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      Cholera knowledge, socioeconomic and WaSH characteristics in Aden - Yemen, 2017: a community-based comparative survey

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          To improve prevention and control response to the cholera outbreak, we sought to assess and compare the community’s cholera awareness and needs in high and low epidemic areas in Aden.


          A community-based comparative survey was conducted in 2017. We used multi-stage cluster sampling. Eligible household heads in high and low epidemic areas were interviewed. The data collected from both areas using a pretested questionnaire.


          Cholera cases and mortality were higher in high epidemic areas compared with low epidemic areas. Socioeconomic, water, sanitation, and hygienic conditions were poorer in high epidemic areas compared with low epidemic areas. Knowledge of cholera transmission and prevention was sub-optimal in both areas. We found a mismatch between the delivered education and distributed preventive materials.


          Stakeholders should tailor the design, content, and implementation of future cholera prevention and control methods to meet the needs of the community. Future educational camping should focus on the transmission prevention, including vaccination. Education and sustainable interventions should be implemented to improve the water, sanitation, and hygiene.

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          Most cited references 19

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          Updated Global Burden of Cholera in Endemic Countries

          Background The global burden of cholera is largely unknown because the majority of cases are not reported. The low reporting can be attributed to limited capacity of epidemiological surveillance and laboratories, as well as social, political, and economic disincentives for reporting. We previously estimated 2.8 million cases and 91,000 deaths annually due to cholera in 51 endemic countries. A major limitation in our previous estimate was that the endemic and non-endemic countries were defined based on the countries’ reported cholera cases. We overcame the limitation with the use of a spatial modelling technique in defining endemic countries, and accordingly updated the estimates of the global burden of cholera. Methods/Principal Findings Countries were classified as cholera endemic, cholera non-endemic, or cholera-free based on whether a spatial regression model predicted an incidence rate over a certain threshold in at least three of five years (2008-2012). The at-risk populations were calculated for each country based on the percent of the country without sustainable access to improved sanitation facilities. Incidence rates from population-based published studies were used to calculate the estimated annual number of cases in endemic countries. The number of annual cholera deaths was calculated using inverse variance-weighted average case-fatality rate (CFRs) from literature-based CFR estimates. We found that approximately 1.3 billion people are at risk for cholera in endemic countries. An estimated 2.86 million cholera cases (uncertainty range: 1.3m-4.0m) occur annually in endemic countries. Among these cases, there are an estimated 95,000 deaths (uncertainty range: 21,000-143,000). Conclusion/Significance The global burden of cholera remains high. Sub-Saharan Africa accounts for the majority of this burden. Our findings can inform programmatic decision-making for cholera control.
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            Cholera is an acute, watery diarrhoeal disease caused by Vibrio cholerae of the O1 or O139 serogroups. In the past two centuries, cholera has emerged and spread from the Ganges Delta six times and from Indonesia once to cause global pandemics. Rational approaches to the case management of cholera with oral and intravenous rehydration therapy have reduced the case fatality of cholera from more than 50% to much less than 1%. Despite improvements in water quality, sanitation, and hygiene, as well as in the clinical treatment of cholera, the disease is still estimated to cause about 100 000 deaths every year. Most deaths occur in cholera-endemic settings, and virtually all deaths occur in developing countries. Contemporary understanding of immune protection against cholera, which results from local intestinal immunity, has yielded safe and protective orally administered cholera vaccines that are now globally stockpiled for use in the control of both epidemic and endemic cholera.
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              The burden of cholera in the slums of Kolkata, India: data from a prospective, community based study.

              To conduct a prospective, community based study in an impoverished urban site in Kolkata (formerly Calcutta) in order to measure the burden of cholera, describe its epidemiology, and search for potential risk factors that could be addressed by public health strategies. The study population was enumerated at the beginning and end of the study period. Surveillance through five field outposts and two referral hospitals for acute, watery, non-bloody diarrhoea was conducted from 1 May 2003 to 30 April 2004. Data and a stool sample for culture of Vibrio cholerae were collected from each patient. Treatment was provided in accordance with national guidelines. From 62 329 individuals under surveillance, 3284 diarrhoea episodes were detected, of which 3276 (99%) had a stool sample collected and 126 (4%) were culture confirmed cholera. Nineteen (15%) were children less than 2 years of age, 29 (23%) had severe dehydration, and 48 (38%) were hospitalised. Risk factors for cholera included a household member with cholera during the period of surveillance, young age, and lower educational level. There was a substantial burden of cholera in Kolkata with risk factors not easily amenable to intervention. Young children bear the brunt not only of diarrhoeal diseases in general, but of cholera as well. Mass vaccination could be a potentially useful tool to prevent and control seasonal cholera in this community.

                Author and article information

                J Prev Med Hyg
                J Prev Med Hyg
                Journal of Preventive Medicine and Hygiene
                Pacini Editore Srl
                06 October 2020
                September 2020
                : 61
                : 3
                : E392-E400
                [1 ] Department of Community Medicine and Public Health, Faculty of Medicine and Health Sciences, University of Aden , Aden, Yemen
                [2 ] CRIMEDIM - Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale , Novara, Italy
                Author notes
                Correspondence: Awsan Bahattab, CRIMEDIM – Research Center in Emergency and Disaster Medicine, Università del Piemonte, vicolo Monte Ariolo 4, 28100 Novara, Italy - E-mail: awsan.bahattab@
                ©2020 Pacini Editore SRL, Pisa, Italy

                This is an open access article distributed in accordance with the CC-BY-NC-ND (Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International) license. The article can be used by giving appropriate credit and mentioning the license, but only for non-commercial purposes and only in the original version. For further information:

                Page count
                Figures: 1, Tables: 6, Equations: 0, References: 25, Pages: 9
                Original Article


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