{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:18:11Z","timestamp":1790011091028,"version":"4.0.1"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T00:00:00Z","timestamp":1742774400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020171","name":"Foreign, Commonwealth and Development Office","doi-asserted-by":"publisher","award":["215675\/Z\/19\/Z"],"award-info":[{"award-number":["215675\/Z\/19\/Z"]}],"id":[{"id":"10.13039\/501100020171","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Institute of Allergy and Infectious Diseases"},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["D43TW011519"],"award-info":[{"award-number":["D43TW011519"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Cholera is a public health challenge in Kenya. This study aimed at identifying the spatio-temporal pattern of cholera and its associated risk factors in high-risk areas to optimize resource use for targeted control.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The study was conducted in Mukuru, an informal settlement, Dadaab refugee camp and counties bordering Lake Victoria. Cholera line list data from 32 subcounties (2013\u20132022) was sourced from Kenya's Ministry of Health. Population and water, sanitation and hygiene data came from the 2019 census. Space\u2013time scan statistic (SaTScan) were used to carry out spatio-temporal analysis and a zero-inflated negative binomial regression model evaluated cholera risk factors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 7316 cholera cases were reported across 22 (69%) subcounties, the highest numbers in 2015, 2016 and 2022 affecting 21, 12 and 3 subcounties, respectively, and none in 2014. Five high-risk space\u2013time clusters encompassing 15 subcounties were identified, with Dadaab and Fafi showing persistent outbreaks. Improved sanitation was the only variable that suggested significant protective effects to cholera control (relative risk 0.9445, p=0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Dadaab and Fafi subcounties were extremely high-risk and improved sanitation significantly reduced cholera outbreaks. These data inform cholera intervention policies in vulnerable regions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/trstmh\/traf032","type":"journal-article","created":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T04:10:26Z","timestamp":1743221426000},"page":"758-766","source":"Crossref","is-referenced-by-count":4,"title":["Spatio-temporal pattern and risk factors associated with cholera outbreaks in selected high-risk areas of Kenya"],"prefix":"10.1093","volume":"119","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7076-3674","authenticated-orcid":false,"given":"Lydia M","family":"Mageto","sequence":"first","affiliation":[{"name":"Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Nairobi Department of Public Health, , P.O. Box 29053, 00625 Nairobi ,","place":["Kenya"]},{"name":"Washington State University, Global Health Kenya , P.O. Box 72938-00200 Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nyamai","family":"Mutono","sequence":"additional","affiliation":[{"name":"Centre for Epidemiological Modelling and Analysis, University of Nairobi , P.O. Box 19676-00202 Nairobi ,","place":["Kenya"]},{"name":"Washington State University, Global Health Kenya , P.O. Box 72938-00200 Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Aboge","sequence":"additional","affiliation":[{"name":"Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Nairobi Department of Public Health, , P.O. Box 29053, 00625 Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Gathura","sequence":"additional","affiliation":[{"name":"Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Nairobi Department of Public Health, , P.O. Box 29053, 00625 Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Okunga","sequence":"additional","affiliation":[{"name":"Division of Disease Surveillance and Response, Ministry of Health , Kenya P.O. Box 30016-00100 Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annastacia","family":"Muange","sequence":"additional","affiliation":[{"name":"Division of Disease Surveillance and Response, Ministry of Health , Kenya P.O. Box 30016-00100 Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia Kathure","family":"Mbae","sequence":"additional","affiliation":[{"name":"Centre for Microbiology Research, Kenya Medical Research Institute , P.O. Box 54840-0020 , Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel M","family":"Thumbi","sequence":"additional","affiliation":[{"name":"Centre for Epidemiological Modelling and Analysis, University of Nairobi , P.O. Box 19676-00202 Nairobi ,","place":["Kenya"]},{"name":"Paul G. Allen School of Global Health, Washington State University, College of Veterinary Medicine , Pullman, WA 99164 ,","place":["USA"]},{"name":"Institute of Infection and Immunology Research, University of Edinburgh , Edinburgh EH9\u00a03FL ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Kariuki","sequence":"additional","affiliation":[{"name":"Centre for Microbiology Research, Kenya Medical Research Institute , P.O. Box 54840-0020 , Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,3,24]]},"reference":[{"issue":"6","key":"2025070113063626000_bib1","doi-asserted-by":"crossref","first-page":"e0003832","DOI":"10.1371\/journal.pntd.0003832","article-title":"Updated global burden of cholera in endemic countries","volume":"9","author":"Ali","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"2025070113063626000_bib2","first-page":"117","article-title":"Cholera outbreaks in Africa","volume":"379","author":"Mengel","year":"2014","journal-title":"Curr Top Microbiol Immunol"},{"issue":"1","key":"2025070113063626000_bib3","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/2049-9957-3-37","article-title":"Interaction between climatic, environmental, and demographic factors on cholera outbreaks in Kenya","volume":"3","author":"Stoltzfus","year":"2014","journal-title":"Infect Dis Poverty"},{"key":"2025070113063626000_bib4","volume-title":"What is cholera?","author":"International Rescue Committee","year":"2017"},{"issue":"1","key":"2025070113063626000_bib5","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.vaccine.2019.07.084","article-title":"Broad approaches to cholera control in Asia: water, sanitation and handwashing","volume":"38","author":"Luby","year":"2020","journal-title":"Vaccine"},{"issue":"5","key":"2025070113063626000_bib6","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1016\/j.jinf.2012.11.013","article-title":"The incubation period of cholera: a systematic review","volume":"66","author":"Azman","year":"2013","journal-title":"J Infect"},{"issue":"2","key":"2025070113063626000_bib7","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1002\/jid.1638","article-title":"Vulnerability in African small-scale fishing communities","volume":"23","author":"Mills","year":"2011","journal-title":"J Int Dev"},{"issue":"5","key":"2025070113063626000_bib8","doi-asserted-by":"crossref","first-page":"798","DOI":"10.3201\/eid1405.071260","article-title":"Lakes as source of cholera outbreaks, Democratic Republic of Congo","volume":"14","author":"Bompangue","year":"2008","journal-title":"Emerg Infect Dis"},{"issue":"1","key":"2025070113063626000_bib9","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1093\/infdis\/jit195","article-title":"Environmental determinants of cholera outbreaks in inland Africa: a systematic review of main transmission foci and propagation routes","volume":"208","author":"Rebaudet","year":"2013","journal-title":"J Infect Dis"},{"issue":"3","key":"2025070113063626000_bib10","doi-asserted-by":"crossref","first-page":"e0011166","DOI":"10.1371\/journal.pntd.0011166","article-title":"Mapping of cholera hotspots in Kenya using epidemiologic and water, sanitation, and hygiene (WASH) indicators as part of Kenya's new 2022\u20132030 cholera elimination plan","volume":"17","author":"Kiama","year":"2023","journal-title":"PLoS Negl Trop Dis"},{"key":"2025070113063626000_bib11","article-title":"Ending cholera: a global roadmap to 2030","author":"Global Task Force on Cholera Control","year":"2017"},{"issue":"6364","key":"2025070113063626000_bib12","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1126\/science.aao2136","article-title":"Integrated view of Vibrio cholerae in the Americas","volume":"358","author":"Domman","year":"2017","journal-title":"Science"},{"issue":"4","key":"2025070113063626000_bib13","doi-asserted-by":"crossref","first-page":"e0008227","DOI":"10.1371\/journal.pntd.0008227","article-title":"Identification of cholera hotspots in Zambia: a spatiotemporal analysis of cholera data from 2008 to 2017","volume":"14","author":"Mwaba","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"2025070113063626000_bib14","doi-asserted-by":"crossref","first-page":"17848","DOI":"10.1038\/s41598-018-36029-4","article-title":"Temporal trend and spatial clustering of cholera epidemic in Kumasi-Ghana","volume":"8","author":"Osei","year":"2018","journal-title":"Sci Rep"},{"issue":"1","key":"2025070113063626000_bib15","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1186\/s13104-019-4731-0","article-title":"Cholera hotspots and surveillance constraints contributing to recurrent epidemics in Tanzania","volume":"12","author":"Hounmanou","year":"2019","journal-title":"BMC Res Notes"},{"issue":"3","key":"2025070113063626000_bib16","doi-asserted-by":"crossref","first-page":"e0005407","DOI":"10.1371\/journal.pntd.0005407","article-title":"Epidemiology of cholera outbreaks and socio-economic characteristics of the communities in the fishing villages of Uganda: 2011\u20132015","volume":"11","author":"Bwire","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"issue":"11","key":"2025070113063626000_bib17","doi-asserted-by":"crossref","first-page":"e0005105","DOI":"10.1371\/journal.pntd.0005105","article-title":"Cholera in Cameroon, 2000\u20132012: spatial and temporal analysis at the operational (health district) and sub climate levels","volume":"10","author":"Ngwa","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"issue":"34","key":"2025070113063626000_bib18","doi-asserted-by":"crossref","first-page":"958","DOI":"10.15585\/mmwr.mm6734a4","article-title":"Cholera outbreak in Dadaab Refugee Camp, Kenya\u2014November 2015\u2013June 2016","volume":"67","author":"Golicha","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025070113063626000_bib19","article-title":"2019 Kenya population and housing census results","author":"Kenya National Bureau of Statistics"},{"key":"2025070113063626000_bib20","article-title":"Refugees and asylum seekers in Garissa","author":"Operational Data Portal, Kenya"},{"issue":"2","key":"2025070113063626000_bib21","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1177\/0894439307298562","article-title":"Scanning for clusters in space and time: a tutorial review of SaTScan","volume":"25","author":"Block","year":"2007","journal-title":"Soc Sci Comput Rev"},{"key":"2025070113063626000_bib22","article-title":"Technical documentation","author":"SaTScan"},{"key":"2025070113063626000_bib23","article-title":"Models for count data with many zeros","volume-title":"International Biometric Conference","author":"Ridout","year":"1998"},{"issue":"9","key":"2025070113063626000_bib24","doi-asserted-by":"crossref","first-page":"5738","DOI":"10.3390\/ijerph19095738","article-title":"Cholera outbreaks in India, 2011\u20132020: a systematic review","volume":"19","author":"Muzembo","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"2025070113063626000_bib25","volume-title":"Cholera \u2013 global situation","author":"World Health Organization","year":"2023"},{"issue":"17","key":"2025070113063626000_bib26","doi-asserted-by":"crossref","first-page":"4436","DOI":"10.1073\/pnas.1617218114","article-title":"El Ni\u00f1o and the shifting geography of cholera in Africa","volume":"114","author":"Moore","year":"2017","journal-title":"Proc Natl Acad Sci USA"},{"key":"2025070113063626000_bib27","doi-asserted-by":"crossref","first-page":"127","DOI":"10.11604\/pamj.2020.36.127.19786","article-title":"A protracted cholera outbreak among residents in an urban setting, Nairobi County, Kenya, 2015","volume":"36","author":"Kigen","year":"2020","journal-title":"Pan Afr Med J"},{"key":"2025070113063626000_bib28","article-title":"Drop in cholera cases worldwide, as key endemic countries report gains in cholera control","author":"World Health Organization","year":"2019"},{"key":"2025070113063626000_bib29","doi-asserted-by":"publisher","DOI":"10.13140\/RG.2.2.13672.83204","article-title":"An assessment of sanitation situation in Mukuru Kwa Njenga informal settlement. The case of Sisal area","author":"Muriithi","year":"2017"},{"issue":"3","key":"2025070113063626000_bib30","first-page":"286","article-title":"Mapping cholera risk in Nairobi County, Kenya: a comprehensive analysis of environmental, socio-economic, and WASH factors","volume":"36","author":"Manaseh","year":"2023","journal-title":"Afr J Health Sci"}],"container-title":["Transactions of The Royal Society of Tropical Medicine and Hygiene"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/trstmh\/article-pdf\/119\/7\/758\/62571595\/traf032.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/trstmh\/article-pdf\/119\/7\/758\/62571595\/traf032.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T17:07:23Z","timestamp":1751389643000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/trstmh\/article\/119\/7\/758\/8092229"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,24]]},"references-count":30,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,3,24]]},"published-print":{"date-parts":[[2025,7,1]]}},"URL":"https:\/\/doi.org\/10.1093\/trstmh\/traf032","relation":{},"ISSN":["0035-9203","1878-3503"],"issn-type":[{"value":"0035-9203","type":"print"},{"value":"1878-3503","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,7]]},"published":{"date-parts":[[2025,3,24]]}}}