Risk Factors for Self-Reported Cholera Within HIV-Affected Households in Rural Haiti

Richterman, Aaron; Cheung, Hoi Ching; Meiselbach, Mark K.; Jérôme, Gregory; Ternier, Ralph; Ivers, Louise C

doi:10.1093/ofid/ofy127

Cited by 8 publications

(13 citation statements)

References 24 publications

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“…In two recent studies in Haiti, where cholera is now endemic after being introduced in 2010, we found an independent association between household food insecurity and both reported history of cholera and reported death from cholera 10 11. Food insecurity is defined as a lack of stable access to food in adequate quantity or quality 12.…”

Section: Introductionmentioning

confidence: 74%

“…Our findings are consistent with individual and household-level analyses that we have previously reported from Haiti. In a multivariable analysis of 2320 people living in HIV-affected households, we found that severe household food insecurity was associated with a greater than threefold increase in an individual’s odds of reporting a history of cholera since the onset of the cholera epidemic in Haiti 10. In a subsequent study of the general population in Haiti using data from the 13 181 households in the 2012 Demographic and Health Survey, we similarly found that both moderate and severe household food insecurity were associated with a household reporting at least one member with history of cholera, independent of household wealth and other measured confounders 11.…”

Section: Discussionmentioning

confidence: 93%

“…Food insecurity is defined as a lack of stable access to food in adequate quantity or quality 12. Food insecurity is closely related to poverty,13 but has been linked to a variety of adverse health outcomes (including mortality) independent of wealth and other measured social determinants of health 10–12 14. The directionality of the relationship between food insecurity and cholera is unknown and may be bidirectional, as it is with other diseases 12 15.…”

Section: Introductionmentioning

confidence: 99%

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The inverse relationship between national food security and annual cholera incidence: a 30-country analysis

Richterman

Azman

Constant³

et al. 2019

BMJ Glob Health

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IntroductionIndividual and household-level evidence suggests a relationship between food insecurity and cholera risk. The relationship between national food security and the size of cholera outbreaks is unknown.MethodsWe analysed the relationship between national food security and annual cholera incidence rate from 2012 to 2015 across 30 countries. We used components of the Global Food Security Index (GFSI) as measures of food security. We included countries with available GFSI reporting cases of cholera during the study period, excluding high-income countries. We developed multivariable zero-inflated negative binomial models with annual cholera incidence rate as the outcome, GFSI components as the exposure of interest, fixed effects for country and year, and time-varying effects related to water, sanitation, and hygiene, oral cholera vaccine deployment, healthcare expenditure, conflict and extreme weather.ResultsThe 30 countries reported 550 106 total cases of cholera from 2012 to 2015, with a median annual incidence rate of 3.1 cases per 100 000 people (IQR 0.3–9.9). We found independent inverse relationships between cholera and Overall GFSI (incidence rate ratio (IRR) 0.57, 95% CI 0.43 to 0.78), GFSI-Availability (IRR 0.81, 95% CI 0.70 to 0.95) and GFSI-Affordability (IRR 0.76, 95% CI 0.62 to 0.92).ConclusionsWe identified a strong inverse relationship between national food security and annual incidence rate of cholera. In the context of prior evidence at the individual and household levels, this suggests that there is a linkage between food insecurity and cholera at the national level that should be further considered in assessing cholera risk in vulnerable regions and in designing cholera control interventions.

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Section: Introductionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The inverse relationship between national food security and annual cholera incidence: a 30-country analysis

Richterman

Azman

Constant³

et al. 2019

BMJ Glob Health

Self Cite

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“…Unfiltered results also suggest the presence of Candida albicans , Alspergillus fumigates and Pneumocystis jirovecii (the causative organism of Pneumocystis pneumonia ). All of these pathogenic fungi are of concern, especially in Haiti where HIV infection rates remain very high, and have been shown to be a risk factor in susceptibility to cholera in Haiti [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

A Metagenomic Approach to Evaluating Surface Water Quality in Haiti

Roy

Arnaud

Jasmin

et al. 2018

IJERPH

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The cholera epidemic that occurred in Haiti post-earthquake in 2010 has resulted in over 9000 deaths during the past eight years. Currently, morbidity and mortality rates for cholera have declined, but cholera cases still occur on a daily basis. One continuing issue is an inability to accurately predict and identify when cholera outbreaks might occur. To explore this surveillance gap, a metagenomic approach employing environmental samples was taken. In this study, surface water samples were collected at two time points from several sites near the original epicenter of the cholera outbreak in the Central Plateau of Haiti. These samples underwent whole genome sequencing and subsequent metagenomic analysis to characterize the microbial community of bacteria, fungi, protists, and viruses, and to identify antibiotic resistance and virulence associated genes. Replicates from sites were analyzed by principle components analysis, and distinct genomic profiles were obtained for each site. Cholera toxin converting phage was detected at one site, and Shiga toxin converting phages at several sites. Members of the Acinetobacter family were frequently detected in samples, including members implicated in waterborne diseases. These results indicate a metagenomic approach to evaluating water samples can be useful for source tracking and the surveillance of pathogens such as Vibrio cholerae over time, as well as for monitoring virulence factors such as cholera toxin.

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“…In a recent analysis of HIV-affected households in rural Haiti we found that household food insecurity was independently associated with reported history of cholera [30]. However, food insecurity and HIV-related outcomes are closely linked [9, 13, 14, 17, 31], and thus it is unknown whether this relationship exists among HIV-unaffected households.…”

Section: Introductionmentioning

confidence: 99%

Food insecurity and self-reported cholera in Haitian households: An analysis of the 2012 Demographic and Health Survey

Richterman

Franke

Constant³

et al. 2019

PLoS Negl Trop Dis

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BackgroundBoth cholera and food insecurity tend to occur in impoverished communities where poor access to food, inadequate sanitation, and an unsafe water supply often coexist. The relationship between the two, however, has not been well-characterized.MethodsWe performed a secondary analysis of household-level data from the 2012 Demographic and Health Survey in Haiti, a nationally and sub-nationally representative cross-sectional household survey conducted every five years. We used multivariable logistic regression to evaluate the relationship between household food security (as measured by the Household Hunger Scale) and (1) reported history of cholera since 2010 by any person in the household and (2) reported death by any person in the household from cholera (among households reporting at least one case). We performed a complete case analysis because there were <1% missing data for all variables.ResultsThere were 13,181 households in the survey, 2,104 of which reported at least one household member with history of cholera. After adjustment for potential confounders, both moderate hunger in the household [Adjusted Odds Ratio (AOR) 1.51, 95% Confidence Interval (CI) 1.30–1.76; p <.0001] and severe hunger in the household (AOR 1.73, 95% CI 1.45–2.08; p <.0001) were significantly associated with reported history of cholera in the household. Severe hunger in the household (AOR 1.85, 95% CI 1.05–3.26; p = 0.03), but not moderate hunger in the household, was independently associated with reported death from cholera in households with at least one case of cholera.ConclusionsIn this study we identified an independent relationship between household food insecurity and both reported history of cholera and death from cholera in a general population. The directionality of this relationship is uncertain and should be further explored in future prospective research.

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Risk Factors for Self-Reported Cholera Within HIV-Affected Households in Rural Haiti

Cited by 8 publications

References 24 publications

The inverse relationship between national food security and annual cholera incidence: a 30-country analysis

The inverse relationship between national food security and annual cholera incidence: a 30-country analysis

A Metagenomic Approach to Evaluating Surface Water Quality in Haiti

Food insecurity and self-reported cholera in Haitian households: An analysis of the 2012 Demographic and Health Survey

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