A cholera outbreak among semi-nomadic pastoralists in northeastern Uganda: Epidemiology and interventions

In sub-Saharan Africa, many nomadic pastoralists have begun to settle in permanent communities as a result of long-term water, food, and civil insecurity. Little is known about the epidemiology of cholera in these emerging semi-nomadic populations. We report the results of a case-control study conducted during a cholera outbreak among semi-nomadic pastoralists in the Karamoja sub-region of northeastern Uganda in 2010. Data from 99 cases and 99 controls were analysed. In multivariate analyses, risk factors identified were: residing in the same household as another cholera case [adjusted odds ratio (aOR) 6.67, 95% confidence interval (CI) 2.83-15.70], eating roadside food (aOR 2.91, 95% CI 1.24-6.81), not disposing of children's faeces in a latrine (aOR 15.76, 95% CI 1.54-161.25), not treating drinking water with chlorine (aOR 3.86, 95% CI 1.63-9.14), female gender (aOR 2.43, 95% CI 1.09-5.43), and childhood age (10-17 years) (aOR 7.14, 95% CI 1.97-25.83). This is the first epidemiological study of cholera reported from a setting of semi-nomadic pastoralism in sub-Saharan Africa. Public health interventions among semi-nomadic pastoralists should include a two-faceted approach to cholera prevention: intensive health education programmes to address behaviours inherited from insecure nomadic lifestyles, as well as improvements in water and sanitation infrastructure. The utilization of community-based village health teams provides an important method of implementing such activities. © 2011 Cambridge University Press.