Predictors of cholera outbreaks among households in Mazimasa and Himutu sub-counties in Butaleja district – Eastern Uganda

Abstract

Background: Cholera is an infectious disease of public health importance can’t be overstated, given the hypovolemia it causes with its associated sequelae, in addition to the possible health ripple effects on the wider community. Whereas the disease is treatable with vaccines available, its treatment is associated with antibiotic resistance, while the vaccination is also contraindicated among children less than 2 years, yet it is ineffective among some older children. Prevention thus remains the most potent approach for the global target to eliminate cholera and has indeed been embraced. However, cholera outbreaks are still rampant, with active cases apparent in 2020. Objective: This study aimed at assessing predictors of cholera outbreaks in Mazimasa and Himutu sub-counties in Butaleja district - eastern Uganda Method: An analytical cross-sectional study was used, involving 368 household heads, Mazimasa and Himutu sub counties were stratified, parishes therein randomly sampled and also stratified so as to randomly sample villages. Households were conveniently sampled, household heads sampled purposively, and engaged in structured interviews. Document reviews were also done, and the data collected analyzed in SPSS version 25 Findings:Slightly more than a tenth of the households sampled had had a member diagnosed with the disease previously 41/368 (11.1%), with slightly more than three quarters of the cases in Mazimasa sub county 31(75.6%). Having a household member with HIV/AIDS (aPR = 1.638, CI = 1.465 - 1.877, p = 0.006), malaria being a common illness in a household (aPR = 1.892, CI = 1.847 - 2.940, P = <0.001), being a male headed household (aPR = 0.933, CI = 0.879 - 0.991, P = 0.023), having one male member in a household (aPR = 0.767, CI = 0.662 - 0.889, p = <0.001), boiling water for drinking (aPR = 0.931, CI = 0.888 - 0.976, P = 0.003), boiling water sometimes (aPR = 0.767, 0.642 - 0.916, P = 0.003), always consuming fish (aPR = 1.143, CI = 1.011 - 2.869, P = <0.001), use of flood water for any purpose (aPR = 0.894, CI = 0.832 - 0.961, P = 0.020), and use of communal toilets constructed with local materials (aPR = 1.223, CI = 1.083 - 1.380, p = 0.001) predicted cholera outbreak at an intra-household level. Flooding frequency being once a year (aPR = 0.928, CI = 0.907 - 0.950, P = <0.001), having a tap as the main water source in the villages (aPR = 1.059, CI = 1.009 - 1.112, P = 0.021), water shortages (aPR = 1.058, CI = 1.005 - 1.115, P = 0.032) in communities, and the frequency of being once per year (aPR = 0.780, CI = 0.645 - 0.943, P = 0.010) predicted cholera outbreaks from an environmental perspective Conclusion: About 1 in every 10 households in Mazimasa and Himutu sub-counties has had a cholera outbreak, predicted by both intra-household and community characteristics. However, intra-household characteristics happened to be more important of the two, with the implication that whereas preventive interventions ought to target both intra-household and community entities, relatively more emphasis should be put on the intra-household entity