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Am. J. Trop. Med. Hyg., 80(5), 2009, pp. 812-818
Copyright © 2009 by The American Society of Tropical Medicine and Hygiene

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Population-Based Study of a Widespread Outbreak of Diarrhea Associated with Increased Mortality and Malnutrition in Botswana, January–March, 2006

Ondrej Mach*, Lydia Lu, Tracy Creek, Anna Bowen, Wences Arvelo, Molly Smit, Japhter Masunge, Muireann Brennan, AND Thomas Handzel
Centers for Disease Control and Prevention, Atlanta, Georgia; BOTUSA Project, Gaborone, Botswana; Botswana Ministry of Health, Gaborone, Botswana

In early 2006, coinciding with heavy rains, Botswana health facilities reported increases in diarrhea, mortality, and acute malnutrition among young children. Data on diarrhea, human immunodeficiency virus, feeding, mortality, and water/sanitation were collected by random cluster survey. Anthropometric data were measured and drinking water samples were tested. Of 537 surveyed children less than five years of age, one-third experienced ≥ 1 episode of diarrhea. Prevalence of acute malnutrition was 7.9%, and the mortality rate for children less than five years of age was 2.6/10,000/day during the outbreak. Significant risk factors for diarrhea included an age less than two years; breastfeeding was protective. Diarrhea lasting for more than 14 days and failure to thrive were risk factors for acute malnutrition. Prevalence of acute malnutrition was higher than previously documented and the mortality rate in children less than five years of age during the outbreak was above the international threshold for emergency action with an estimated 547 excess deaths. This survey highlights the need for safe infant feeding and effective treatment of malnutrition and diarrhea in young children.

Received August 13, 2008. Accepted for publication January 13, 2009.

Acknowledgments: We thank L. Zaks, A. Kim, T. Finkbeiner, B. Woodruff, E. Mintz, N. Shaffer, C. Bern, M. Davis and others in Botswana and Atlanta for their participation in this study.

Financial support: This study was supported by the Centers for Disease Control and Prevention. However, there was no special grant or fund made available specifically for this investigation; operational funds for outbreak response were used.

* Address correspondence to Ondrej Mach, Global Immunization Division, Centers for Disease Control and Prevention, Mailstop E05, 1600 Clifton Road, Atlanta, GA 30333. E-mail: omach{at}cdc.gov

Authors’ addresses: Ondrej Mach, Lydia Lu, Tracy Creek, Anna Bowen, Wences Arvelo, Muireann Brennan, and Thomas Handzel, Global Immunization Division, Centers for Disease Control and Prevention, Mailstop E05, 1600 Clifton Road, Atlanta, GA 30333, E-mail: omach{at}cdc.gov. Molly Smit, BOTUSA Project, Gaborone, Botswana. Japhter Masunge, Botswana Ministry of Health, Gaborone, Botswana.






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Copyright © 2009 by the American Society of Tropical Medicine and Hygiene.