Epidemic cholera in Kakuma Refugee Camp, Kenya, 2009: the importance of sanitation and soap

  • Abdirahman Sheikh Mahamud Kenya Medical Research Institute/ Centers for Disease Control and Prevention, Nairobi, Kenya
  • Jamal A Ahmed US Centers for Disease Control and Prevention, Nairobi, Kenya
  • Raymond Nyoka US Centers for Disease Control and Prevention, Nairobi, Kenya
  • Erick Auko Kenya Medical Research Institute/CDC
  • Vincet Kahi International Rescue Committee, Kenya
  • James Ndirangu nteInternational Rescue Committee, Kenya
  • Margaret Nguhi nteInternational Rescue Committee, Kenya
  • John Wagacha Burton United Nations High Commissioner for Refugees
  • Bosco Z Muhindo United Nations High Commissioner for Refugees
  • Robert F Breiman US Centers for Disease Control and Prevention, Kenya
  • Rachel B. Eidex US Centers for Disease Control and Prevention, Kenya

Abstract

Introduction: Cholera remains a major public health problem that causes substantial morbidity and mortality in displaced populations due to inadequate or unprotected water supplies, poor sanitation and hygiene, overcrowding, and limited resources. A cholera outbreak with 224 cases and four deaths occurred in Kakuma Refugee Camp in Kenya from September to December 2009.

Methodology: We conducted a case-control study to characterize the epidemiology of the outbreak. Cases were identified by reviewing the hospital registry for patients meeting the World Health Organization (WHO) case definition for cholera. For each case a matched control was selected. A questionnaire focusing on potential risk factors was administered to cases and controls.

Results: From 18 September to 15 December 2009, a total of 224 cases were identified and were hospitalised at Kakuma IRC hospital.  Three refugees and one Kenyan national died of cholera. V. cholerae O1, serotype Inaba was isolated in 44 (42%) out of 104 stool specimens collected. A total of 93 cases and 93 matched controls were enrolled in the study. In a multivariate model, washing hands with soap was protective against cholera (adjusted odds ratio [AOR] =0.25[0.09-0.71]; p < 0.01), while presence of dirty water storage containers was a risk factor (AOR=4.39[1.12-17.14]; p=0.03).

Conclusion:  Provision of soap, along with education on hand hygiene and cleaning water storage containers, may be an affordable intervention to prevent cholera.

Author Biographies

Abdirahman Sheikh Mahamud, Kenya Medical Research Institute/ Centers for Disease Control and Prevention, Nairobi, Kenya
Medical officer in the Department of Africa Refugee Health Program CDC-KEMRI
Jamal A Ahmed, US Centers for Disease Control and Prevention, Nairobi, Kenya
Medical Officer - CDC
Raymond Nyoka, US Centers for Disease Control and Prevention, Nairobi, Kenya
Senior statistician
Erick Auko, Kenya Medical Research Institute/CDC
Data manager
Vincet Kahi, International Rescue Committee, Kenya

Health co-ordinator IRC

James Ndirangu, nteInternational Rescue Committee, Kenya

Clinical service manager- Kakuma

Margaret Nguhi, nteInternational Rescue Committee, Kenya
Surveillance co-ordinato r- Kakuma
John Wagacha Burton, United Nations High Commissioner for Refugees
Health co-ordinator UNHCR office- Nairobi
Bosco Z Muhindo, United Nations High Commissioner for Refugees
Health co-ordinator UNHCR office- Kakuma
Robert F Breiman, US Centers for Disease Control and Prevention, Kenya

Country Director,

Centers for Disease Control and Prevention, Nairobi, Kenya

Rachel B. Eidex, US Centers for Disease Control and Prevention, Kenya

Cheif,

Refugee Health Program

CDC-Kenya

Published
2011-11-30
How to Cite
Mahamud A, Ahmed J, Nyoka R, Auko E, Kahi V, Ndirangu J, Nguhi M, Burton J, Muhindo B, Breiman R, Eidex R (2011) Epidemic cholera in Kakuma Refugee Camp, Kenya, 2009: the importance of sanitation and soap. The Journal Of Infection In Developing Countries 6 (03): 234-241. https://doi.org/10.3855/jidc.1966
Section
Original Articles

Keywords

Cholera; refugee; soap; sanitation; Kenya