title: A cholera outbreak among semi-nomadic pastoralists in northeastern Uganda: epidemiology and interventions.
abstract: In sub-Saharan Africa, many nomadic pastoralists have begun to settle in permanent communities as a result of long-term water, food, and civil insecurity. Little is known about the epidemiology of cholera in these emerging semi-nomadic populations. We report the results of a case-control study conducted during a cholera outbreak among semi-nomadic pastoralists in the Karamoja sub-region of northeastern Uganda in 2010. Data from 99 cases and 99 controls were analysed. In multivariate analyses, risk factors identified were: residing in the same household as another cholera case [adjusted odds ratio (aOR) 6·67, 95% confidence interval (CI) 2·83-15·70], eating roadside food (aOR 2·91, 95% CI 1·24-6·81), not disposing of children's faeces in a latrine (aOR 15·76, 95% CI 1·54-161·25), not treating drinking water with chlorine (aOR 3·86, 95% CI 1·63-9·14), female gender (aOR 2·43, 95% CI 1·09-5·43), and childhood age (10-17 years) (aOR 7·14, 95% CI 1·97-25·83). This is the first epidemiological study of cholera reported from a setting of semi-nomadic pastoralism in sub-Saharan Africa. Public health interventions among semi-nomadic pastoralists should include a two-faceted approach to cholera prevention: intensive health education programmes to address behaviours inherited from insecure nomadic lifestyles, as well as improvements in water and sanitation infrastructure. The utilization of community-based village health teams provides an important method of implementing such activities.
authors.affiliation: Albany Medical College, NY 12208, USA. CumminM@mail.amc.edu
authors.forename: M J
authors.initials: MJ
authors.lastname: Cummings
authors.forename: J F
authors.initials: JF
authors.lastname: Wamala
authors.forename: M
authors.initials: M
authors.lastname: Eyura
authors.forename: M
authors.initials: M
authors.lastname: Malimbo
authors.forename: M E
authors.initials: ME
authors.lastname: Omeke
authors.forename: D
authors.initials: D
authors.lastname: Mayer
authors.forename: L
authors.initials: L
authors.lastname: Lukwago
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000453:epidemiology*; D002939:Ciprofloxacin / Q000627:therapeutic use; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D007552:Isotonic Solutions / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D000077325:Ringer's Lactate; D012307:Risk Factors; D014454:Uganda / Q000453:epidemiology; D014871:Water Microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D002939:Ciprofloxacin