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. 2025 Jul 1;25(1):848.
doi: 10.1186/s12879-025-11219-4.

Cholera outbreak associated with drinking contaminated river water in Kayunga District, Uganda, June - August 2023

Adams Kamukama  1 , Yasiini Nuwamanya  2 , Edith Namulondo  2 , Leah Naluwagga Baliruno  2 , Irene Byakatonda Kyamwine  2 , Hildah Tendo Nansikombi  2 , Lilian Bulage  2 , Richard Migisha  2 , Benon Kwesiga  2 , Alex Riolexus Ario  2
Affiliations

Cholera outbreak associated with drinking contaminated river water in Kayunga District, Uganda, June - August 2023

Adams Kamukama et al. BMC Infect Dis. .

Abstract

Background: Cholera is endemic in Uganda with cases reported annually. On July 19, 2023, the Uganda Ministry of Health declared a cholera outbreak in Kayunga District following death of four family members within eight days and confirmation of Vibrio cholerae by culture. We investigated the outbreak to determine the magnitude and its mode of transmission and generate evidence to inform interventions.

Methods: We defined a suspected case of cholera as onset of acute watery diarrhea in a resident of Kayunga District aged ≥ 2 years during June 24-August 29, 2023. A confirmed case was a suspected case with Vibrio cholerae cultured from stool. We described cases, conducted an environmental assessment and performed an un-matched case-control study in Lusenke Village which was the epicenter of the outbreak. We used logistic regression to identify factors associated with cholera infection.

Results: We identified 78 case-patients (34 suspected and 44 confirmed); 10 (13%) died. Males were more affected than females (attack rate (AR) = 2.4 vs. 1.6/1,000). Lusenke Village was most affected (AR = 41/1,000). The outbreak began following a funeral of the index case in Kayonjo, an inland village on July 1, 2024. Eleven days later, cases were reported in the distant Lusenke Village. We observed evidence of open defecation, bathing, and washing clothes along the river banks where water for drinking and domestic use was harvested. Using unboiled/untreated river water domestically (Adjusted Odds Ratio (aOR) = 4.5, CI = 1.2-17) increased the odds of cholera infection. Drinking the water in addition to using it domestically further increased the likelihood of cholera infection (aOR = 17, CI = 3.8-78).

Conclusion: This was likely a propagated outbreak triggered by a funeral of a suspected case whose source of infection was unknown and amplified through contamination of river water used and drank by village members. The outbreak ended within one week after a public health ban on drinking and use of River Nile water, community sensitization and providing prophylactic antibiotics.

Keywords: Cholera; Outbreak; River Nile; Uganda.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This outbreak investigation was conducted as a response to a public health emergency, following a directive from the Uganda Ministry of Health. The study was approved by the United States Centers for Disease Control and Prevention (U.S CDC) human subject review board and conducted per the applicable federal law and CDC policy. §§See e.g., 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. § 241(d); 5 U.S.C. § 552a; 44 U.S.C. § 3501 et seq. Additionally, we obtained permission to conduct the investigation from the Kayunga District health authorities. We obtained verbal informed consent from participants who were ≥ 18 years old, or from their parents or guardians for those < 18 years (Appendix1). In addition, we obtained assent from participants below the age of 18. For those who had died, we obtained informed consent from their next-of-kin. We ensured confidentiality by conducting interviews in privacy ensuring that no one could follow proceedings of the interview. Unique identifiers were used and raw data were kept in a password protected computer and shared only among the investigation team. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Location of Kayunga District in Uganda
Fig. 2
Fig. 2
Attack rate by sub-county during a cholera outbreak in Kayunga District, Uganda, June–August, 2023
Fig. 3
Fig. 3
Clustering of cases around water collection points along River Nile during a cholera outbreak in Kayunga District, Uganda, June–August, 2023
Fig. 4
Fig. 4
Distribution of cases over time during the cholera outbreak in Kayunga District, Uganda, June–August, 2023
See this image and copyright information in PMC

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