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Factors Associated with Fatal Outcomes Following Cholera-Like Syndrome in Far North Region of Cameroon: A Community-Based Survey

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  • 1 Meilleur Accès aux Soins de Santé (M.A. SANTE), Yaoundé, Cameroon.
  • | 2 Department of Biomedical Sciences, University of Dschang, Dschang, Cameroon.
  • | 3 Division of Health Operations Research, Ministry of Public Health, Yaoundé, Cameroon.
  • | 4 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Abstract

This study demonstrates that most cholera deaths in this region of Cameroon occur out of hospital. This is a region which is prone to cholera, and interventions are needed to improve access to emergency medical care, especially during cholera outbreaks. Cameroon has experienced 14 cholera epidemics during the last 20 years, and these have had high case fatality rates. This study attempted to assess the effect of delays in seeking care and the locations of care as possible risk factors for cholera mortality. The study used data from a community-based survey regarding the circumstances of 97 fatal cases and 197 control (nonfatal) cases following a cholera-like syndrome in villages with cholera-like diseases during cholera outbreaks in Cameroon during 2009–2011. Deaths occurred in one of four environments: the community, in a temporary community treatment center (TCTC), in transit to a treatment center, or in a hospital (39%, 32%, 5%, and 24%, respectively). Using a case–control analysis, factors associated with deaths included the nonuse of a cholera treatment center, receiving health care in a TCTC instead of a hospital, and greater than 4 hours delay between the onset of symptoms and the decision to go to a treatment center (odds ratios of 17.1 [confidence interval (CI): 7.0–41.8], 2.5 [CI: 1.2–5.0], and 2.2 [CI: 1.0–4.6], respectively). During cholera epidemics, a higher proportion of deaths are still occurring in communities. The nonuse and delays in deciding to go a treatment center, and treatment at TCTC rather than a hospital were risk factors for death among patients with cholera-like syndrome in Cameroon. Informing people on community management of cholera-like syndrome and improving care in all health facilities are needed to reduce deaths during cholera epidemics.

Author Notes

* Address correspondence to David A. Sack, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street/E5537, Baltimore, MD 21205. E-mail: dsack1@jhu.edu

Financial support: This study was funded by the Delivering Oral Vaccine Effectively (DOVE) project, which is supported by the Bill & Melinda Gates Foundation (OPP1053556) and administered through the Johns Hopkins Bloomberg School of Public Health.

Authors' addresses: Fabrice N. Djouma, Epidemiology, Meilleur Accès aux Soins de Santé, Yaounde, Cameroon, E-mail: nembotfabrice2009@yahoo. Jerome Ateudjieu, Department of Biomedical Sciences, University of Dschang, Dschang, Cameroon, E-mail: jateudj@yahoo.fr. Malathi Ram, Amanda K. Debes, and David A. Sack, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: mram1@jhu.edu, adebes1@jhu.edu, and dsack1@jhu.edu.

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