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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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.

  • 1.

    World Health Organization, 2008. Outbreak news. Cholera, Zimbabwe. Wkly Epidemiol Rec 83: 449450.

  • 2.

    World Health Organization, 2009. Cholera outbreak, Zimbabwe. Wkly Epidemiol Rec 84: 5052.

  • 3.

    World Health Organization, 2009. Cholera, Zimbabwe–update. Wkly Epidemiol Rec 84: 109110.

  • 4.

    Fisher D, 2009. Cholera in Zimbabwe. Ann Acad Med Singapore 38: 82.

  • 5.

    Mason PR, 2009. Zimbabwe experiences the worst epidemic of cholera in Africa. J Infect Dev Ctries 3: 148151.

  • 6.

    Ministry of Health and Child Welfare Zimbabwe, 2009. C4 Surveillance Statistics. Harare, Zimbabwe: Cholera Command and Control Center. World Health Organization.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Centers for Disease Control and Prevention, 1993. Epidemic cholera–Burundi and Zimbabwe, 1992–1993. MMWR Morb Mortal Wkly Rep 42: 407409.

  • 8.

    Bradley M, Shakespeare R, Ruwende A, Woolhouse ME, Mason E, Munatsi A, 1996. Epidemiological features of epidemic cholera (El Tor) in Zimbabwe. Trans R Soc Trop Med Hyg 90: 378382.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Sack DA, Sack RB, Nair GB, Siddique AK, 2004. Cholera. Lancet 363: 223233.

  • 10.

    World Health Organization, 2010. Cholera. Available at: http://www.who.int/mediacentre/factsheets/fs107/en/index.html. Accessed February 22, 2011.

  • 11.

    Juvenile Justice Information Portfolio, 1995. Committee on the Rights of the Child - 3. State Party Zimbabwe. Available at: http://www.unicef-irc.org/portfolios/documents/459_zimbabwe.htm. Accessed July 28, 2011.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Central Census Office Zimbabwe, 2002. Provincial Profile. Masvingo. Harare, Zimbabwe: Central Census Office Zimbabwe.

  • 13.

    Central Census Office Zimbabwe, 2002. Provincial Profile. Mashonaland West. Harare, Zimbabwe: Central Census Office Zimbabwe.

  • 14.

    Central Census Office Zimbabwe, 2002. Provincial Profile. Midlands. Harare, Zimbabwe: Central Census Office Zimbabwe.

  • 15.

    Borgdorff MW, Walker GJ, 1988. Estimating coverage from routine information. Trop Doct 18: 130134.

  • 16.

    Gregson S, Zhuwau T, Anderson RM, Chimbadzwa T, Chiwandiwa SK, 1995. Age and religion selection biases in HIV-1 prevalence data from antenatal clinics in Manicaland, Zimbabwe. Cent Afr J Med 41: 339346.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Nhindiri P, Munjanja S, Zhanda I, Lindmark G, Nystrom L, 1996. A community-based study on utilisation of maternity services in rural Zimbabwe. Afr J Health 3: 120125.

  • 18.

    Tumwine JK, 1989. Measles in Chimanimani, Zimbabwe. East Afr Med J 66: 531534.

  • 19.

    Bartels SA, Greenough PG, Tamar M, VanRooyen MJ, 2010. Investigation of a cholera outbreak in Ethiopia's Oromiya region. Disaster Med Public Health Prep 4: 312317.

  • 20.

    Central Census Office, 2002. Provincial Profile: Masvingo. Harare, Zimbabwe: Central Census Office.

  • 21.

    Hetta OM, Lundstrom KJ, 1984. Training rural health staff for oral rehydration therapy in southern Sudan. Trop Doct 14: 151154.

  • 22.

    Shikanga OT, Mutonga D, Abade M, Amwayi S, Ope M, Limo H, Mintz ED, Quick RE, Breiman RF, Feikin DR, 2009. High mortality in a cholera outbreak in western Kenya after post-election violence in 2008. Am J Trop Med Hyg 81: 10851090.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Einarsdottir J, Passa A, Gunnlaugsson G, 2001. Health education and cholera in rural Guinea-bissau. Int J Infect Dis 5: 133138.

  • 24.

    Quick RE, Gerber ML, Palacios AM, Beingolea L, Vargas R, Mujica O, Moreno D, Seminario L, Smithwick EB, Tauxe RV, 1996. Using a knowledge, attitudes and practices survey to supplement findings of an outbreak investigation: cholera prevention measures during the 1991 epidemic in Peru. Int J Epidemiol 25: 872878.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Sircar BK, Saha MR, Deb BC, Singh PK, Pal SC, 1990. Effectiveness of oral rehydration salt solution (ORS) in reduction of death during cholera epidemic. Indian J Public Health 34: 6870.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Quick RE, Vargas R, Moreno D, Mujica O, Beingolea L, Palacios AM, Seminario L, Tauxe RV, 1993. Epidemic cholera in the Amazon: the challenge of preventing death. Am J Trop Med Hyg 48: 597602.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Chowdhury AM, Vaughan JP, Abed FH, 1988. Use and safety of home-made oral rehydration solutions: an epidemiological evaluation from Bangladesh. Int J Epidemiol 17: 655665.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    De Zoysa I, Carson D, Feachem R, Kirkwood B, Lindsay-Smith E, Loewenson R, 1984. Home-based oral rehydration therapy in rural Zimbabwe. Trans R Soc Trop Med Hyg 78: 102105.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Sachar RK, Javal GS, Cowan B, Grewal HN, 1985. Home-based education of mothers in treatment of diarrhoea with oral rehydration solution. J Diarrhoeal Dis Res 3: 2931.

    • PubMed
    • Search Google Scholar
    • Export Citation
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