Community Mortality from Cholera: Urban and Rural Districts in Zimbabwe

Diane Morof Epidemic Intelligence Service Officer assigned to International Emergency and Refugee Health Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; United Nations International Children's Fund–Zimbabwe, Harare, Zimbabwe; City of Kadoma, Kadoma, Zimbabwe; Medical Emergency Relief International, Harare, Zimbabwe; German Agro Action–European Commission Humanitarian Aid Office, Harare, Zimbabwe; World Health Organization, Zimbabwe, Harare, Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe

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Susan T. Cookson Epidemic Intelligence Service Officer assigned to International Emergency and Refugee Health Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; United Nations International Children's Fund–Zimbabwe, Harare, Zimbabwe; City of Kadoma, Kadoma, Zimbabwe; Medical Emergency Relief International, Harare, Zimbabwe; German Agro Action–European Commission Humanitarian Aid Office, Harare, Zimbabwe; World Health Organization, Zimbabwe, Harare, Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe

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Susan Laver Epidemic Intelligence Service Officer assigned to International Emergency and Refugee Health Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; United Nations International Children's Fund–Zimbabwe, Harare, Zimbabwe; City of Kadoma, Kadoma, Zimbabwe; Medical Emergency Relief International, Harare, Zimbabwe; German Agro Action–European Commission Humanitarian Aid Office, Harare, Zimbabwe; World Health Organization, Zimbabwe, Harare, Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe

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Daniel Chirundu Epidemic Intelligence Service Officer assigned to International Emergency and Refugee Health Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; United Nations International Children's Fund–Zimbabwe, Harare, Zimbabwe; City of Kadoma, Kadoma, Zimbabwe; Medical Emergency Relief International, Harare, Zimbabwe; German Agro Action–European Commission Humanitarian Aid Office, Harare, Zimbabwe; World Health Organization, Zimbabwe, Harare, Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe

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Sarika Desai Epidemic Intelligence Service Officer assigned to International Emergency and Refugee Health Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; United Nations International Children's Fund–Zimbabwe, Harare, Zimbabwe; City of Kadoma, Kadoma, Zimbabwe; Medical Emergency Relief International, Harare, Zimbabwe; German Agro Action–European Commission Humanitarian Aid Office, Harare, Zimbabwe; World Health Organization, Zimbabwe, Harare, Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe

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Penninah Mathenge Epidemic Intelligence Service Officer assigned to International Emergency and Refugee Health Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; United Nations International Children's Fund–Zimbabwe, Harare, Zimbabwe; City of Kadoma, Kadoma, Zimbabwe; Medical Emergency Relief International, Harare, Zimbabwe; German Agro Action–European Commission Humanitarian Aid Office, Harare, Zimbabwe; World Health Organization, Zimbabwe, Harare, Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe

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Donald Shambare Epidemic Intelligence Service Officer assigned to International Emergency and Refugee Health Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; United Nations International Children's Fund–Zimbabwe, Harare, Zimbabwe; City of Kadoma, Kadoma, Zimbabwe; Medical Emergency Relief International, Harare, Zimbabwe; German Agro Action–European Commission Humanitarian Aid Office, Harare, Zimbabwe; World Health Organization, Zimbabwe, Harare, Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe

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Lincoln Charimari Epidemic Intelligence Service Officer assigned to International Emergency and Refugee Health Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; United Nations International Children's Fund–Zimbabwe, Harare, Zimbabwe; City of Kadoma, Kadoma, Zimbabwe; Medical Emergency Relief International, Harare, Zimbabwe; German Agro Action–European Commission Humanitarian Aid Office, Harare, Zimbabwe; World Health Organization, Zimbabwe, Harare, Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe

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Stanley Midzi Epidemic Intelligence Service Officer assigned to International Emergency and Refugee Health Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; United Nations International Children's Fund–Zimbabwe, Harare, Zimbabwe; City of Kadoma, Kadoma, Zimbabwe; Medical Emergency Relief International, Harare, Zimbabwe; German Agro Action–European Commission Humanitarian Aid Office, Harare, Zimbabwe; World Health Organization, Zimbabwe, Harare, Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe

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Curtis Blanton Epidemic Intelligence Service Officer assigned to International Emergency and Refugee Health Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; United Nations International Children's Fund–Zimbabwe, Harare, Zimbabwe; City of Kadoma, Kadoma, Zimbabwe; Medical Emergency Relief International, Harare, Zimbabwe; German Agro Action–European Commission Humanitarian Aid Office, Harare, Zimbabwe; World Health Organization, Zimbabwe, Harare, Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe

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Thomas Handzel Epidemic Intelligence Service Officer assigned to International Emergency and Refugee Health Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; United Nations International Children's Fund–Zimbabwe, Harare, Zimbabwe; City of Kadoma, Kadoma, Zimbabwe; Medical Emergency Relief International, Harare, Zimbabwe; German Agro Action–European Commission Humanitarian Aid Office, Harare, Zimbabwe; World Health Organization, Zimbabwe, Harare, Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe

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DOI:
https://doi.org/10.4269/ajtmh.11-0696
Volume/Issue:
Volume 88: Issue 4
Page(s):
645–650
Restricted access
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In 2008–2009, Zimbabwe experienced an unprecedented cholera outbreak with more than 4,000 deaths. More than 60% of deaths occurred at the community level. We conducted descriptive and case–control studies to describe community deaths. Cases were in cholera patients who died outside health facilities. Two surviving cholera patients were matched by age, time of symptom onset, and location to each case-patient. Proxies completed questionnaires regarding mortality risk factors. Cholera awareness and importance of rehydration was high but availability of oral rehydration salts was low. A total of 55 case-patients were matched to 110 controls. The odds of death were higher among males (adjusted odd ratio [AOR] = 5.00, 95% confidence interval [CI] = 1.54–14.30) and persons with larger household sizes (AOR = 1.21, 95% CI = 1.00–1.46). Receiving home-based rehydration (AOR = 0.21, 95% CI = 0.06–0.71) and visiting cholera treatment centers (CTCs) (AOR = 0.07, 95% CI = 0.02–0.23) were protective. Receiving cholera information was associated with home-based rehydration and visiting CTCs. When we compared cases and controls who did not go to CTCs, males were still at increased odds of death (AOR = 5.00, 95% CI = 1.56–16.10) and receiving home-based rehydration (AOR = 0.14, 95% CI = 0.04–0.53) and being married (AOR = 0.26, 95% CI = 0.08–0.83) were protective. Inability to receive home-based rehydration or visit CTCs was associated with mortality. Community education must reinforce the importance of prompt rehydration and CTC referral.

Author Notes

* Address correspondence to Diane Morof, Epidemic Intelligence Service Officer, International Emergency Refugee Health Branch, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop F-57, Atlanta, GA 30341. E-mail: dmorof@cdc.gov

Financial support: This study was supported by the Centers for Disease Control and Prevention.

Authors' addresses: Diane Morof, Epidemic Intelligence Service Officer assigned to International Emergency Refugee Health Branch, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: dmorof@cdc.gov. Susan T. Cookson, Curtis Blanton, and Thomas Handzel, International Emergency Refugee Health Branch, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: sgc0@cdc.gov, cblanton@cdc.gov, and tnh7@cdc.gov. Susan Laver and Penninah Mathenge, Head Collaborating Centre for Operational Research and Evaluation, United Nations International Children's Fund, Belgravia, Harare, Zimbabwe, E-mails: slaver@unicef.org and pmathenge@unicef.org. Daniel Chirundu, Kadoma City Health Department, Kadoma Midlands Province, Zimbabwe, E-mail: dchirundu@healthnet.org.zw. Sarika Desai, HIV and STI Department, Health Protection Services–Colindale, Health Protection Agency, London, UK, E-mail: sarika.desai@hpa.org.uk. Donald Shambare and Lincoln Charimari, World Health Organization Country Office, Harare, Zimbabwe, E-mails: shambared@zw.afro.who.int and charimaril@zw.afro.who.int. Stanley Midzi, Ministry of Health and Child Welfare Headquarters, Harare, Zimbabwe, E-mail: midzis@zw.afro.who.int.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2013
Received:
08 Nov 2011
|
Accepted:
17 Dec 2012
|
Published Online:
03 Apr 2013
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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