Cross-Border Cholera Outbreaks in Sub-Saharan Africa, the Mystery behind the Silent Illness: What Needs to Be Done?
Cross-Border Cholera Outbreaks in Sub-Saharan Africa, the Mystery behind the Silent Illness: What Needs to Be Done?
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DOI：
10.1371/journal.pone.0156674
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发表时间：
2016-06-03
期刊：
影响因子：
3.7
通讯作者：
Orach, Christopher Garimoi
中科院分区：
文献类型：
--
作者：
Bwire, Godfrey;Mwesawina, Maurice;Orach, Christopher Garimoi
跨境霍乱疫情是撒哈拉以南非洲地区的一个主要公共卫生问题，导致每年报告的霍乱病例和死亡人数居高不下。这些疫情影响到所有类别的人，对预防和控制具有挑战性。本文以乌干达-刚果民主共和国和马拉维-莫桑比克边境为例，介绍了在东部和南部非洲次区域跨境霍乱疫情控制期间吸取的教训，并对未来的疫情预防和控制提出了建议。关于东部和南部非洲最近跨界霍乱疫情管理的疫情应对报告和记录经验，分别在乌干达和马拉维。选择乌干达-刚果民主共和国和马拉维-莫桑比克边界是因为共享这些边界的国家向世卫组织报告了高霍乱疾病负担。乌干达记录了118例病例，2例死亡，病死率为1.7%。五岁以下儿童和学龄儿童是受影响最严重的年龄组，分别占马拉维-莫桑比克和乌干达-刚果民主共和国沿着边界所有患者的24.2%和36.4%。这些暴发持续了3个多月，并蔓延到新的地区，分别在马拉维和乌干达造成60例病例，3例死亡，CRF为5%，102例零死亡。导致这些疾病爆发的因素是：环境卫生和个人卫生不良、使用受污染的水、洪水和猖獗的跨界流动。疫情控制工作主要涉及单方面的措施实施的只有一个受影响的countries.ConclusionsCross-border霍乱疫情有助于高年度报告的霍乱负担在撒哈拉以南非洲，但他们仍然沉默，边缘化和识别不良的霍乱行为者（政府和国际机构）。五岁以下儿童和在校儿童是受影响最严重的年龄组。为了成功预防和控制这些疫情，应审查指导方针和战略，为霍乱行为者在这些流行病的合作、预防、检测、监测和控制方面分配明确的作用和责任。
IntroductionCross-border cholera outbreaks are a major public health problem in Sub-Saharan Africa contributing to the high annual reported cholera cases and deaths. These outbreaks affect all categories of people and are challenging to prevent and control. This article describes lessons learnt during the cross-border cholera outbreak control in Eastern and Southern Africa sub-regions using the case of Uganda-DRC and Malawi-Mozambique borders and makes recommendations for future outbreak prevention and control.Materials and MethodsWe reviewed weekly surveillance data, outbreak response reports and documented experiences on the management of the most recent cross-border cholera outbreaks in Eastern and Southern Africa sub-regions, namely in Uganda and Malawi respectively. Uganda-Democratic Republic of Congo and Malawi-Mozambique borders were selected because the countries sharing these borders reported high cholera disease burden to WHO.ResultsA total of 603 cross-border cholera cases with 5 deaths were recorded in Malawi and Uganda in 2015. Uganda recorded 118 cases with 2 deaths and CFR of 1.7%. The under-fives and school going children were the most affected age groups contributing 24.2% and 36.4% of all patients seen along Malawi-Mozambique and Uganda-DRC borders, respectively. These outbreaks lasted for over 3 months and spread to new areas leading to 60 cases with 3 deaths, CRF of 5%, and 102 cases 0 deaths in Malawi and Uganda, respectively. Factors contributing to these outbreaks were: poor sanitation and hygiene, use of contaminated water, floods and rampant cross- border movements. The outbreak control efforts mainly involved unilateral measures implemented by only one of the affected countries.ConclusionsCross-border cholera outbreaks contribute to the high annual reported cholera burden in Sub-Saharan Africa yet they remain silent, marginalized and poorly identified by cholera actors (governments and international agencies). The under-fives and the school going children were the most affected age groups. To successfully prevent and control these outbreaks, guidelines and strategies should be reviewed to assign clear roles and responsibilities to cholera actors on collaboration, prevention, detection, monitoring and control of these epidemics.