HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Shikanga, O-T. Articles by Feikin, D. R. PubMed PubMed Citation Articles by Shikanga, O-T. Articles by Feikin, D. R.

High Mortality in a Cholera Outbreak in Western Kenya after Post-Election Violence in 2008

In 2008, a cholera outbreak with unusually high mortality occurred in western Kenya during civil unrest after disputed presidential elections. Through active case finding, we found a 200% increase in fatal cases and a 37% increase in surviving cases over passively reported cases; the case-fatality ratio increased from 5.5% to 11.4%. In conditional logistic regression of a matched case-control study of fatal versus non-fatal cholera infection, home antibiotic treatment (odds ratio [OR] 0.049; 95% CI: < 0.001–0.43), hospitalization (OR, 0.066; 95% CI, 0.001–0.54), treatment in government-operated health facilities (OR, 0.15; 95% CI, 0.015–0.73), and receiving education about cholera by health workers (OR, 0.19; 95% CI, 0.018–0.96) were protective against death. Among 13 hospitalized fatal cases, chart review showed inadequate intravenous and oral hydration and substantial staff and supply shortages at the time of admission. Cholera mortality was under-reported and very high, in part because of factors exacerbated by widespread post-election violence.

Received July 15, 2009. Accepted for publication August 13, 2009.

Acknowledgments: We thank the medical officers of the District Ministries of Health of Kisumu East, Migori and Rongo districts and the Nyanza Provincial Ministry of Health for their participation in this study. We also thank the Division of Disease Surveillance and Response, Kenya Ministry of Health, for their input. Tabu Collins, Field Epidemiology and Laboratory Training Program, deserves special appreciation for helping gather data on staffing and medication shortages. We thank John Williamson of the Division of Parasitic Diseases, National Center for Zoonotic, Vector-borne and Enteric Diseases, Centers for Disease Control and Prevention, and Myat-Htoo Razak, resident supervisor of Field Epidemiology and Laboratory Training Program, for his support.

Financial support: This study was funded by core funding from the International Emerging Infections Program and Field Epidemiology and Laboratory Training Program, Centers for Disease Control and Prevention.

Disclosure: The authors have no financial disclosures to declare.

^* Address correspondence to Daniel R. Feikin, KEMRI/CDC, PO Box 1578, Kisumu, Kenya. E-mail: dfeikin{at}ke.cdc.gov

Authors’ addresses: O-Tipo Shikanga, David Mutonga, Mohammed Abade, Samuel Amwayi, Maurice Ope, Hillary Limo, and Robert F. Breiman, Kenya Medical Research Institute/Centers for Disease Control and Prevention, Off Mbagathi Road, Mbagathi Way, Nairobi, Kenya. Eric D. Mintz and Robert E. Quick, CDC, Enterics Diseases Epidemiology, 1600 Clifton Road, Atlanta, GA 30333. Daniel R. Feikin, KEMRI/CDC, PO Box 1578, Kisumu, Kenya.

Reprint requests: Daniel R. Feikin, KEMRI/CDC, PO Box 1578, Kisumu, Kenya, E-mail: dfeikin{at}ke.cdc.gov.