Community mortality from cholera: Urban and rural districts in Zimbabwe

Diane Morof, Susan T. Cookson, Susan Laver, Daniel Chirundu, Sarika Desai, Penninah Mathenge, Donald Shambare, Lincoln Charimari, Stanley Midzi, Curtis Blanton, Thomas Handzel

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)645-650
Number of pages6
JournalAmerican Journal of Tropical Medicine and Hygiene
Volume88
Issue number4
DOIs
Publication statusPublished - Apr 2013

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