title: Epidemic cholera in Guinea-Bissau: the challenge of preventing deaths in rural West Africa.
abstract: OBJECTIVE
  An epidemiologic investigation was conducted to identify factors associated with cholera mortality in a rural African setting and interventions likely to prevent deaths in future epidemics.
  
  
  METHODS
  The authors reviewed surveillance data from rural Biombo, Guinea-Bissau, interviewed family members of persons who died of cholera, and conducted a case-control study in the catchment area of a health center with a high case:fatality ratio (CFR).
  
  
  RESULTS
  Forty-three deaths occurred among the 1169 persons who reported to health centers with cholera during the epidemic (CFR = 3.7%). Delayed rehydration and over-hydration probably contributed to 10 of these deaths. An additional 19 cholera deaths occurred outside health centers. In the case-control study, persons with cholera who died were 5.4 times (95% CI = 1.0-53.4) more likely to be in poor health or intoxicated at illness onset than persons with cholera who survived. Fatal cases were 6.0 times (95% CI = 1.1-60.8) more likely to not attend the health center than survivors.
  
  
  CONCLUSIONS
  The low overall CFR in Biombo, compared to CFRs reported during other epidemics in sub-Saharan Africa, suggests that medical care provided at rudimentary rural health centers prevented numerous deaths. Additional deaths may be prevented by strengthening the infrastructure of health services in the rural areas and by enhanced public education regarding the need for persons with cholera to promptly seek medical care.
authors.affiliation: Regional Health Board of Biombo, Ministry of Public Health, Bissau, Guinea-Bissau.
authors.forename: G
authors.initials: G
authors.lastname: Gunnlaugsson
authors.forename: F J
authors.initials: FJ
authors.lastname: Angulo
authors.forename: J
authors.initials: J
authors.lastname: Einarsdóttir
authors.forename: A
authors.initials: A
authors.lastname: Passa
authors.forename: R V
authors.initials: RV
authors.lastname: Tauxe
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000453:epidemiology / Q000401:mortality*; D003906:Developing Countries; D004196:Disease Outbreaks; D005260:Female; D006169:Guinea-Bissau / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012424:Rural Population; D014734:Vibrio cholerae / Q000302:isolation & purification*