Abstract
IntroductionIn early October 2015, the health facility in Mahama, a refugee camp for Burundians, began to record an increase in the incidence of a disease characterized by fever, chills and abdominal pain. The investigation of the outbreak confirmed Salmonella Typhi as the cause. A case-control study was conducted to identify risk factors for the disease.MethodsA retrospective matched case-control study was conducted between January and February 2016. Data were obtained through a survey of matched cases and controls, based on an epidemiological case definition and environmental assessment. Odd ratios were calculated to determine the risk factors associated with typhoid fever.ResultsOverall, 260 cases and 770 controls were enrolled in the study. Findings from the multivariable logistic regression identified that having a family member who had been infected with S. Typhi in the last 3 months (OR 2.7; p < 0.001), poor awareness of typhoid fever (OR 1.6; p = 0.011), inconsistent hand washing after use of the latrine (OR 1.8; p = 0.003), eating food prepared at home (OR 2.8; p < 0.001) or at community market (OR 11.4; p = 0.005) were risk factors for typhoid fever transmission. Environmental assessments established the local sorghum beer and yoghurt were contaminated with yeast, aerobic flora, coliforms or Staphylococcus.ConclusionThese findings highlight the need of reinforcement of hygiene promotion, food safety regulations, hygiene education for beverage and food handlers in community market and intensification of environmental interventions to break the transmission of S.Typhi in Mahama.
Highlights
In early October 2015, the health facility in Mahama, a refugee camp for Burundians, began to record an increase in the incidence of a disease characterized by fever, chills and abdominal pain
Commencing in early October 2015, the camp health facility began to record an increase in the incidence of a disease characterized by fever, chills and abdominal pain
Descriptive epidemiology of the outbreak: The analysis of retrospective data collected from patients' clinical records showed that the index case reported to the health facility on 6 October 2015
Summary
In early October 2015, the health facility in Mahama, a refugee camp for Burundians, began to record an increase in the incidence of a disease characterized by fever, chills and abdominal pain. The index case was a 24-year-old male, who presented at the Mahama camp health center on 6 October 2015, complaining of fever, chills, headache, abdominal pain, diarrhea and vomiting, lasting for an unknown period of time He was treated with antibiotics for 7 days without improvement and subsequently referred to the nearby Kirehe district hospital for further investigation, as a suspected case of sepsis. Following confirmation of the outbreak, prevention and control measures such as active surveillance, case management, community mobilization and hygiene education, improvement in sanitation and provision of clean water were scaled up in the camp Despite these interventions, which resulted in availability of adequate clean water and sanitation facilities, the number of cases continued to increase, demonstrating the need for a better understanding of the risk factors and pathways for transmission of the disease.
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