Cholera outbreak investigation report in Mille woreda, Afar region, Ethiopia, 2019

Introduction: Cholera has remained as one of the important public health problems in Asia and Africa causing substantial morbidity and mortality. Although the burden is greatest in low-income populations with poor access to safe water, and sanitation, cholera is also an important health problem globally. Cholera occurs both as a short outbreak and protracted epidemic/pandemic and when uncontrolled; is devastating to communities and to their prospects for development. To respond quickly and control the outbreak, investigation is crucial; identify risk factors that cause the outbreak, and suggest prevention and control measures. Objective: To identify risk factors and etiology of diarrheal disease outbreak and suggest prevention and control measures in Mille woreda, Afar region Ethiopia, May- June, 2018. Method: Descriptive followed by unmatched case-control study with 1:2 ratio were conducted from May-June 2018. A total of 68 patients and 136 controls were enrolled. A structured interviewer-administered questionnaire was used and medical records and line lists review. Simple random sampling was used to select controls and the first 68 cases. Data were analyzed by SPSS and presented using odd ratio, and tables. Environmental and patient samples were collected for culture and rapid diagnostic test. Result: The investigation identified 229 cholera patients, including 22 rapid diagnostic test confirmed patients and seven culture confirmed patients (attack rate: 8.31%, 229/27,562). Index patient were imported from epi-linked woreda. Diglena geraro kebele were the Epicenter of the outbreak. Epicure trend shows common source infection. Using bifurcation of Awash River for drinking, use untreated/ uncoiled water, poor hand washing practices, and close contact with cholera sick person were found to be associated with cholera. Conclusion: This outbreak was caused by vibrio cholera 01 secondary to drinking water from a bifurcation of Awash River and using untreated water. Contact with diseased person, and use untreated/ uncoiled water was associated with being patients. In order to reduce the risk of cholera, safe drinking water or water treatment chemicals needs to be provided to communities.