title: Epidemiology of cholera outbreaks and socio-economic characteristics of the communities in the fishing villages of Uganda: 2011-2015.
abstract: The communities in fishing villages in the Great Lakes Region of Africa and particularly in Uganda experience recurrent cholera outbreaks that lead to considerable mortality and morbidity. We evaluated cholera epidemiology and population characteristics in the fishing villages of Uganda to better target prevention and control interventions of cholera and contribute to its elimination from those communities.
  
  
  
  We conducted a prospective study between 2011-15 in fishing villages in Uganda. We collected, reviewed and documented epidemiological and socioeconomic data for 10 cholera outbreaks that occurred in fishing communities located along the African Great Lakes and River Nile in Uganda. These outbreaks caused 1,827 suspected cholera cases and 43 deaths, with a Case-Fatality Ratio (CFR) of 2.4%. Though the communities in the fishing villages make up only 5-10% of the Ugandan population, they bear the biggest burden of cholera contributing 58% and 55% of all reported cases and deaths in Uganda during the study period. The CFR was significantly higher among males than females (3.2% vs. 1.3%, p = 0.02). The outbreaks were seasonal with most cases occurring during the months of April-May. Male children under age of 5 years, and 5-9 years had increased risk. Cholera was endemic in some villages with well-defined "hotspots". Practices predisposing communities to cholera outbreaks included: the use of contaminated lake water, poor sanitation and hygiene. Additional factors were: ignorance, illiteracy, and poverty.
  
  
  
  Cholera outbreaks were a major cause of morbidity and mortality among the fishing communities in Uganda. In addition to improvements in water, sanitation, and hygiene, oral cholera vaccines could play an important role in the prevention and control of these outbreaks, particularly when targeted to high-risk areas and populations. Promotion and facilitation of access to social services including education and reduction in poverty should contribute to cholera prevention, control and elimination in these communities.
authors.affiliation: Department of Community Health, Ministry of Health (MOH), Kampala, Uganda.
authors.forename: Godfrey
authors.identifier: 0000-0002-8376-2857
authors.initials: G
authors.lastname: Bwire
authors.affiliation: Agence de Médecine Préventive (AMP), Paris, France.
authors.forename: Aline
authors.initials: A
authors.lastname: Munier
authors.affiliation: Agence de Médecine Préventive (AMP), Abidjan, Cote d'Ivoire.
authors.forename: Issaka
authors.initials: I
authors.lastname: Ouedraogo
authors.affiliation: Agence de Médecine Préventive (AMP), Abidjan, Cote d'Ivoire.
authors.forename: Leonard
authors.initials: L
authors.lastname: Heyerdahl
authors.affiliation: Department of Community and Behavioral Sciences, Makerere University School of Public Health (MUSPH), Kampala, Uganda.
authors.forename: Henry
authors.initials: H
authors.lastname: Komakech
authors.affiliation: National Health Laboratory Services, Ministry of Health, Kampala, Uganda.
authors.forename: Atek
authors.initials: A
authors.lastname: Kagirita
authors.affiliation: Agence de Médecine Préventive (AMP), Ferney-Voltaire, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Wood
authors.affiliation: Agence de Médecine Préventive (AMP), Abidjan, Cote d'Ivoire.
authors.forename: Raymond
authors.initials: R
authors.lastname: Mhlanga
authors.affiliation: Agence de Médecine Préventive (AMP), Paris, France.
authors.forename: Berthe
authors.initials: B
authors.lastname: Njanpop-Lafourcade
authors.affiliation: National Disease Control Department, Ministry of Health, Kampala, Uganda.
authors.forename: Mugagga
authors.initials: M
authors.lastname: Malimbo
authors.affiliation: Health Emergency Operation Centre (EOC), Ministry of Health, Kampala, Uganda.
authors.forename: Issa
authors.initials: I
authors.lastname: Makumbi
authors.affiliation: Department of Health, Mbale District Local Government, Mbale, Uganda.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wandawa
authors.affiliation: Agence de Médecine Préventive (AMP), Paris, France.
authors.forename: Bradford D
authors.initials: BD
authors.lastname: Gessner
authors.affiliation: Department of Community and Behavioral Sciences, Makerere University School of Public Health (MUSPH), Kampala, Uganda.
authors.forename: Christopher Garimoi
authors.initials: CG
authors.lastname: Orach
authors.affiliation: Agence de Médecine Préventive (AMP), Paris, France.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Mengel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000453:epidemiology* / Q000401:mortality; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population; D012621:Seasons; D012737:Sex Factors; D012959:Socioeconomic Factors; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult