Identification And Mapping Of Risk Factors Associated With Cholera In Selected Communities In The Greater Accra Region, Ghana

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2021-09

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University Of Ghana

Abstract

Background Cholera is an acute diarrhoeal disease caused by the toxigenic Vibrio cholerae O1 or O139 strains. Globally, it is estimated to infect over 1.3 million people with over 21, 000 deaths annually with the most affected countries being in Africa and Asia. In Ghana, cholera has become endemic in some communities in the Greater Accra Region (GAR) with reported focal epidemics. The factors contributing to its persistence and spread in these communities are not well understood. To prevent future epidemics, it is important to identify the specific risks in these communities that may account for its persistence. This study, therefore, identified and mapped risk factors associated with cholera at the household and community levels in the GAR. Methods A community-based cross-sectional comparative study was conducted in 24 (12 each) from cholera endemic and non-endemic communities from March 2019 to March 2020. The multistage cluster sampling procedure was used in selecting households and a structured questionnaire was used to collect data from the head of households. Drinking water from selected households was sampled for water quality and the community water bodies were assessed for the presence of toxigenic strains of V. cholerae during the wet and dry seasons. A sanitation inspection guide was used to assess the sanitation conditions of the communities and GPS coordinates of the identified risk taken. Data were analysed using STATA version 14 software. Associations between the history of cholera and the independent variables were determined using Chi-square/Fisher exact test and multivariable penalized logistic regression. The differences in bacterial counts were determined using the Kruskal Wallis rank test. A p-value less than 0.05 was considered significant for the associations. Principal Component Analysis was used to categorize the household wealth index and the environmental sanitation conditions. Significantly identified risk factors were mapped with the historical cholera cases using Arc GIS. Results Results of the multivariable penalized logistic regression showed that the presence of waste dumpsites (AOR=2.96, 95% CI: 1.11-7.88, p=0.030) and big open drainage (AOR=5.78, 95% CI: 1.89-17.72, p=0.002) were predictors of cholera occurrence. Whereas cooking in a detached kitchen (AOR=0.22, 95% CI: 0.06-0.82. P=0.024), or in yard (AOR=0.42, 95% CI: 0.21-0.86, p=0.017), and the availability of public toilets in the neighbourhood (AOR=0.28, 95% CI: 0.08-0.97, p=0.046) were significantly protective against cholera. The household drinking water was mostly contaminated with faecal coliforms with counts exceeding the zero cfu/100ml standard. Klebsiella penumoniae and Escherichia coli were the dominant organisms isolated. The household stored water was more contaminated than that obtained from the direct source and the differences were significant. The contamination was generally higher in the wet season than in the dry season. No toxigenic Vibrio cholerae O1 or O139 was isolated from the household drinking water and the environmental water bodies. However, Vibrio fluvialis and Vibrio algionolyticus were isolated from the environmental water bodies. Environmental sanitation revealed 66.2% (300/453) of the endemic communities to have poor sanitation compared to the 67.5% (306/453) of the non-endemic communities with good sanitation conditions. Conclusion/Recommendation The presence of public toilets, waste dumpsites, and open drainage systems close to each other and their combined effect may account for the cholera endemicity in the endemic communities. Household drinking water contaminated with faecal coliforms is an indicator of high risk for cholera transmission. The absence of toxigenic strains of Vibrio cholerae O1 or O139 in the drinking and environmental water bodies could predict the absence of cholera occurrence. Vibrio fluvialis and Vibrio algionolyticus emerging cholera-like diarrhoea pathogens were isolated from the environmental water bodies. Poor environmental sanitation is still prevalent in the endemic communities. It is recommended that sanitation laws and the treatment of household drinking water at the point-of-used as well as siting of public toilets, waste dumpsites, and open drainages beyond 500 m from households are enforced.

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PhD. Public Health

Keywords

Risk Factors, Cholera, Greater Accra Region, Ghana

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