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© 1994 Oxford University Press

other

Epidemic Cholera during Refugee Resettlement in Malawi

DOUGLAS L HATCH*, RONALD J WALDMAN*,**, GEOFFREY W LUNGU{dagger} and C PIRI{ddagger}

* International Health Program Office, Centers for Disease Control CDC/EPO/DFE/International Branch, 1600 Clifton Road, NE MS C-08, Atlanta, GA 30333, USA
** World Health Organization Geneva, Switzerland
{dagger} Office of the United Nations High Commissioner for Refugees, Blantyre Office Malawi
{ddagger} Ministry of Health Nsanje District, Malawi

BACKGROUND: In June 1988 a cholera epidemic occurred in a Mozambican refugee population resettling in southern Malawi.

METHODS: A case-control study was conducted to determine possible risk factors for disease. The characteristics of 48 refugee households with any members) hospitalized for suspected cholera were compared to 441 randomly sampled refugee households without hospitalizations.

RESULTS: Vibrio choierae 01 was isolated from 50% (5/10) of case-patient stool cultures. Having any water containers with ≥10 I capacity was associated with a significantly lower odds of suspected cholera in households (adjusted odds ratio [aOR] = 0.02, 95% confidence interval [Cl]: 0.003–0.12), as was having metal cooking pots (aOR = 0.3, 95% Cl: 0.12–0.7), after adjusting for length of residence and socioeconomic status (logistic regression model). Households with two or more children <5 years old were at markedly increased odds of suspected cholera (P < 0.0001). These results suggest that water containers and cooking pots served important preventive functions during this cholera outbreak. Young children may have contributed to cholera transmission, but the reason(s) remains undetermined.

Received 1 April 1994


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