title: Epidemic cholera in Kakuma Refugee Camp, Kenya, 2009: the importance of sanitation and soap.
abstract: BACKGROUND
  Cholera remains a major public health problem that causes substantial morbidity and mortality in displaced populations due to inadequate or unprotected water supplies, poor sanitation and hygiene, overcrowding, and limited resources. A cholera outbreak with 224 cases and four deaths occurred in Kakuma Refugee Camp in Kenya from September to December 2009.
  
  
  METHODS
  We conducted a case-control study to characterize the epidemiology of the outbreak. Cases were identified by reviewing the hospital registry for patients meeting the World Health Organization (WHO) case definition for cholera. For each case a matched control was selected. A questionnaire focusing on potential risk factors was administered to cases and controls.
  
  
  RESULTS
  From 18 September to 15 December 2009, a total of 224 cases were identified and were hospitalised at Kakuma IRC hospital.  Three refugees and one Kenyan national died of cholera. V. cholerae O1, serotype Inaba was isolated in 44 (42%) out of 104 stool specimens collected. A total of 93 cases and 93 matched controls were enrolled in the study. In a multivariate model, washing hands with soap was protective against cholera (adjusted odds ratio [AOR] =0.25[0.09-0.71]; p < 0.01), while presence of dirty water storage containers was a risk factor (AOR=4.39[1.12-17.14]; p=0.03).
  
  
  CONCLUSIONS
  Provision of soap, along with education on hand hygiene and cleaning water storage containers, may be an affordable intervention to prevent cholera.
authors.affiliation: Kenya Medical Research Institute/ Centers for Disease Control and Prevention, Nairobi, Kenya. amahamud@cdc.gov
authors.forename: Abdirahman Sheikh
authors.initials: AS
authors.lastname: Mahamud
authors.forename: Jamal A
authors.initials: JA
authors.lastname: Ahmed
authors.forename: Raymond
authors.initials: R
authors.lastname: Nyoka
authors.forename: Erick
authors.initials: E
authors.lastname: Auko
authors.forename: Vincet
authors.initials: V
authors.lastname: Kahi
authors.forename: James
authors.initials: J
authors.lastname: Ndirangu
authors.forename: Margaret
authors.initials: M
authors.lastname: Nguhi
authors.forename: John Wagacha
authors.initials: JW
authors.lastname: Burton
authors.forename: Bosco Z
authors.initials: BZ
authors.lastname: Muhindo
authors.forename: Robert F
authors.initials: RF
authors.lastname: Breiman
authors.forename: Rachel B
authors.initials: RB
authors.lastname: Eidex
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D058872:Epidemics; D005260:Female; D006235:Hand Disinfection / Q000379:methods; D006801:Humans; D006920:Hygiene / Q000193:education; D007630:Kenya / Q000453:epidemiology; D008297:Male; D012036:Refugees; D012499:Sanitation / Q000379:methods*; D012915:Soaps; D011795:Surveys and Questionnaires; D041241:Vibrio cholerae O1 / Q000302:isolation & purification*; D055815:Young Adult
chemical_list: D012915:Soaps