Abstract
Yemen was affected by a major cholera epidemic in 2016, while a civil war, which has devastated the country since March 2015, has exacerbated the humanitarian situation. Cholera is a disease caused by the bacterium Vibrio cholera, thus this study aims to analyze the epidemiological features of the outbreak and explore the relation of the outbreak to the current armed conflict situation. The data were obtained from the national surveillance system in Yemen. This contains details of 15,074 cases registered as suspected cholera patients per governorate from week 39 to 52 in 2016. In addition to the data concerning cholera, other data on conflict-related injuries, and population movement (numbers of Internally Displaced Persons - IDPs - and number of displaced returnees) were used to assess the correlation using Spearman's rho analysis. The data analysis shows the intensity of the conflict as measured by the total casualties per governorate (conflict-related injuries and death) is significantly correlated with the number of cholera cases per governorate (r 0.483, P = 0.026). The analysis also shows a positive, but not significant correlation between cholera cases, and both the number of conflict internal displaced people (IDPs) (r 0.389, P = 0.081), and number of returnees (r = 432, P = 0.050).
Highlights
Cholera is one of the crucial indicators of poor infrastructure and it is a continual risk to public health in the least developed countries worldwide [1]
The case fatality rate was 0.42 % which was much less than the case fatality rates during the outbreaks of 2009 and 2010 [17,18,19]. This cholera outbreak occurred during the ongoing armed conflict in Yemen in 2016, this study aims to analyze the epidemiological characteristics of the outbreak and the correlation between the current outbreak and ongoing armed conflict
Stool samples were collected from 824 suspected cholera cases around 5.5% of the total suspected cholera cases in 2016, twenty-six percent of the stool samples were positive of serotype O1 (Ogawa)
Summary
Cholera is one of the crucial indicators of poor infrastructure and it is a continual risk to public health in the least developed countries worldwide [1]. Poverty, overcrowding, poor hygiene, contaminated food, and lack of safe drinking water are the main risk factors for cholera that may be a consequence of conflict. Knowledge of the relationship between cholera and conflict is limited or unknown, in case of Yemen. This may be because cholera has an epidemic pattern, and affects a massive number of people across several areas of conflict. This is turn makes it difficult to manage outbreaks, due in particular to the lack of information [6]
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