High Mortality in a Cholera Outbreak in Western Kenya after Post-Election Violence in 2008

Abstract

Abstract. In 2008, a cholera outbreak with unusually high mortality occurred in western Kenya during civil unrest after disputed presidential elections. Through active case finding, we found a 200% increase in fatal cases and a 37% increase in surviving cases over passively reported cases; the case-fatality ratio increased from 5.5% to 11.4%. In conditional logistic regression of a matched case-control study of fatal versus non-fatal cholera infection, home antibiotic treatment (odds ratio [OR] 0.049; 95% CI: < 0.001-0.43), hospitalization (OR, 0.066; 95% CI, 0.001-0.54), treatment in government-operated health facilities (OR, 0.15; 95% CI, 0.015-0.73), and receiving education about cholera by health workers (OR, 0.19; 95% CI, 0.018-0.96) were protective against death. Among 13 hospitalized fatal cases, chart review showed inadequate intravenous and oral hydration and substantial staff and supply shortages at the time of admission. Cholera mortality was under-reported and very high, in part because of factors exacerbated by widespread post-election violence.

Epidemiology of an outbreak of cholera in a south-west state of Nigeria

“…[3][4][5] The epidemic curve in our investigation suggests a common source, followed by limited person-to-person transmission. In addition, a time lag of nine days was observed between the occurrence of the index case and the report of the outbreak to local public health authorities.…”

“…The case fatality rates were lower in outbreaks that were reported from other African countries: Guinea-Bissau (3.4%), Zambia (3.5%), Tanzania (2.1%) and Zimbabwe (2.9%). 3 The outbreak in this study coincided with a period of industrial action which may have limited access to healthcare facilities.…”

“…Therefore, disease surveillance records were relied on largely, which may not have been completed and might have been influenced by political or other considerations. 3 Furthermore, the current outbreak was not confirmed using the conventional culture methods. However, the diagnostic performance, utility and limitations of the cholera dipstick test kit that was used have been described.…”

“…[3][4][5][6][7][8][9][10] In addition, the distribution of cases in the local government areas was similar to the spread of the cholera outbreak in western Kenya, where 10 (48%) of 21 districts were affected in one province. 3 In this Cholera is endemic in Nigeria. 2,3,11,12 This follows the worldwide cholera epidemic of 1970.…”

“…3 In this Cholera is endemic in Nigeria. 2,3,11,12 This follows the worldwide cholera epidemic of 1970. 12 With rapid urbanisation and population growth, coupled with inadequate sanitation, inadequate water supply and poor sewage disposal, most towns in Nigeria are at risk of cholera outbreaks.…”