title: Assessing the risk factors of cholera epidemic in the Buea Health District of Cameroon.
abstract: BACKGROUND
  Cholera is an acute diarrheal disease caused by the bacterium, Vibrio cholerae. A cholera epidemic occurred in Cameroon in 2010. After a cholera-free period at the end of 2010, new cases started appearing in early 2011. The disease affected 23,152 people and killed 843, with the South West Region registering 336 cases and 13 deaths. Hence, we assessed the risk factors of cholera epidemic in the Buea Health District to provide evidence-based cholera guidelines.
  
  
  METHODS
  We conducted an unmatched case-control study. Cases were identified from health facility records and controls were neighbours of the cases in the same community. We interviewed 135 participants on socio-economic, household hygiene, food and water exposures practices using a semi-structured questionnaire. Data was analyzed using STATA. Fisher exact test and logistic regression were computed. P < 0.05 was considered to be statistically significant.
  
  
  RESULTS
  The 135 participants included 34 (25.2 %) cholera cases and 101 (74.8 %) controls. More females [78 (57.8 %)] participated in the study. Ages ranged from 1 year 3 months to 72 years; with a mean of 29.86 (±14.51) years. The cholera attack rate was 0.03 % with no fatality. Most participants [129 (99.2 %)] had heard of cholera. Poor hygienic practices [77 (59.2 %)] and contaminated water sources [54 (41.5 %)] were the main reported transmission routes of cholera. Good hygienic practices [108 (83.1 %)] were the main preventive methods of cholera in both cases [23 (76.6 %)] and controls [85 (85.0 %)]. Logistic regression analysis showed age below 21 years (OR = 1.72, 95 % CI: 0.73-4.06, p = 0.251), eating outside the home (OR = 1.06, CI: 0.46-2.43, p = 1.00) and poor food preservation method (OR = 9.20, CI: 3.67-23.08, p < 0.0001) were independent risk factors of cholera. Also, irregular water supply (OR = 0.66, 95 % CI: 0.30-1.43, p = 0.320), poor kitchen facility (OR = 0.60, CI: 0.16-2.23, p = 0.560), lack of home toilet (OR = 0.69, CI: 0.25-1.86, p = 0.490), and education below tertiary (OR = 0.87, 95 % CI: 0.36-2.11, p = 0.818) were independent protective factors for the occurrence of cholera.
  
  
  CONCLUSIONS
  There was a good knowledge of cholera among participants. Poor food preservation method was a significant independent risk factor of cholera. Improvement in hygiene and sanitation conditions and water infrastructural development is crucial to combating the epidemic.
authors.affiliation: Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O Box 12, Buea, Cameroon. nsaghads@hotmail.com.
authors.forename: Dickson Shey
authors.initials: DS
authors.lastname: Nsagha
authors.affiliation: Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O Box 12, Buea, Cameroon. atashili@yahoo.ie.
authors.forename: Julius
authors.initials: J
authors.lastname: Atashili
authors.affiliation: Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O Box 12, Buea, Cameroon. ndepf@yahoo.com.
authors.forename: Peter Nde
authors.initials: PN
authors.lastname: Fon
authors.affiliation: Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, P.O Box 12, Buea, Cameroon. asangbengelvis@gmail.com.
authors.forename: Elvis Asangbeng
authors.initials: EA
authors.lastname: Tanue
authors.affiliation: Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, P.O Box 12, Buea, Cameroon. ayimacharlotte@yahoo.com.
authors.forename: Charlotte Wenze
authors.initials: CW
authors.lastname: Ayima
authors.affiliation: Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, P.O Box 12, Buea, Cameroon. yayaodette@yahoo.com.
authors.forename: Odette Dzemo
authors.initials: OD
authors.lastname: Kibu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002163:Cameroon / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D058872:Epidemics / Q000517:prevention & control / Q000706:statistics & numerical data*; D005260:Female; D005523:Food Supply / Q000592:standards; D006801:Humans; D006920:Hygiene / Q000592:standards; D007223:Infant; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012499:Sanitation / Q000592:standards; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014881:Water Supply / Q000592:standards; D055815:Young Adult