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. 2014 Oct 1;3(1):37.
doi: 10.1186/2049-9957-3-37. eCollection 2014.

Interaction between climatic, environmental, and demographic factors on cholera outbreaks in Kenya

James D Stoltzfus  1 , Jane Y Carter  2 , Muge Akpinar-Elci  3 , Martin Matu  2 , Victoria Kimotho  2 , Mark J Giganti  1 , Daniel Langat  3 , Omur Cinar Elci  1
Affiliations

Interaction between climatic, environmental, and demographic factors on cholera outbreaks in Kenya

James D Stoltzfus et al. Infect Dis Poverty. .

Abstract

Background: Cholera remains an important public health concern in developing countries including Kenya where 11,769 cases and 274 deaths were reported in 2009 according to the World Health Organization (WHO). This ecological study investigates the impact of various climatic, environmental, and demographic variables on the spatial distribution of cholera cases in Kenya.

Methods: District-level data was gathered from Kenya's Division of Disease Surveillance and Response, the Meteorological Department, and the National Bureau of Statistics. The data included the entire population of Kenya from 1999 to 2009.

Results: Multivariate analyses showed that districts had an increased risk of cholera outbreaks when a greater proportion of the population lived more than five kilometers from a health facility (RR: 1.025 per 1% increase; 95% CI: 1.010, 1.039), bordered a body of water (RR: 5.5; 95% CI: 2.472, 12.404), experienced increased rainfall from October to December (RR: 1.003 per 1 mm increase; 95% CI: 1.001, 1.005), and experienced decreased rainfall from April to June (RR: 0.996 per 1 mm increase; 95% CI: 0.992, 0.999). There was no detectable association between cholera and population density, poverty, availability of piped water, waste disposal methods, rainfall from January to March, or rainfall from July to September.

Conclusion: Bordering a large body of water, lack of health facilities nearby, and changes in rainfall were significantly associated with an increased risk of cholera in Kenya.

Keywords: Cholera; Education; Health infrastructure; Population density; Poverty; Rainfall; Waste disposal; Water supply.

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Figures

Figure 1
Figure 1
Reported number of cholera cases and average rainfall across the 69 districts in Kenya, by year.
Figure 2
Figure 2
District-level distribution of cholera cases and various demographic characteristics in Kenya. (1) Combined number of cholera cases reported per district in eight separate years: 1999–2001, 2003, 2005, 2007–2009. (2) Population density (persons/km2), per district. (3) Percentage of the Muslim population, per district. (4) Percentage of the population older than six years of age who never attended school, per district. (5) Percentage of the population per district below the rural poverty line (set at $1,239 Ksh [$13.34 USD] per day). Sources: Cholera data: Division of Disease Surveillance and Response. All other variables: 2005/06 Integrated Household Budget Survey.
Figure 3
Figure 3
District-level distribution of cholera cases and various environmental characteristics in Kenya. (1) Combined number of cholera cases reported per district in eight separate years: 1999–2001, 2003, 2005, 2007–2009. (2) Percentage of the population per district without piped water supply. (3) Same as Map 1, plus the distribution of water bodies and flood plains. (4) Percentage of the population per district with unsafe sanitary facilities defined as anything other than flush toilet, ventilated improved pit latrine, or pit latrine. (5) Percentage of the population per district who lives five or more km away from a health facility. Sources: Cholera data: Division of Disease Surveillance and Response. Water bodies and floodplain data: World Resource Institute. All other variables: 2005/06 Integrated Household Budget Survey.
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