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Geographic distribution and mortality risk factors during the cholera outbreak in a rural region of Haiti, 2010-2011.

Abstract：

BACKGROUND:In 2010 and 2011, Haiti was heavily affected by a large cholera outbreak that spread throughout the country. Although national health structure-based cholera surveillance was rapidly initiated, a substantial number of community cases might have been missed, particularly in remote areas. We conducted a community-based survey in a large rural, mountainous area across four districts of the Nord department including areas with good versus poor accessibility by road, and rapid versus delayed response to the outbreak to document the true cholera burden and assess geographic distribution and risk factors for cholera mortality. METHODOLOGY/PRINCIPAL FINDINGS:A two-stage, household-based cluster survey was conducted in 138 clusters of 23 households in four districts of the Nord Department from April 22nd to May 13th 2011. A total of 3,187 households and 16,900 individuals were included in the survey, of whom 2,034 (12.0%) reported at least one episode of watery diarrhea since the beginning of the outbreak. The two more remote districts, Borgne and Pilate were most affected with attack rates up to 16.2%, and case fatality rates up to 15.2% as compared to the two more accessible districts. Care seeking was also less frequent in the more remote areas with as low as 61.6% of reported patients seeking care. Living in remote areas was found as a risk factor for mortality together with older age, greater severity of illness and not seeking care. CONCLUSIONS/SIGNIFICANCE:These results highlight important geographical disparities and demonstrate that the epidemic caused the highest burden both in terms of cases and deaths in the most remote areas, where up to 5% of the population may have died during the first months of the epidemic. Adapted strategies are needed to rapidly provide treatment as well as prevention measures in remote communities.

journal_name

PLoS Negl Trop Dis

journal_title

PLoS neglected tropical diseases

authors

Page AL,Ciglenecki I,Jasmin ER,Desvignes L,Grandesso F,Polonsky J,Nicholas S,Alberti KP,Porten K,Luquero FJ

doi

10.1371/journal.pntd.0003605

subject

Has Abstract

pub_date

2015-03-26 00:00:00

pages

e0003605

issue

eissn

1935-2727

issn

1935-2735

pii

PNTD-D-14-01965

journal_volume

pub_type

历史文章,杂志文章

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Geographic distribution and mortality risk factors during the cholera outbreak in a rural region of Haiti, 2010-2011.