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. 2020 Jun 25:36:127.
doi: 10.11604/pamj.2020.36.127.19786. eCollection 2020.

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

Hudson Taabukk Kigen  1   2 , Waqo Boru  1   2 , Zeinab Gura  1   2 , George Githuka  1   2 , Robert Mulembani  2   3 , Jacob Rotich  1   2 , Isack Abdi  1   2 , Tura Galgalo  2   4 , Jane Githuku  1   2 , Mark Obonyo  2   3 , Raphael Muli  5 , Ian Njeru  1   6 , Daniel Langat  1   6 , Peter Nsubuga  7 , Jackson Kioko  1 , Sara Lowther  8
Affiliations

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

Hudson Taabukk Kigen et al. Pan Afr Med J. .

Abstract

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/≤12 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.

Keywords: Cholera; Kenya; Nairobi; Vibrio cholerae; case-control; county; outbreak.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
spatial distribution of cholera cases per 100,000 population reported in 14 of the 47 counties in Kenya, December 2014 - June, 2015
Figure 2
Figure 2
spatial distribution of cholera cases per 100,000 population reported per sub-county, Nairobi county, Kenya, December, 2014 - June, 2015
Figure 3
Figure 3
cholera epidemic curve of Nairobi county in comparison with the national (14 counties) cholera outbreak (N =4218) by date of symptoms onset, December 2014 - June 2015, Kenya, 2015
Figure 4
Figure 4
an integrated Nairobi county cholera epidemic curve (N=781) and sub county panels by date of symptom onset showing persistent case reporting and multiple peaks, Nairobi county, Kenya, 2015
See this image and copyright information in PMC

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