Factors Associated with Fatal Outcomes Following Cholera-Like Syndrome in Far North Region of Cameroon: A Community-Based Survey

Abstract

This study demonstrates that most cholera deaths in this region of Cameroon occur out of hospital. This is a region which is prone to cholera, and interventions are needed to improve access to emergency medical care, especially during cholera outbreaks. Cameroon has experienced 14 cholera epidemics during the last 20 years, and these have had high case fatality rates. This study attempted to assess the effect of delays in seeking care and the locations of care as possible risk factors for cholera mortality. The study used data from a community-based survey regarding the circumstances of 97 fatal cases and 197 control (nonfatal) cases following a cholera-like syndrome in villages with cholera-like diseases during cholera outbreaks in Cameroon during 2009-2011. Deaths occurred in one of four environments: the community, in a temporary community treatment center (TCTC), in transit to a treatment center, or in a hospital (39%, 32%, 5%, and 24%, respectively). Using a case-control analysis, factors associated with deaths included the nonuse of a cholera treatment center, receiving health care in a TCTC instead of a hospital, and greater than 4 hours delay between the onset of symptoms and the decision to go to a treatment center (odds ratios of 17.1 [confidence interval (CI): 7.0-41.8], 2.5 [CI: 1.2-5.0], and 2.2 [CI: 1.0-4.6], respectively). During cholera epidemics, a higher proportion of deaths are still occurring in communities. The nonuse and delays in deciding to go a treatment center, and treatment at TCTC rather than a hospital were risk factors for death among patients with cholera-like syndrome in Cameroon. Informing people on community management of cholera-like syndrome and improving care in all health facilities are needed to reduce deaths during cholera epidemics.

Risk and Protective Factors for Cholera Deaths during an Urban Outbreak—Lusaka, Zambia, 2017–2018

“…17 However, this is the first study to identify lower education as a risk factor for cholera mortality. 12,13,[18][19][20][21][22] The increased odds of cholera mortality in those with lower education levels, in the context of an affected population with potentially similar SES, emphasizes the importance of education as a key contributor to one's health and well-being. A lower education level can inhibit one's ability to protect oneself from diseases, such as cholera.…”

Health facility preparedness for cholera outbreak response in four cholera-prone districts in Cameroon: a cross sectional study

“…Though close to 75% of the health facilities had personnel trained on cholera surveillance in the last 12 months, most of them were working in urban health facilities in Douala. Interestingly, only 33% facilities had trained personnel in Kousseri Health district which is one of the most affected districts during recent epidemics [2, 19]. Also, some essential surveillance materials like case definition, reporting forms, investigation forms, and stool bottles were still lacking in the majority of the facilities.…”

“…As a consequence, this may increase the attack and death rates of the outbreak. A study in the Far North region of Cameroon revealed that a good number of deaths from cholera occurred in the healthcare facilities [13]. The objective of this study was to evaluate the level of preparedness of health facilities to cope with any sudden cholera outbreak in four cholera hotspot districts in Cameroon.…”

Cholera Epidemic — Lusaka, Zambia, October 2017–May 2018

“…In the current outbreak, a higher percentage of deaths occurred in the community (59%) than in CTCs (41%). Delay in seeking care is a known risk factor for cholera mortality but is most often associated with outbreaks in rural areas where transportation and distance to care are limiting factors ( 9 ). Preliminary qualitative data and community reports indicate that stigma over concern about being associated with poor hygiene might have played a role in patients delaying seeking care in Lusaka; findings from the KAP survey indicated that residents associated cholera with poor hygiene.…”