The Pan African Medical Journal (Jun 2020)

A protracted cholera outbreak among residents in an urban setting, Nairobi county, Kenya, 2015

  • Hudson Taabukk Kigen,
  • Waqo Boru,
  • Zeinab Gura,
  • George Githuka,
  • Robert Mulembani,
  • Jacob Rotich,
  • Isack Abdi,
  • Tura Galgalo,
  • Jane Githuku,
  • Mark Obonyo,
  • Raphael Muli,
  • Ian Njeru,
  • Daniel Langat,
  • Peter Nsubuga,
  • Jackson Kioko,
  • Sara Lowther

DOI
https://doi.org/10.11604/pamj.2020.36.127.19786
Journal volume & issue
Vol. 36, no. 127

Abstract

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INTRODUCTION: In 2015, a cholera outbreak was confirmed in Nairobi county, Kenya, which we investigated to identify risk factors for infection and recommend control measures. METHODS: we analyzed national cholera surveillance data to describe epidemiological patterns and carried out a case-control study to find reasons for the Nairobi county outbreak. Suspected cholera cases were Nairobi residents aged 2 years with acute watery diarrhea (4 stools/â12 hours) and illness onset 1-14 May 2015. Confirmed cases had Vibrio cholerae isolated from stool. Case-patients were frequency-matched to persons without diarrhea (1:2 by age group, residence), interviewed using standardized questionaires. Logistic regression identified factors associated with case status. Household water was analyzed for fecal coliforms and Escherichia coli. RESULTS: during December 2014-June 2015, 4,218 cholera cases including 282 (6.7%) confirmed cases and 79 deaths (case-fatality rate [CFR] 1.9%) were reported from 14 of 47 Kenyan counties. Nairobi county reported 781 (19.0 %) cases (attack rate, 18/100,000 persons), including 607 (78%) hospitalisations, 20 deaths (CFR 2.6%) and 55 laboratory-confirmed cases (7.0%). Seven (70%) of 10 water samples from communal water points had coliforms; one had Escherichia coli. Factors associated with cholera in Nairobi were drinking untreated water (adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] 2.3-18.8), lacking health education (aOR 2.4, CI 1.1-7.9) and eating food outside home (aOR 2.4, 95% CI 1.2-5.7). CONCLUSION: we recommend safe water, health education, avoiding eating foods prepared outside home and improved sanitation in Nairobi county. Adherence to these practices could have prevented this protacted cholera outbreak.

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