Sachet water consumption as a risk factor for cholera in urban settings: Findings from a case control study in Kinshasa, Democratic Republic of the Congo during the 2017-2018 outbreak.

<h4>Background</h4>Behavioural risk factors for cholera are well established in rural and semi-urban contexts, but not in densely populated mega-cities in Sub-Saharan Africa. In November 2017, a cholera epidemic occurred in Kinshasa, the Democratic Republic of the Congo, where no outbrea...

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Autores principales:	Placide Mbala-Kingebeni, Florian Vogt, Berthe Miwanda, Tresor Sundika, Nancy Mbula, Isaac Pankwa, Leopold Lubula, Veerle Vanlerberghe, Alain Magazani, Mildred Tita Afoumbom, Jean-Jacques Muyembe-Tamfum
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/f5aa053720f54a07903ca318962e4b22
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spelling	oai:doaj.org-article:f5aa053720f54a07903ca318962e4b222021-11-25T06:33:32ZSachet water consumption as a risk factor for cholera in urban settings: Findings from a case control study in Kinshasa, Democratic Republic of the Congo during the 2017-2018 outbreak.1935-27271935-273510.1371/journal.pntd.0009477https://doaj.org/article/f5aa053720f54a07903ca318962e4b222021-07-01T00:00:00Zhttps://doi.org/10.1371/journal.pntd.0009477https://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735<h4>Background</h4>Behavioural risk factors for cholera are well established in rural and semi-urban contexts, but not in densely populated mega-cities in Sub-Saharan Africa. In November 2017, a cholera epidemic occurred in Kinshasa, the Democratic Republic of the Congo, where no outbreak had been recorded for nearly a decade. During this outbreak, we investigated context-specific risk factors for cholera in an urban setting among a population that is not frequently exposed to cholera.<h4>Methodology/principal findings</h4>We recruited 390 participants from three affected health zones of Kinshasa into a 1:1 matched case control study. Cases were identified from cholera treatment centre admission records, while controls were recruited from the vicinity of the cases' place of residence. We used standardized case report forms for the collection of socio-demographic and behavioural risk factors. We used augmented backward elimination in a conditional logistic regression model to identify risk factors. The consumption of sachet water was strongly associated with the risk of being a cholera case (p-value 0.019), which increased with increasing frequency of consumption from rarely (OR 2.2, 95% CI 0.9-5.2) to often (OR 4.0, 95% CI 1.6-9.9) to very often (OR 4.1, 95% CI 1.0-16.7). Overall, more than 80% of all participants reported consumption of this type of drinking water. The risk factors funeral attendance and contact with someone suffering from diarrhoea showed a p-value of 0.09 and 0.08, respectively. No socio-demographic characteristics were associated with the risk of cholera.<h4>Conclusions/significance</h4>Drinking water consumption from sachets, which are sold informally on the streets in most Sub-Saharan African cities, are an overlooked route of infection in urban cholera outbreaks. Outbreak response measures need to acknowledge context-specific risk factors to remain a valuable tool in the efforts to achieve national and regional targets to reduce the burden of cholera in Sub-Saharan Africa.Placide Mbala-KingebeniFlorian VogtBerthe MiwandaTresor SundikaNancy MbulaIsaac PankwaLeopold LubulaVeerle VanlerbergheAlain MagazaniMildred Tita AfoumbomJean-Jacques Muyembe-TamfumPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 15, Iss 7, p e0009477 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
spellingShingle	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Placide Mbala-Kingebeni Florian Vogt Berthe Miwanda Tresor Sundika Nancy Mbula Isaac Pankwa Leopold Lubula Veerle Vanlerberghe Alain Magazani Mildred Tita Afoumbom Jean-Jacques Muyembe-Tamfum Sachet water consumption as a risk factor for cholera in urban settings: Findings from a case control study in Kinshasa, Democratic Republic of the Congo during the 2017-2018 outbreak.
description	<h4>Background</h4>Behavioural risk factors for cholera are well established in rural and semi-urban contexts, but not in densely populated mega-cities in Sub-Saharan Africa. In November 2017, a cholera epidemic occurred in Kinshasa, the Democratic Republic of the Congo, where no outbreak had been recorded for nearly a decade. During this outbreak, we investigated context-specific risk factors for cholera in an urban setting among a population that is not frequently exposed to cholera.<h4>Methodology/principal findings</h4>We recruited 390 participants from three affected health zones of Kinshasa into a 1:1 matched case control study. Cases were identified from cholera treatment centre admission records, while controls were recruited from the vicinity of the cases' place of residence. We used standardized case report forms for the collection of socio-demographic and behavioural risk factors. We used augmented backward elimination in a conditional logistic regression model to identify risk factors. The consumption of sachet water was strongly associated with the risk of being a cholera case (p-value 0.019), which increased with increasing frequency of consumption from rarely (OR 2.2, 95% CI 0.9-5.2) to often (OR 4.0, 95% CI 1.6-9.9) to very often (OR 4.1, 95% CI 1.0-16.7). Overall, more than 80% of all participants reported consumption of this type of drinking water. The risk factors funeral attendance and contact with someone suffering from diarrhoea showed a p-value of 0.09 and 0.08, respectively. No socio-demographic characteristics were associated with the risk of cholera.<h4>Conclusions/significance</h4>Drinking water consumption from sachets, which are sold informally on the streets in most Sub-Saharan African cities, are an overlooked route of infection in urban cholera outbreaks. Outbreak response measures need to acknowledge context-specific risk factors to remain a valuable tool in the efforts to achieve national and regional targets to reduce the burden of cholera in Sub-Saharan Africa.
format	article
author	Placide Mbala-Kingebeni Florian Vogt Berthe Miwanda Tresor Sundika Nancy Mbula Isaac Pankwa Leopold Lubula Veerle Vanlerberghe Alain Magazani Mildred Tita Afoumbom Jean-Jacques Muyembe-Tamfum
author_facet	Placide Mbala-Kingebeni Florian Vogt Berthe Miwanda Tresor Sundika Nancy Mbula Isaac Pankwa Leopold Lubula Veerle Vanlerberghe Alain Magazani Mildred Tita Afoumbom Jean-Jacques Muyembe-Tamfum
author_sort	Placide Mbala-Kingebeni
title	Sachet water consumption as a risk factor for cholera in urban settings: Findings from a case control study in Kinshasa, Democratic Republic of the Congo during the 2017-2018 outbreak.
title_short	Sachet water consumption as a risk factor for cholera in urban settings: Findings from a case control study in Kinshasa, Democratic Republic of the Congo during the 2017-2018 outbreak.
title_full	Sachet water consumption as a risk factor for cholera in urban settings: Findings from a case control study in Kinshasa, Democratic Republic of the Congo during the 2017-2018 outbreak.
title_fullStr	Sachet water consumption as a risk factor for cholera in urban settings: Findings from a case control study in Kinshasa, Democratic Republic of the Congo during the 2017-2018 outbreak.
title_full_unstemmed	Sachet water consumption as a risk factor for cholera in urban settings: Findings from a case control study in Kinshasa, Democratic Republic of the Congo during the 2017-2018 outbreak.
title_sort	sachet water consumption as a risk factor for cholera in urban settings: findings from a case control study in kinshasa, democratic republic of the congo during the 2017-2018 outbreak.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/f5aa053720f54a07903ca318962e4b22
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Sachet water consumption as a risk factor for cholera in urban settings: Findings from a case control study in Kinshasa, Democratic Republic of the Congo during the 2017-2018 outbreak.

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