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A cholera outbreak among semi-nomadic pastoralists in northeastern Uganda: epidemiology and interventions.

Authors
  • Cummings, M J
  • Wamala, J F
  • Eyura, M
  • Malimbo, M
  • Omeke, M E
  • Mayer, D
  • Lukwago, L
Type
Published Article
Journal
Epidemiology and Infection
Publisher
Cambridge University Press
Publication Date
Aug 01, 2012
Volume
140
Issue
8
Pages
1376–1385
Identifiers
DOI: 10.1017/S0950268811001956
PMID: 21943798
Source
Medline
License
Unknown

Abstract

In sub-Saharan Africa, many nomadic pastoralists have begun to settle in permanent communities as a result of long-term water, food, and civil insecurity. Little is known about the epidemiology of cholera in these emerging semi-nomadic populations. We report the results of a case-control study conducted during a cholera outbreak among semi-nomadic pastoralists in the Karamoja sub-region of northeastern Uganda in 2010. Data from 99 cases and 99 controls were analysed. In multivariate analyses, risk factors identified were: residing in the same household as another cholera case [adjusted odds ratio (aOR) 6·67, 95% confidence interval (CI) 2·83-15·70], eating roadside food (aOR 2·91, 95% CI 1·24-6·81), not disposing of children's faeces in a latrine (aOR 15·76, 95% CI 1·54-161·25), not treating drinking water with chlorine (aOR 3·86, 95% CI 1·63-9·14), female gender (aOR 2·43, 95% CI 1·09-5·43), and childhood age (10-17 years) (aOR 7·14, 95% CI 1·97-25·83). This is the first epidemiological study of cholera reported from a setting of semi-nomadic pastoralism in sub-Saharan Africa. Public health interventions among semi-nomadic pastoralists should include a two-faceted approach to cholera prevention: intensive health education programmes to address behaviours inherited from insecure nomadic lifestyles, as well as improvements in water and sanitation infrastructure. The utilization of community-based village health teams provides an important method of implementing such activities.

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