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. 2016 Jun 3;11(6):e0156674.
doi: 10.1371/journal.pone.0156674. eCollection 2016.

Cross-Border Cholera Outbreaks in Sub-Saharan Africa, the Mystery behind the Silent Illness: What Needs to Be Done?

Godfrey Bwire  1 , Maurice Mwesawina  2 , Yosia Baluku  3 , Setiala S E Kanyanda  2 , Christopher Garimoi Orach  4
Affiliations

Cross-Border Cholera Outbreaks in Sub-Saharan Africa, the Mystery behind the Silent Illness: What Needs to Be Done?

Godfrey Bwire et al. PLoS One. .

Abstract

Introduction: Cross-border cholera outbreaks are a major public health problem in Sub-Saharan Africa contributing to the high annual reported cholera cases and deaths. These outbreaks affect all categories of people and are challenging to prevent and control. This article describes lessons learnt during the cross-border cholera outbreak control in Eastern and Southern Africa sub-regions using the case of Uganda-DRC and Malawi-Mozambique borders and makes recommendations for future outbreak prevention and control.

Materials and methods: We reviewed weekly surveillance data, outbreak response reports and documented experiences on the management of the most recent cross-border cholera outbreaks in Eastern and Southern Africa sub-regions, namely in Uganda and Malawi respectively. Uganda-Democratic Republic of Congo and Malawi-Mozambique borders were selected because the countries sharing these borders reported high cholera disease burden to WHO.

Results: A total of 603 cross-border cholera cases with 5 deaths were recorded in Malawi and Uganda in 2015. Uganda recorded 118 cases with 2 deaths and CFR of 1.7%. The under-fives and school going children were the most affected age groups contributing 24.2% and 36.4% of all patients seen along Malawi-Mozambique and Uganda-DRC borders, respectively. These outbreaks lasted for over 3 months and spread to new areas leading to 60 cases with 3 deaths, CRF of 5%, and 102 cases 0 deaths in Malawi and Uganda, respectively. Factors contributing to these outbreaks were: poor sanitation and hygiene, use of contaminated water, floods and rampant cross-border movements. The outbreak control efforts mainly involved unilateral measures implemented by only one of the affected countries.

Conclusions: Cross-border cholera outbreaks contribute to the high annual reported cholera burden in Sub-Saharan Africa yet they remain silent, marginalized and poorly identified by cholera actors (governments and international agencies). The under-fives and the school going children were the most affected age groups. To successfully prevent and control these outbreaks, guidelines and strategies should be reviewed to assign clear roles and responsibilities to cholera actors on collaboration, prevention, detection, monitoring and control of these epidemics.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The map of Africa showing the location of Uganda and Malawi and the neighboring countries on the study borders.
Fig 2
Fig 2
The map of Malawi (2a) and Uganda (2b) showing the location of the cholera affected districts and the distribution of the cholera cases in the study area.
Fig 3
Fig 3. Reported cross-border cholera cases in Malawi and Uganda in 2015.
Fig 4
Fig 4. The distribution of cholera cases by country of origin and sex.
Fig 5
Fig 5. The age distribution of cross-border cholera cases reported in Malawi and Uganda cholera treatment centres in 2015.
See this image and copyright information in PMC

References

    1. Naidoo A, Patric K. Cholera: a continuous epidemic in Africa. J R Soc Promot Health. 2002;122(2):89–94. - PubMed
    1. Gaffga NH, Tauxe RV, Mintz ED. Cholera: A new homeland in Africa? Am J Trop Med Hyg. 2007;77(4):705–13. - PubMed
    1. Bhattacharya S, Black R, Bourgeois L, Clemens J, Cravioto A, Deen JL, et al. Public health. The cholera crisis in Africa. Science. 2009;324(5929):885 10.1126/science.1173890 - DOI - PubMed
    1. Okeke IN. Africa in the Time of Cholera: A History of Pandemics from 1817 to the Present. Emerging Infectious Diseases. 2012. p. 362–362.
    1. Mengel MA, Delrieu I, Heyerdahl L, Gessner BD. Cholera outbreaks in Africa. Current Topics in Microbiology and Immunology. 2014. p. 117–44. - PubMed