Epidemiology of cholera outbreaks and socio-economic characteristics of the communities in the fishing villages of Uganda: 2011-2015

Abstract

BackgroundThe communities in fishing villages in the Great Lakes Region of Africa and particularly in Uganda experience recurrent cholera outbreaks that lead to considerable mortality and morbidity. We evaluated cholera epidemiology and population characteristics in the fishing villages of Uganda to better target prevention and control interventions of cholera and contribute to its elimination from those communities.Methodology/Principal findingsWe conducted a prospective study between 2011–15 in fishing villages in Uganda. We collected, reviewed and documented epidemiological and socioeconomic data for 10 cholera outbreaks that occurred in fishing communities located along the African Great Lakes and River Nile in Uganda. These outbreaks caused 1,827 suspected cholera cases and 43 deaths, with a Case-Fatality Ratio (CFR) of 2.4%. Though the communities in the fishing villages make up only 5–10% of the Ugandan population, they bear the biggest burden of cholera contributing 58% and 55% of all reported cases and deaths in Uganda during the study period. The CFR was significantly higher among males than females (3.2% vs. 1.3%, p = 0.02). The outbreaks were seasonal with most cases occurring during the months of April-May. Male children under age of 5 years, and 5–9 years had increased risk. Cholera was endemic in some villages with well-defined “hotspots”. Practices predisposing communities to cholera outbreaks included: the use of contaminated lake water, poor sanitation and hygiene. Additional factors were: ignorance, illiteracy, and poverty.Conclusions/SignificanceCholera outbreaks were a major cause of morbidity and mortality among the fishing communities in Uganda. In addition to improvements in water, sanitation, and hygiene, oral cholera vaccines could play an important role in the prevention and control of these outbreaks, particularly when targeted to high-risk areas and populations. Promotion and facilitation of access to social services including education and reduction in poverty should contribute to cholera prevention, control and elimination in these communities.

Epidemiological investigation of an acute gastroenteritis outbreak in a tribal village near Madhya Pradesh-Maharashtra border

“…In an outbreak investigation of cholera in western Kenya, 2015 by Oyugi, observed that 69% (36) reported having suffered abdominal pain and fever while 12%. 8 Date-wise analysis of number of cases revealed that number of cases were at its peak followed by sharp fall on subsequent days, this finding supports point source nature of the epidemic with single incubation period.…”

“…In an outbreak investigation of cholera in western Kenya, 2015 by Oyugi, it was observed that females constituted 61% (95/156) of all participants, The ages of 939 (96%) cases were recorded and their median age was 16 years (Range <1 to 100 years). 8 The age group 6-15 years had the highest number of cases at 27% (256), while the least cases were in the age group <2 years at 7% (72).…”

Infectious disease outbreaks in the African region: overview of events reported to the World Health Organization in 2018

“…vulnerable due to conflict, food insecurity, poor socio-economic status, environmental conditions, inadequate access to safe water and sanitation, and limited access to health services [31]. Furthermore, the ongoing and prolonged humanitarian crises in these countries drive population movements, thus facilitating the spread of the disease within and between countries as well as causing extensive deterioration of health, transport, shelter and water, sanitation and hygiene services [32,33].…”

Prolonging herd immunity to cholera via vaccination: Accounting for human mobility and waning vaccine effects

“…One practical implementation of the "Mass and Maintain" vaccination strategy in a camp setting can include a one-time mass vaccination campaign followed by routine vaccination of new members of the population, such as births and new entries. Population sub-groups with high vulnerability and mobility, such as coastal fishing communities, [41] may also benefit from the "Mass and Maintain" vaccination strategy targeted at seasonal influxes of migrants such as new fishermen. In an urban or open population, such as Dhaka or Calcutta, routine identification of new members becomes more challenging, but performance of the WHO Expanded Programme on Immunization in cholera endemic regions like Bangladesh are promising.…”