Factors associated with cholera outbreaks in Isiolo County, Kenya

Abstract

Isiolo County accommodates nomadic pastoralists with sedentary lifestyles. Since 2010, the county has had cholera incidences every year apart from 2014. In 2013 alone for instance, Isiolo confirmed 8 deaths from cholera (WHO, 2013); in 2016, 10 people were confirmed positive and 500 others treated from exposure (Relief web, 2016); in 2018, Isiolo was one of the six counties that contributed a cumulative of 2943 cholera cases with 55 fatalities (Reliefweb, 2018). There is a dearth of evidence on factors associated with the re-emergence and spread of cholera in Isiolo County. This cross sectional study applied simple random and purposive sampling of households and health care providers respectively, to assess how knowledge and attitude factors, environmental health factors and health system factors influence occurrence of cholera in Isiolo County. We employed Fischer’s formula to obtain a sample of 401 respondents. Results indicate that participants interviewed were of modal age 20-39 (60.3%). There were more female respondents (62.6%) than male (37.4%). The majority (75.8%) were married and 76.8% had acquired some form of education ranging from primary to tertiary level. A bigger proportion of participants (69.3%) had no employment at all and majority of those who worked were self employed (70%) earning a monthly household income of < 1000.00 shillings. 37.2% of the respondents reported having had at least a case of acute watery diarrhea in the past one week from a family member aged 5 years and above. Overall, evidence from this study shows that respondents who knew proper use of toilets (ₐOR=1.38; 95% CI 0.80,2.37) and washing hands after using the toilet (ₐOR=3.54; 95% CI 1.42, 8.81; p=0.01) as preventive ways, were less likely to experience occurrence of cholera compared to those who did not. Not washing hands after handling children’s feaces (ₐOR=1.98; 95% CI 1.13, 3.46; p=0.02); consuming unwashed fruits or vegetables (ₐOR =0.41; 95% CI 0.25, 0.69) proper cooking of food as a practice (ₐOR=0.52; 95% CI 0.28, 0.96; p=0.04) were found to be significant predictors to occurrence of cholera. Those who were willing to let a child receive cholera vaccine (OR=1.96; 95% CI, 1.14, 3.34); knew fever as a symptom (ₐOR=0.57; 95% CI 0.33, 0.98; p=0.04) were also less likely to experience occurrence of cholera. We conclude that occurrence of cholera is predicted by knowing prevention measures such as proper use of toilet and washing hands after use of toilet. Hygiene factors including not washing hands after handling children’s feces, consuming unwashed fruits or vegetables and proper cooking of food were also found to be significantly associated with cholera occurrence. Willingness to let a child receive cholera vaccine and knowledge of cholera symptoms predicted occurrence. The study recommends extensive health education in the county with specific focus on sensitization on the role of sanitation and general hygiene in prevention of cholera. This would require that (i) safety of drinking water is ensured (ii) the importance of toilet ownership is emphasized and (iii) the community is sensitized on the need to present themselves for vaccination against cholera. County health sector stakeholders should explore opportunities to adjust the current service delivery model to address predictor factors not proximal to the community like hospital distance to improve access to healthcare.