Volume 80, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


An outbreak of watery diarrhea struck within the Kakuma refugee camp in Kenya in April 2005; 418 people were treated, and 4 persons died. O1 was isolated from 33 patients. In June 2005, we conducted a retrospective matched case-control study to define risk factors associated with cholera among camp residents and identify interventions that could prevent further cases and future outbreaks. We identified cases of cholera through medical records at the main health facility in the camp and matched controls (without watery diarrhea since November 2004) to the cases by age category (< 2, 2–4, 5–14, and > 14 years) and location of residence within the camp. Cases were defined as any person of any age with profuse, effortless watery diarrhea (three or more stools in 24 hours). A multivariate model showed that storing drinking water at home in sealed or covered containers was protective against cholera (matched odds ratio [MOR] = 0.49 [0.25, 0.96]), whereas “sharing a latrine with at least three households” (MOR = 2.17 [1.01, 4.68]) and arriving at the Kakuma camp on or after November 2004 (MOR = 4.66 [1.35, 16.05]) were risk factors. Improving sanitation and promoting methods to ensure safe drinking water are likely to be effective measures in moderating future cholera outbreaks in this setting. Higher risks for cholera illness among refugees recently “in-migrated” suggest that there may be value in targeting new arrivals in the camp for risk reduction messages and interventions, such as covered water storage containers, to prevent cholera.


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  1. ProMed, 2004. Cholera—Pakistan (Spin Boldak Afghan Refugee Camp) Available at: http://www.promedmail.org. Accessed September 13, 2006.
  2. ProMed, 2005.Uganda: Cholera kills 2 in northern IDP camp. Available at: http://www.promedmail.org. Accessed September 13, 2006.
  3. ProMed, 2005. Cholera, Liberian refugee camp—Ghana (Central Region). Available at: http://www.promedmail.org. Accessed September 13, 2006.
  4. ProMed, 2005. Cholera—Congo DR (refugee camps). Available at: http://www.promedmail.org. Accessed September 13, 2006.
  5. ProMed, 2006. Refugee camp—Thailand (Ratchaburi Province). Available at: http://www.promedmail.org. Accessed September 13, 2006.
  6. Sack DA, Sack RB, Nair GB, Siddique AK, 2004. Cholera. Lancet 363 : 223–233. [Google Scholar]
  7. Mugoya I, Kariuki S, Galgalo T, Njuguna C, Omollo J, Njoroge J, Kalani R, Nzioka C, Tetteh C, Bedno S, Breiman RF, Feikin DR, 2008. The rapid spread of Vibrio cholerae O1 throughout Kenya, 2005. Am J Trop Med Hyg 78 : 527–533. [Google Scholar]
  8. Kariuki Njenga M, Traicoff D, Tetteh C, Likimani S, Oundo J, Breiman R, Nyamongo J, Burke H, Nsubuga P, White ME, 2008. Laboratory epidemiologist: skilled partner in field epidemiology and disease surveillance in Kenya. J Public Health Policy 29 : 149–164. [Google Scholar]
  9. Cronin AA, 2005. Mission to Kakuma Refugee Camp to Address a Cholera Outbreak. United Nations High Commissioner for Refugees, Technical Support Section.
  10. International Rescue Committee, 2005. Kakuma Refugee Camp Final Report: January–December 2004.
  11. Bopp CA, Ries AA, Wells JG, 1999. Laboratory Methods for the Diagnosis of Epidemic Dysentery and Cholera. Atlanta, GA: Centers for Disease Control and Prevention.
  12. Davis CE, Hyde JE, Bangdiwala SI, Nelson JJ, 1986. Macro to Calculate Collinearity Diagnostics from Variance-Covariance Matrix in Nonlinear Regression. Modern Statistical Methods in Chronic Disease Epidemiology. New York: John Wiley & Sons, Inc.
  13. Cronin AA, Shrestha D, Cornier N, Abdalla F, Ezard N, Aramburu C, 2008. A review of water and sanitation provision in refugee camps in association with selected health and nutrition indicators: the need for integrated service provision. J Water Health 06 : 1–13. [Google Scholar]
  14. Deb BC, Sircar BK, Sengupta PG, De SP, Mondal SK, Gupta DN, Daha NC, Ghosh S, Mitra U, Pal SC, 1986. Studies on interventions to prevent el tor cholera transmission in urban slums. Bull World Health Organ 64 : 127–131. [Google Scholar]
  15. Todar K, 2005. Vibrio cholerae and Asiatic Cholera. Available at: http://textbookofbacteriology.net/cholera.html. Accessed June 2005.
  16. von Seidlein L, Wang XY, Macuamule A, Mondlane C, Puri M, Hendriksen I, Deen JL, Chaignat CL, Clemens JD, Ansar-uzzaman M, Barreto A, Songane FF, Lucas M, 2008. Is HIV infection associated with an increased risk for cholera? Findings from a case-control study in Mozambique. Trop Med Int Health 13 : 683–688. [Google Scholar]
  17. Peterson EA, Roberts L, Toole MJ, Peterson DE, 1998. The effect of soap distribution on diarrhoea: Nyamithuthu Refugee Camp. Int J Epidemiol 27 : 520–524. [Google Scholar]
  18. Legros D, Paquet C, Perea W, Marty I, Mugisha NK, Royer H, Neira M, Ivanoff B, 1999. Mass vaccination with a two-dose oral cholera vaccine in a refugee camp. Bull World Health Organ 77 : 837–842. [Google Scholar]
  19. Naficy A, Rao MR, Paquet C, Antona D, Sorkin A, Clemons JD, 1998. Treatment and vaccination strategies to control cholera in sub-saharan refugee settings. JAMA 279 : 521–525. [Google Scholar]
  20. Chaignat CL, 2007. Use of oral cholera vaccine in complex emergencies: what next? Summary report of an expert meeting and recommendations of WHO. J Health Popul Nutr 25 : 244–261. [Google Scholar]
  21. Lucas ME, von Seidlein L, Wang XY, Ampuero J, Puri M, Ali M, Ansaruzzaman M, Amos J, Macuamule A, Cavailler P, Guerin PJ, Mahoudeau C, Kahozi-Sangwa P, Chaignat CL, Barreto A, Songane FF, Clemens JD, 2005. Effectiveness of mass oral cholera vaccination in Beira, Mozambique. N Engl J Med 352 : 757–767. [Google Scholar]
  22. Ahmed F, Clemens JD, Rao MR, Banik AK, 1994. Family latrines and paediatric shigellosis in rural Bangladesh: benefit or risk. Int J Epidemiol 23 : 856–862. [Google Scholar]
  23. Swerdlow DL, Malenga G, Begkoyian G, Nyangulu D, Toole M, Waldman RJ, Puhr DN, Tauxe RV, 1997. Epidemic cholera among refugees in Malawi, Africa: treatment and transmission. Epidemiol Infect 118 : 207–214. [Google Scholar]
  24. Roberts L, Chartier Y, Chartier O, Malenga G, Toole M, Rodka H, 2001. Keeping clean water clean in a Malawi refugee camp: a randomized intervention trial. Bull World Health Organ 79 : 280–287. [Google Scholar]
  25. Tauxe RV, Mintz ED, Quick RE, 1995. Epidemic cholera in the New World: translating field epidemiology into new prevention strategies. Emerg Infect Dis 1 : 141–146. [Google Scholar]
  26. Sur D, Deen JL, Manna B, Niyogi SK, Deb AK, Kanungo S, Sarkar BL, Kim DR, Danovaro-Holliday MC, Holliday K, Gupta VK, Ali M, von Seidlein L, Clemons JD, Bhattacharya SK, 2005. The burden of cholera in the slums of Kolkata, India: data from a prospective, community based study. Arch Dis Child 90 : 1175–1181. [Google Scholar]
  27. Rodrigues A, Sandstrom A, Ca T, Steinsland H, Jensen H, Aaby P, 2000. Protection from cholera by adding lime juice to food: results from community and laboratory studies in Guinea-Bissau, West Africa. Trop Med Int Health 5 : 418–422. [Google Scholar]
  28. Khazaei H-A, Rezaei N, Bagheri G-R, Mahmoudi M, Moin A-A, Dankoub M-A, Gazeran A, 2005. The epidemiology of Vibrio cholerae in Zobol City, southeast of Iran. Arch Iran Med 8 : 197–201. [Google Scholar]
  29. Izadi S, Tabatabaei S-M, Miradi M-R, Sheikhzadeh K, 2005. Routes of transmission of cholera in the border areas of Zahedan District, Sistan and Baluchestan Province, summer 2003. J Med Sci 5 : 233–238. [Google Scholar]
  30. Hutin Y, Luby S, Paquet C, 2003. A large cholera outbreak in Kano City, Nigeria: the importance of hand washing with soap and the danger of street-vended water. J Water Health 1 : 45–52. [Google Scholar]
  31. Birmingham ME, Lee LA, 1997. Epidemic cholera in Burundi: patterns of transmission in the Great Rift Valley Lake region. Lancet 349 : 981–985. [Google Scholar]
  32. Acosta CJ, Galindo CM, Kimario J, Senkoro K, Urassa H, Casals C, Corachan M, Eseko N, Tanner M, Mshinda H, Lwilla F, Vila J, Alonso PL, 2001. Cholera outbreak in Southern Tanzania: risk factors and patterns of transmission. Emerg Infect Dis 7 : 583–587. [Google Scholar]

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  • Received : 28 Jul 2008
  • Accepted : 28 Oct 2008

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