Environmental Risk Factors during the Zimbabwe Cholera Outbreak, 2008-2009 公开
Berendes, David (2011)
Abstract
Environmental Risk Factors during the Zimbabwe Cholera Outbreak,
2008-2009
By David Berendes
Cholera is a waterborne disease that causes outbreaks worldwide.
Despite advances in
safe water distribution networks in the developing world, cholera
and other waterborne
diseases persist in the environment. In Zimbabwe, gradual economic
collapse over the
last 10 years culminated in the creation of a complex humanitarian
emergency state in
2008, with massive loss of health and water infrastructure. This
situation put the country
at risk for one of the largest and most severe cholera outbreaks in
the past 10 years. The
goal of this study was to assess the effect of safe water use,
particularly borehole use, at
the village level in preventing cholera spread and lowering cholera
attack rates in the
Chivi and Gokwe North districts during the outbreak. Safe water
use, and borehole use
in particular, was associated with reduced attack rates and fewer
outbreak-affected
villages when compared with unsafe water use by villages. Both the
reductions seen in
attack rates and those seen in cholera prevalence across villages
were borderline
significant. Missing data was an issue in the analysis, and
imputation methods were
compared and contrasted in the development of final logistic and
multiple linear
regression models. Despite the limited availability of timely
point-of-use water treatment
in the Zimbabwean cholera outbreak, a characteristic inherent to
many response efforts,
there was suggestive but inconclusive evidence that water quality
at the source may
reduce cholera morbidity by itself. This paper has important
implications not only for
field outbreak data methodology, but for water and sanitation
promotion as well. While
simple imputation methods seem to be the norm in outbreaks in the
field, there was value
in multiple imputation methods for improving the validity and
precision of the model
estimates.
Environmental Factors in Boreholes Use Affecting the Cholera
Outbreak in Zimbabwe
By
David Berendes
B.S., Duke University, 2009
Thesis Committee Chair: Juan Leon PhD, MPH
A thesis submitted to the Faculty of the
Rollins School of Public Health of Emory University
in partial fulfillment of the requirements for the degree of
Master of Science in Public Health
in Global Epidemiology
2011
Table of Contents
Table of Contents
Literature Review: 1
Cholera Surveillance 2
Cholera Types and Environmental Features 3
Clinical Features of Cholera: 4
Treatment of Cholera and Mortality: 5
Cholera Transmission 6
Cholera Outbreaks: 7
Safe Water: 7
Cholera in Africa: 11
Complex Humanitarian Emergencies: 12
Zimbabwe: 16
District-Level Water Access: 17
Goals and Aims: 18
Significance: 19
Materials and Methods: 20
Analysis: 23
Results: 26
Water: 26
Cholera and Water Source Analysis in Study Villages: 28
Cholera Modeling: 29
Discussion: 33
Future Directions and Public Health Implications: 41
Tables and Figures: 43
Table 1: Village Demographics and Attack Rate by District 43
Table 2: Main source of pre-outbreak drinking water and cholera
distribution for all villages 44
Table 3: Borehole Functionality and Distribution Across Districts
45
Table 4: Cholera Spread and Attack Rate Analysis by Village Main
Water Source Type 46
Table 5: Logistic Regression Model Cholera Distribution by Village
on Safe/Unsafe Water Use 47
Table 6: Logistic Regression Model Cholera Distribution by Village
on Borehole/Unsafe Water Use 48
Table 7: Risk Factors Associated with Cholera Attack Rate by
Village 49
Appendix A: IRB Clearance 50
References: 51
About this Master's Thesis
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