Abstract
BackgroundCholera is newly emergent in Papua New Guinea but may soon become endemic. Identifying the risk factors for cholera provides evidence for targeted prevention and control measures.MethodsWe conducted a hospital-based case–control study to identify cholera risk factors. Using stool culture as the standard, we evaluated a cholera point of care test in the field.Results176 participants were recruited: 54 cases and 122 controls. Independent risk factors for cholera were: being over 20 years of age (aOR 2.5; 95%CI 1.1, 5.4), defecating in the open air (or river) (aOR 4.5; 95% CI 1.4, 14.4) and knowing someone who travelled to a cholera affected area (aOR 4.1; 95%CI 1.6, 10.7); while the availability of soap for handwashing at home was protective (aOR 0.41; 95%CI 0.19, 0.87). Those reporting access to a piped water distribution system in the home were twice as likely to report the availability of soap for handwashing. The sensitivity and specificity of the rapid test were 72% (95% CI 47–90) and 71% (95%CI 44–90%).ConclusionsImproving population access to the piped water distribution system and sanitation will likely reduce transmission by enabling enhanced hygiene and limiting the contamination of water sources. The One step V. cholerae O1/O139 Antigen Test is of limited utility for clinical decision making in a hospital setting with access to traditional laboratory methods. Settlement dwellers and mobile populations of all age groups should be targeted for interventions in Papua New Guinea.
Highlights
IntroductionIdentifying the risk factors for cholera provides evidence for targeted prevention and control measures
Cholera is newly emergent in Papua New Guinea but may soon become endemic
Cholera risk factors in the rural community setting in Papua New Guinea have been previously reported [6]; there is no information on cholera risk factors in the urban setting, where cholera transmission has been most sustained, especially in the informal settlements
Summary
Identifying the risk factors for cholera provides evidence for targeted prevention and control measures. Understanding the risk factors for cholera is important to enable the implementation of targeted prevention and control measures and to provide compelling specific evidence to government infrastructure decision makers. As of May 2011, Papua New Guinea has recorded over 15,000 cases of cholera at a case-fatality ratio of 3.2% [1]. Many of these cases presented to the longest running treatment centre in the country at Angau Memorial Hospital. Further risk factors include rainfall, seasonality, poor sanitation, travel, conflict, population displacement, health facilities with poor infection control and living near contaminated water sources. Cholera risk factors in the rural community setting in Papua New Guinea have been previously reported [6]; there is no information on cholera risk factors in the urban setting, where cholera transmission has been most sustained, especially in the informal settlements
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