A cholera outbreak in a rural north central Nigerian community: an unmatched case-control study

Abstract

BACKGROUND: Cholera remains a disease of public health importance in Nigeria associated with high morbidity and mortality. In November 2014, the Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP) was notified of an increase in suspected cholera cases in Gomani, Kwali Local Government Area. NFELTP residents were deployed to investigate the outbreak with the objectives of verifying the diagnosis, identifying risk factors and instituting appropriate control measures to control the outbreak. METHODS: We conducted an unmatched case-control study. We defined a cholera case as any person aged ≥5 years with acute watery diarrhea in Gomani community. We identified community controls. A total of 43 cases and 68 controls were recruited. Structured questionnaires were administered to both cases and controls. Four stool samples from case-patients and two water samples from the community water source were collected for laboratory investigation. We performed univariate and bivariate analysis using Epi-Info version 7.1.3.10. RESULTS: The mean age of cases and controls was 20.3 years and 25.4 respectively (p value 0.09). Females constituted 58.1% (cases) and 51.5%(controls). The attack rate was 4.3% with a case fatality rate of 13%. Four stool (100%) specimen tested positive for Vibrio cholerae. The water source and environment were polluted by indiscriminate defecation. Compared to controls, cases were more likely to have drank from Zamani river (OR 14.2, 95% CI: 5.5-36.8) and living in households(HH) with more than 5 persons/HH (OR 5.9, 95% CI: 1.3-27.2). Good hand hygiene was found to be protective (OR 0.3, 95% CI: 0.1-0.7). CONCLUSION: Vibrio cholerae was the cause of the outbreak in Gomani. Drinking water from Zamani river, living in overcrowded HH and poor hand hygiene were significantly associated with the outbreak. We initiated hand hygiene and water treatment to control the outbreak.