Online Program

Spatio-temporal patterns observed during the 2008-2009 cholera outbreak in Zimbabwe

Tuesday, November 5, 2013 : 9:30 a.m. - 9:50 a.m.

Ian Kracalik, M.A., M.P.H., Emerging Pathogens Institute, University of Flroida, Gainesville, FL
Zindoga Mukandavire, PhD, Department of Global Health and Development, London School of Tropical Medicine and Hygiene, London, United Kingdom
Portia Manangazira, Dr., Ministry of Health & Child Welfare Zimbabwe, Harare, Zimbabwe
Andrew Tatem, PhD, Department of Geography and Environment, University of Southampton, Southampton, United Kingdom
Dave Smith, PhD, Department of Epidemiology, Johns Hopkins Bloomberg School of Public, Maryland, MD
J. Glenn Morris, MD, Emerging Pathogens Institute, University of Florida, Gainesville, FL
Cholera has emerged as a major threat to public health in Zimbabwe. One of the largest cholera outbreaks in recent history in the country occurred during 2008-2009 resulting in about 100,000 reported cases and a case fatality ratio of about 4.3%. Using weekly district level data on reported cholera cases and deaths obtained from the Zimbabwe Ministry of Health and Child Welfare (MoHCW), we carried out spatio-temporal analysis of the outbreaks to identify areas with an increased burden of disease and described the spatial patterns of the epidemic. Results show that the distribution of cases and deaths was spatially heterogeneous. Cumulative attack rates/100,000 population varied widely ranging from 4.3 (95% CI: 3.0, 6.0) in Shurugwi to a high of 4943.8 (95% CI: 481.1, 508.1) in Beitbridge. Case fatality ratios also showed wide variation ranging from 0% (95% CI: 0, 41) in Lupane to 29.6% (95% CI: 23.2, 36.7) in Murehwa. Clustering was identified in districts in the northern, eastern, and south eastern borders of the country. These areas have a history of previous cholera outbreaks and highlight the need for targeted interventions. Cholera deaths were shown to be higher in the rural districts of the country, suggesting poor access to health care facilities or basic oral rehydration solution for cholera treatment. The findings here point to the importance of recognizing the heterogeneous nature of cholera outbreaks and the need to identify key factors that may help improve surveillance and disease control.

Learning Areas:

Other professions or practice related to public health
Planning of health education strategies, interventions, and programs
Public health or related research

Learning Objectives:
Describe the spread of epidemic cholera during the outbreak in Zimbabwe to help explain how the disease propagated throughout the country. Identify areas of Zimbabwe that experienced a disproportionate burden of illness. Evaluate the public health response during the epidemic for future planning.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have acted as a research associate and project coordinator on several federally funded projects related to the spatial epidemiology of infectious diseases including cholera. Among my many scientific interests has been examining factors related to the epidemic spread of cholera.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.