title: Cholera outbreak in a southwest community of Nigeria: investigation of risk factors and evaluation of a district surveillance system.
abstract: BACKGROUND
  Following confirmation of cholera outbreak in a southwest community of Nigeria, we set to identify possible risk factors for contracting the disease and to evaluate the completeness as well as the representativeness of the cases reported to a district health authority.
  
  
  METHODS
  Cholera cases were identified through an active case search that involved the review of records in health facilities and a house-to-house search using the standard case definition in the Nigeria integrated disease surveillance and response technical guidelines. Two neighborhood controls appropriately matched on age and sex for each case, were also identified. An interviewer-administered questionnaire was used to collect information on the demographic characteristics and potential risk factors. Completeness of reporting of cases notified to the district health authority was evaluated using a two source capture-recapture method. In addition, the representativeness of the reported cases was determined by comparing the age and sex distributions of notified cases to those identified through the active case search.
  
  
  RESULTS
  Thirty-nine cases were identified, of which 22 consented to participate. Contact with a diarrhoea case at home or in the neighborhood within the last 7 days prior to illness onset in cases was significantly associated with having cholera (Matched triplets Odds Ratio 8.5, 95% CI: 1.36-52.9). The completeness of the district surveillance report was estimated to be 54%. In the district notification data compared with the active case search data, males <5 years (31% vs 18%) and females 15 years (3% vs 21%) were significantly over- and under-represented, respectively.
  
  
  CONCLUSIONS
  The odds of having cholera were increased in those who had contact with a case of diarrhea. Reporting of cases to the district health authority was not complete and the surveillance data on gender and age grouping were not representative of the cases that occurred in the population. There is a need for efficient reporting of cases to the health authority during outbreaks in order to improve decision-making and public health interventions.
authors.affiliation: Department of Epidemiology and Medical Statistics, Faculty of Public Health,College of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: A A
authors.initials: AA
authors.lastname: Fatiregun
authors.forename: I O
authors.initials: IO
authors.lastname: Ajayi
authors.forename: E E
authors.initials: EE
authors.lastname: Isere
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000453:epidemiology* / Q000517:prevention & control; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D016017:Odds Ratio; D062486:Public Health Surveillance; D012307:Risk Factors