High case fatality cholera outbreak in Western Kenya, August 2010

Abstract

IntroductionCholera is a disease caused by the bacterium Vibrio cholera and has been an important public health problem since its first pandemic in 1817. Kenya has had numerous outbreaks of cholera ever since it was first detected there during 1971. In August 2010 an outbreak of cholera occurred in Kuria West District spreading to the neighboring Migori District. We conducted an investigation in order to determine the magnitude of the problem and institute control measures.MethodsIn order to update the line lists we reviewed records in Migori and Kuria district hospitals and conducted active case search in the community between 30th August and 6th September 2010. Data was analyzed using Epi-Info 3.5.2.ResultsA total of 114 cases and with 10 deaths (Case Fatality Rate = 9%) were documented. The index case was an 80 years old woman from Mabera Division who had hosted a cultural marriage ceremony a day before the outbreak. The mean age of case patients was 34.5 years (Standard Deviation=23.4) with a range 5 to 80 years. Females accounted for 61.4% of cases; people aged 10-39 years accounted 46.9%, those 40-69 years accounted for 29.2% and those above 70 years accounted for 9.7% of the cases. Sixty percent of deaths occurred among patients aged 50 years and over, case fatality rate was highest in this age group (16.7%) followed by those aged 40-49 years (12.5%), 20-29 years (10%) and 10-19 years (4.8%). The outbreak was confirmed within 2 weeks of onset after one (16.7%) of the six samples taken tested positive for V. cholera (serotype Inaba).ConclusionHigh case fatality rate and late laboratory confirmation was noted in this outbreak. There was urgent need to capacity build the districts on cholera case management, outbreak management, and equip the Migori District Hospital laboratory to allow prompt confirmation.

Health seeking behaviour among suspected cases of cholera in Cameroonian health districts in Lake Chad basin

“…The delay between the onset of diarrhoea and seeking care in this study is sufficient to increase the disease seriousness and the death rate since cholera has the capacity to kill within hours of the onset of symptoms [ 10 , 11 ]. To the best of our knowledge, previous studies have not considered this element of the disease when describing the health seeking behaviour of patients.…”

“…These case fatality rates are too high compared to what is expected. According to the WHO, if case management is completed correctly, the CFR would be <1% [ 11 ]. The objective of the study is to determine if health seeking behaviour of patients suspected of cholera determines the outcome of their illnesses.…”

“…Delays in care-seeking and incorrect case management have been identified by many authors to be responsible for high CFR of Diarrhoeal diseases [ 1 , 11 – 14 ]. Possible explanations of high CFR in Cameroon can be that patients arrive in the health facilities when their conditions are already critical (late arrival), insufficient number of personnel and insufficient supplies (ORS, ringer, antibiotics etc.)…”

An outbreak of cholera in western Kenya, 2015: a case control study

“…The MoH and partners in the two counties had put up several cholera treatment centres and distributed chlorine tablets to the households. In addition, patient follow up and tracing of close contacts was done and these significantly contributed to keeping the CFR lower compared to 2010 outbreak in Migori which had a CFR of 9% [ 16 ]. That study recommended early detection and confirmation of outbreaks in the area, a gap which we still observed in this study.…”

“…During outbreaks, water treatment using chlorine and provision of clean piped water to the populace, and proper handwashing are key measures of intervention [ 3 , 15 ]. In Western Kenya, Migori county experienced previous cholera outbreak in the year 2010 that had a high case fatality rate (CFR) of 9% and one of the contributory factors to this high CFR was the delay in laboratory confirmation of the suspected cases at the beginning of the outbreak [ 16 ]. On February 5, 2015, the Ministry of Health (MOH) was notified of an increase in the number of patients presenting with acute watery diarrhea in two counties located in Western Kenya, including four deaths.…”