title: Outbreak of cholera in the East Akim Municipality of Ghana following unhygienic practices by small-scale gold miners, November 2010.
abstract: BACKGROUND
  In October 2010 an outbreak of cholera began among a group of small-scale gold miners in the East-Akim Municipality (EAM), Eastern Region. We investigated to verify the diagnosis, identify risk factors and recommend control measures.
  
  
  METHODS
  We conducted a descriptive investigation, active case-search and an unmatched case-control study. A cholera case-patient was a person with acute watery diarrhoea, with or without vomiting in EAM from 1st October to 20(th) November, 2010. Stool from case-patients and water samples were taken for laboratory diagnosis. We performed univariate and bivariate analysis using epi-info version 3.3.
  
  
  RESULTS
  Of 136 case-patients, 77 (56.6%) were males, of which 40% were miners or from miners households. Index case, a 20 yr-old male miner from Apapam village reported on October 13(th), and case-patients peaked (18.4%) 20 days later. Attack rate was 2/1000 population with no fatality. Ages ranged from 1-84 years; mean of 34±18 yrs. Age-group 20-29 yrs was mostly affected (30.1%) with Apapam village having most case-patients (19.9%). Vibrio cholera serotype ogawa was isolated from stool samples. The main water source, Birim river was polluted by small-scale miners through defecation, post-defecation baths and sand-washings. Compared to controls, case-patients were more likely to have drunk from Birim-River [OR= 6.99, 95% CI: 2.75-18].
  
  
  CONCLUSIONS
  Vibrio cholera serotype ogawa caused the EAM cholera-outbreak affecting many young adult-males. Drinking water from contaminated community-wide -River was the major risk factors. Boiling or chlorination of water was initiated based on our recommendations and this controlled the outbreak.
authors: Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana, P. O. Box LG13, Legon, Ghana. oparej@yahoo.com
authors: Jkl
authors: J
authors: Opare
authors: C
authors: C
authors: Ohuabunwo
authors: E
authors: E
authors: Afari
authors: F
authors: F
authors: Wurapa
authors: So
authors: S
authors: Sackey
authors: J
authors: J
authors: Der
authors: K
authors: K
authors: Afakye
authors: E
authors: E
authors: Odei
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000175:diagnosis / Q000453:epidemiology*; D004196:Disease Outbreaks; D060766:Drinking Water / Q000382:microbiology; D005260:Female; D005869:Ghana; D006046:Gold; D006801:Humans; D006920:Hygiene; D007223:Infant; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D008906:Mining; D012307:Risk Factors; D045483:Rivers / Q000382:microbiology; D017678:Sex Distribution; D014734:Vibrio cholerae / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D060766:Drinking Water; D006046:Gold
keywords: Ghana; case-control study; cholera; miners; outbreaks; serotype-ogawa
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