21), practicing communal hand washing in a basin (aOR = 6.5; 95% CI: 2.30-18.11) and vending of food as an occupation (aOR = 3.4; 95% CI: 1.06-10.74) were independently associated with the outbreak.Conclusionpoor latrine coverage and personal hygiene practices were identified as the main drivers of the outbreak. We recommended improved public health education on latrine usage and promotion of hand washing with soap and water in the community.
Highlights
Cholera is a diarrheal disease caused by the ingestion of bacterium Vibrio cholera in faecally contaminated water or food, and it presents with a sudden onset of acute watery diarrhea leading to severe dehydration that can be fatal [1]
Proper handwashing technique with water and soap, both before meals and after defecation is an intervention that was reported as a protective factor in a study in Zambia [18]
Handwashing should be promoted during health promotion campaigns in the community as part of behavior change communication during outbreak situations
Summary
Cholera is a diarrheal disease caused by the ingestion of bacterium Vibrio cholera in faecally contaminated water or food, and it presents with a sudden onset of acute watery diarrhea leading to severe dehydration that can be fatal [1]. It remains a challenge in poor countries with improper sanitation, inadequate water supply, unprotected water sources and crowded or displaced populations [2,3,4,5,6]. Our objectives were to determine the magnitude of the outbreak in the two counties, characterize the cholera cases in terms of time, place and person and identify risk factors for the outbreak
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