Assessing differences in cholera risk factor prevalence between migrant Haitians and Dominicans in the Dominican Republic Open Access

Abstract

Background: When cholera emerged in Haiti, it quickly spread across the island of Hispaniola, reaching the Dominican Republic in less than a month. The epidemic in the Dominican Republic has been mild in compared to the Haitian epidemic, but the cholera burden has been disproportionately borne by certain marginalized groups. Cholera risk is associated with access to water, sanitation and hygiene (WASH) infrastructure, and this study sought to examine differences in cholera risk factor prevalence between migrant Haitians and Dominicans living in an agricultural province of the Dominican Republic, focusing on WASH infrastructure and cholera knowledge.

Methods: A cross-sectional survey was carried out in the Duarte Province, Dominican Republic in July 2012. A total of 363 surveys were completed in Haitian (n = 103) and Dominican (n = 260) households in 18 provincial communities. The survey instrument included modules for demographic information; cholera knowledge; socioeconomic status; and access to WASH infrastructure. Binary logistic regression was used to assess differential access to WASH infrastructure between Haitians and Dominicans, and Poisson regression was used to assess differences in numerical scores of cholera knowledge.

Results: Dominican and Haitian households differed greatly on many demographic characteristics, with low educational attainment and socioeconomic status among Haitians compared to Dominicans. Access to improved drinking water was low among both groups, but Haitians had lower access in both rural (aOR = 0.005, 95% CI 0.002, 1.02) and urban (aOR = 0.21, 95% CI 0.05, 1.01) areas. No differences in access to sanitation were detected between Haitians and Dominicans (aOR = 1.00, 95% CI 0.57, 1.76) after adjusting for socio-demographic confounders. Haitians had lower knowledge of cholera symptoms and transmission than Dominicans, even when adjusting for confounders (aOR = 0.66, 95% CI 0.55, 0.81).

Conclusions: Access to household WASH facilities differs across nationality, but is affected by socio-demographic factors as well as urban-rural geography. Provincial health authorities should target WASH interventions to migrant Haitian and rural agricultural communities in order to eliminate cholera from the province. Low cholera knowledge among Haitians may reflect low access to health care and could be addressed through community-based outreach efforts.

Table of Contents

Chapter I: Literature Review..................................................................................... 1

Chapter II: Manuscript............................................................................................. 7

Introduction........................................................................................................... 7 Methods................................................................................................................ 10 Results.................................................................................................................. 18 Discussion.............................................................................................................. 24

Chapter III: Public Health Implications......................................................................... 33

References............................................................................................................. 37

Tables and Figures................................................................................................... 42

Appendix: Survey Instrument..................................................................................... 50

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Environmental Sciences Health Sciences, Epidemiology
Keyword	Risk factors Migration Cholera Haiti Dominican Republic Water and sanitation
Committee Chair / Thesis Advisor	Freeman, Matthew, Emory University
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti) University, college or educational institution (other than Emory)

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