Epidemic cholera in Kakuma Refugee Camp, Kenya, 2009: the importance of sanitation and soap

Abstract

Introduction: Cholera remains a major public health problem that causes substantial morbidity and mortality in displaced populations due to inadequate or unprotected water supplies, poor sanitation and hygiene, overcrowding, and limited resources. A cholera outbreak with 224 cases and four deaths occurred in Kakuma Refugee Camp in Kenya from September to December 2009. Methodology: We conducted a case-control study to characterize the epidemiology of the outbreak. Cases were identified by reviewing the hospital registry for patients meeting the World Health Organization (WHO) case definition for cholera. For each case a matched control was selected. A questionnaire focusing on potential risk factors was administered to cases and controls. Results: From 18 September to 15 December 2009, a total of 224 cases were identified and were hospitalised at Kakuma IRC hospital. Three refugees and one Kenyan national died of cholera. V. cholerae O1, serotype Inaba was isolated in 44 (42%) out of 104 stool specimens collected. A total of 93 cases and 93 matched controls were enrolled in the study. In a multivariate model, washing hands with soap was protective against cholera (adjusted odds ratio [AOR] =0.25[0.09-0.71]; p < 0.01), while presence of dirty water storage containers was a risk factor (AOR=4.39[1.12-17.14]; p=0.03). Conclusion: Provision of soap, along with education on hand hygiene and cleaning water storage containers, may be an affordable intervention to prevent cholera.

Sanitation practices and perceptions in Kakuma refugee camp, Kenya: Comparing the status quo with a novel service-based approach

“…With the rapid influx of refugees and constrained sanitation options, conditions in refugee camps are especially challenging. [5][6][7][8] Implementing well-designed sanitation solutions that aim to decrease exposure to human fecal waste can prevent diarrheal disease in refugee camps. [9][10]…”

Surveillance of bacterial pathogens of diarrhoea in two selected sub metros within the Accra metropolis

“…CFR ranging from less than 1% have been reported in Nigeria (781/3000) 15 and Kenya (4/224). 16 Cholera has generally been associated with poor sanitation often associated with displaced populations, and natural disasters. [17][18][19] It however appears that cholera is now endemic in the Accra metropolis, and this calls for an urgent need to strengthen surveillance systems.…”

Feasibility of a preventive mass vaccination campaign with two doses of oral cholera vaccine during a humanitarian emergency in South Sudan

“…Large-scale outbreaks have been documented among Rwandan refugees in the Democratic Republic of Congo in 1994, 2 in refugee camps in South Sudan in 2007 3 and among Somali refugees in Kenya in 2009. 4 Preventative cholera MVCs have so far been limited or restricted to small-scale interventions [5][6][7][8][9] and their use still debated. OCV has also been used in a preventative way in a complex emergency (Aceh, Indonesia in 2005) and in an internally displaced person camp (Darfur, Sudan, 2004).…”