JMIR Publications

ABSTRACT

Background:

Yemen has recently faced the largest cholera outbreak in the world since late September 2016. In 2019, 858,667 cases with 1,024 deaths were reported in 2019 where AL-Hudeidah was one of the most affected areas.

Objective:

This study aimed to determine the risk factors associated with cholera transmission in AL-Hudeidah city.

Methods:

A total of 104 cholera cases (57 females and 47 males) who presented to cholera treatment centers in Al Hudeidah city with three or more watery stools in a 24-hour period and with moderate or severe dehydration were identified. Each case was matched by age and gender with two controls who were living in the next house of the case. A semi-structured questionnaire was used to collect data on behavioral and environmental risk factors such as drinking water form public wells, storing water in containers, consumption of unwashed vegetables or fruits and sharing toilet.

Results:

The median age was 20 years (range: 5-80) for cases and 23 (range: 5-85) for controls. Only 6% of cases and 4% of controls were employed. Multivariate analysis showed that eating unwashed vegetables or fruits (OR 7.0, 95% CI: 1.6 – 30.6; P =0.012), storing water in containers (OR = 3, 95% CI: 1.3-7.3; P =0.013), drinking water from public well (OR= 2.5, 95% CI: 1.1-5.7: P= 0.022) and using public toilet (OR 5.2, 95% CI :1.1-24.4; P =0.038) were significantly associated with cholera.

Conclusions:

Drinking water form public wells, storing water in containers, consumption of unwashed vegetables or fruits and sharing toilet are main risk factors of Cholera. Therefore, increasing awareness of population toward the importance of water chlorination and washing fruits and vegetables through health education campaign is strongly recommended.