title: Community mortality from cholera: urban and rural districts in Zimbabwe.
abstract: In 2008-2009, Zimbabwe experienced an unprecedented cholera outbreak with more than 4,000 deaths. More than 60% of deaths occurred at the community level. We conducted descriptive and case-control studies to describe community deaths. Cases were in cholera patients who died outside health facilities. Two surviving cholera patients were matched by age, time of symptom onset, and location to each case-patient. Proxies completed questionnaires regarding mortality risk factors. Cholera awareness and importance of rehydration was high but availability of oral rehydration salts was low. A total of 55 case-patients were matched to 110 controls. The odds of death were higher among males (adjusted odd ratio [AOR] = 5.00, 95% confidence interval [CI] = 1.54-14.30) and persons with larger household sizes (AOR = 1.21, 95% CI = 1.00-1.46). Receiving home-based rehydration (AOR = 0.21, 95% CI = 0.06-0.71) and visiting cholera treatment centers (CTCs) (AOR = 0.07, 95% CI = 0.02-0.23) were protective. Receiving cholera information was associated with home-based rehydration and visiting CTCs. When we compared cases and controls who did not go to CTCs, males were still at increased odds of death (AOR = 5.00, 95% CI = 1.56-16.10) and receiving home-based rehydration (AOR = 0.14, 95% CI = 0.04-0.53) and being married (AOR = 0.26, 95% CI = 0.08-0.83) were protective. Inability to receive home-based rehydration or visit CTCs was associated with mortality. Community education must reinforce the importance of prompt rehydration and CTC referral.
authors: Epidemic Intelligence Service Officer assigned to International Emergency and Refugee Health Branch, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. dmorof@cdc.gov
authors: Diane
authors: D
authors: Morof
authors: Susan T
authors: ST
authors: Cookson
authors: Susan
authors: S
authors: Laver
authors: Daniel
authors: D
authors: Chirundu
authors: Sarika
authors: S
authors: Desai
authors: Penninah
authors: P
authors: Mathenge
authors: Donald
authors: D
authors: Shambare
authors: Lincoln
authors: L
authors: Charimari
authors: Stanley
authors: S
authors: Midzi
authors: Curtis
authors: C
authors: Blanton
authors: Thomas
authors: T
authors: Handzel
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000401:mortality* / Q000517:prevention & control*; D016001:Confidence Intervals; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data; D018562:Disease Transmission, Infectious / Q000517:prevention & control* / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006798:Housing; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D019035:Rural Health Services / Q000706:statistics & numerical data; D012424:Rural Population; D011795:Surveys and Questionnaires; D013997:Time Factors; D014505:Urban Population; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology
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