Major Stressors Favoring Cholera Trigger and Dissemination in Guinea-Bissau (West Africa).

Ana Machado,Eva Amorim,Adriano A Bordalo

doi:10.3390/ijerph182111296

Abstract

Cholera remains a heavy burden worldwide, especially in Sub-Saharan African countries, which account for the majority of the reported cases on the continent. In this study, a 27-year retrospective analysis of cholera epidemics in Guinea-Bissau was performed in order to highlight major stressors fueling the trigger and dissemination of the disease. Although the role of environmental factors did not always have the same degree of importance for the onset of epidemics, a cholera seasonal pattern was clearly perceived, with most of the reported cases occurring during the wet season. The generated theoretical hypothesis indicated rainfall above climatological average, associated with a lack of WASH (water, sanitation and hygiene) infrastructure, and the occurrence of concomitant epidemics in neighboring countries as the key indicators for optimal conditions for cholera to thrive in Guinea-Bissau. Warmer air temperature, the increase in sea surface temperature, and the decrease in salinity in the coastal areas may also contribute to the emergence and/or aggravation of cholera events. Prediction of the conditions favorable for cholera growth and identification of risk pathways will allow the timely allocation of resources, and support the development of alert tools and mitigation strategies.

Highlights

Since the turn of the century, there has been an increasing concern with identifying and addressing the factors driving water-associated infectious diseases observed worldwide [1].With millions of cases emerging every year, cholera, an acute, secretory diarrhea disease transmitted by the consumption of contaminated drinking water and food, still poses a serious health problem worldwide, especially in low- and middle-income countries.Africa, alone, accounts for the large majority of the worldwide officially notified cholera cases and associated deaths each year, with a cholera fatality rate (CFR) of 2.28%, which is nearly double the global average (~1%) in non-African regions [2]
Cholera is endemic in Guinea-Bissau [44], being first officially stated in 1986, the Portuguese army colonial medical services, in 1973, had already referred several cases in the hinterland
A clear increase in cholera outbreaks was noticed from the mid-1990s onwards

Summary

Introduction

Since the turn of the century, there has been an increasing concern with identifying and addressing the factors driving water-associated infectious diseases observed worldwide [1].With millions of cases emerging every year, cholera, an acute, secretory diarrhea disease transmitted by the consumption of contaminated drinking water and food, still poses a serious health problem worldwide, especially in low- and middle-income countries.Africa, alone, accounts for the large majority of the worldwide officially notified cholera cases and associated deaths each year, with a cholera fatality rate (CFR) of 2.28%, which is nearly double the global average (~1%) in non-African regions [2]. In order to tackle the problem, in 2017, the Global Task Force on Cholera Control (GTFCC) launched a global strategy on cholera control, Ending Cholera: A Global Roadmap to 2030, with the objective of reducing cholera deaths by 90% worldwide [5]. This multisectoral approach is closely associated with the United Nations Sustainable Development Goals, to ensure access to clean water and sanitation for all, to reduce existing inequities, and to promote healthy lives and well-being at all ages [6]

Objectives

Methods

Results

Conclusion