[Five years of cholera surveillance in Ivory Coast during social and political crisis, 2001 to 2005].
For an efficient struggle against infectious diseases with epidemic potential, the Cdte d'Ivoire set up a precocious alert system in 2001 with a main objective: to detect epidemics of cholera, measles, yellow fever and meningitis and to provide necessary information for their control and their prevention. During the 2001 to 2005 period, the country was marked by military and political crisis which occurred in 2002; the country had to face up to a reappearance of cholera. How did it evolve in such a context? The question was to describe the performances of the system and the evolution of cholera from weekly data collected by the centers of epidemiological monitoring in health districts. The cases and declared deaths were compiled and the indicators of morbidity and mortality were then studied according to time site and individual features on the period of 2001 to 2005. From 2001 to 2005, 11,874 cases were notified with 564 deaths and a lethal rate of 4.7%. In 2001, from the initial source of infection, the civil jail, the epidemic of cholera disseminated itself through visitors in the whole city of Abidjan where 3250 cases were notified. Out of city, 20 outbreaks have been declared with a total of 3010 cases. The yearly highest impact, 37 living cases/100,000 inhabitants recorded in 2001, decreased regularly until 2005 with 0.2 living cases/100,000. After 2002, outbreaks were located mainly in the half south of the country which welcomed displaced populations from the north, preferably in transition or settling zones near the front line. The lethal rate in Abidjan (2.3%) was less important than that of other health districts (8.6%). The lethal rate globally increased as the impact decreased. Vibrio cholerae was responsible for the epidemics. The group of 15 years old and over was the most affected (12.69 living cases/100,000) whereas the highest lethal rate appeared in the group under 5 years old (6.6%). The reappearance and constant cholera epidemics in Côte d'Ivoire are due to bad general hygiene conditions, insufficient supply of drinking water from wells or packaged, concentration of populations in the south of the country due to war and uncontrolled development of the poor and unsanitary precarious boroughs. Outburst during the dry season is a warning signal of an important epidemic during the raining season especially in poor urban areas. The precocious alert system has permitted to detect the epidemics, to follow up their evolution and to orientate the struggle against cholera in Côte d'Ivoire.
Ekra
K D
KD
Département de santé publique et informatique médicale, UFR sciences médicales de l'Universita de Cocody, BPV 34 Abidjan, Côte d'Ivoire.
Attoh-Touré
H
H
Bénié
B V J
BV
Coulibaly
D
D
Koutouan
M G
MG
Aka
L N
LN
Dagnan
S N
SN
Coulibaly
A
A
Douba
A
A
Tiembré
I
I
Odéhouri-Koudou
P
P
Tagliante-Saracino
J
J
D002771:Cholera / Q000453:epidemiology* / Q000401:mortality / Q000635:transmission; D007560:Cote d'Ivoire / Q000453:epidemiology; D005843:Geography; D006801:Humans; D009017:Morbidity; D011057:Politics; D011156:Population Density; D012919:Social Behavior