Cholera outbreak investigation and its determinants in Enderta district of Tigray: a case-control study

Abstract

Background

In 2015, Ethiopia had an estimated 275,221 cholera cases. Death accounted for 10,458. Enderta district (population=125,739) cholera outbreak started on June 22, 2017. We have conducted this investigation to verify the outbreak and determine risk factors associated with cholera in Enderta district, Tigray, Ethiopia, in 2017.

Methods

Descriptive followed by 1:1 unmatched case-control study design was conducted from August 2-24, 2017. Case was defined as a person aged five years or more with a history of sudden onset of acute watery diarrhea, with three or more episodes of loose watery stool per day with or without vomiting residing in Enderta district. All 120 cholera patients from August 2-24 were included in the study. For each case one non diseased neighbor was selected as control. Interview of cases and controls was conducted using semi structured face to face interview. All the data collected from cases and controls were entered, cleaned and analyzed using SPSS version 22.

Results

We identified 120 cases, 79(65.8%) of them were males. There were two deaths and 119 (99.2%) were hospitalized. The median age of cases was 30 years (range 5-85 years) and for controls was 35 years [7-78]. Symptoms reported included diarrhea 120 (100%) and vomiting 115 (95.8%). Among 120 cases and 120 controls, drinking untreated river water [AOR (95% CI) =0.04 (0.02-0.12)], drinking a holy water [AOR (95% CI) = 22.9(3.6-145.6)] and close contact with cholera patient [AOR (95% CI) = 5.6 (6.2-27.08)] were associated with cholera in multivariable analysis.

Conclusions

Enderta district’s cholera outbreak was associated with drinking untreated river water, drinking a holy water and close contact with cholera patients. We recommend the Enderta district health office to provide water treating chemicals, health education, and hygiene promotion activities.