{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T07:14:19Z","timestamp":1790234059459,"version":"4.1.0"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,11,4]],"date-time":"2020-11-04T00:00:00Z","timestamp":1604448000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,11,4]],"date-time":"2020-11-04T00:00:00Z","timestamp":1604448000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"President\u2019s Emergency Plan for AIDS Relief (PEPFAR) through the US Centers for Disease Control and Prevention","award":["Cooperative Agreement number GH001353\u201301"],"award-info":[{"award-number":["Cooperative Agreement number GH001353\u201301"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infect Dis Poverty"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>On 23 February 2018, the Uganda Ministry of Health (MOH) declared a cholera outbreak affecting more than 60 persons in Kyangwali Refugee Settlement, Hoima District, bordering the Democratic Republic of Congo (DRC). We investigated to determine the outbreak scope and risk factors for transmission, and recommend evidence-based control measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We defined a suspected case as sudden onset of watery diarrhoea in any person aged \u2265 2\u2009years in Hoima District, 1 February\u20139 May 2018. A confirmed case was a suspected case with\n                      <jats:italic>Vibrio cholerae<\/jats:italic>\n                      cultured from a stool sample. We found cases by active community search and record reviews at Cholera Treatment Centres. We calculated case-fatality rates (CFR) and attack rates (AR) by sub-county and nationality. In a case-control study, we compared exposure factors among case- and control-households. We estimated the association between the exposures and outcome using Mantel-Haenszel method. We conducted an environmental assessment in the refugee settlement, including testing samples of stream water, tank water, and spring water for presence of fecal coliforms. We tested suspected cholera cases using cholera rapid diagnostic test (RDT) kits followed by culture for confirmation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 2122 case-patients and 44 deaths (CFR\u2009=\u20092.1%). Case-patients originating from Demographic Republic of Congo were the most affected (AR\u2009=\u200915\/1000). The overall attack rate in Hoima District was 3.2\/1000, with Kyangwali sub-county being the most affected (AR\u2009=\u200913\/1000). The outbreak lasted 4 months, which was a multiple point-source. Environmental assessment showed that a stream separating two villages in Kyangwali Refugee Settlement was a site of open defecation for refugees. Among three water sources tested, only stream water was feacally-contaminated, yielding &gt;\u2009100\u2009CFU\/100\u2009ml. Of 130 stool samples tested, 124 (95%) yielded\n                      <jats:italic>V. cholerae<\/jats:italic>\n                      by culture\n                      <jats:italic>.<\/jats:italic>\n                      Stream water was most strongly associated with illness (odds ratio [\n                      <jats:italic>OR<\/jats:italic>\n                      ]\u2009=\u200914.2, 95%\n                      <jats:italic>CI<\/jats:italic>\n                      : 1.5\u2013133), although tank water also appeared to be independently associated with illness (\n                      <jats:italic>OR<\/jats:italic>\n                      \u2009=\u200911.6, 95%\n                      <jats:italic>CI<\/jats:italic>\n                      : 1.4\u201394). Persons who drank tank and stream water had a 17-fold higher odds of illness compared with persons who drank from other sources (\n                      <jats:italic>OR<\/jats:italic>\n                      \u2009=\u200917.3, 95%\n                      <jats:italic>CI<\/jats:italic>\n                      : 2.2\u2013137).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our investigation demonstrated that this was a prolonged cholera outbreak that affected four sub-counties and two divisions in Hoima District, and was associated with drinking of contaminated stream water. In addition, tank water also appears to be unsafe. We recommended boiling drinking water, increasing latrine coverage, and provision of safe water by the District and entire High Commission for refugees.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40249-020-00761-9","type":"journal-article","created":{"date-parts":[[2020,11,4]],"date-time":"2020-11-04T02:02:46Z","timestamp":1604455366000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["A prolonged cholera outbreak caused by drinking contaminated stream water, Kyangwali refugee settlement, Hoima District, Western Uganda: 2018"],"prefix":"10.1186","volume":"9","author":[{"given":"Fred","family":"Monje","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex Riolexus","family":"Ario","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angella","family":"Musewa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Bainomugisha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernadette Basuta","family":"Mirembe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dativa Maria","family":"Aliddeki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Eurien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Godfrey","family":"Nsereko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Nanziri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Kisaakye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian","family":"Ntono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benon","family":"Kwesiga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Kadobera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilian","family":"Bulage","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Godfrey","family":"Bwire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Tusiime","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Harris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bao-Ping","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,11,4]]},"reference":[{"key":"761_CR1","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.4269\/ajtmh.17-0296","volume":"97","author":"A Roobthaisong","year":"2017","unstructured":"Roobthaisong A, Okada K, Htun N, Aung WW, Wongboot W, Kamjumphol W, et al. 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Ugandan Newspaper (New Vision). 2018; Available from: https:\/\/www.newvision.co.ug\/news\/1471945\/cholera-kills-22-hoima-refugee-camp ."},{"key":"761_CR29","doi-asserted-by":"crossref","unstructured":"Bwire G, Malimbo M, Makumbi I, Kagirita A, Wamala JF, Kalyebi P, et al. Cholera surveillance in Uganda: an analysis of notifications for the years 2007\u20132011. J Infect Dis. 2013;208:78\u201385.\u00a0.","DOI":"10.1093\/infdis\/jit203"},{"key":"761_CR30","doi-asserted-by":"crossref","unstructured":"Bwire G, Sack DA, Almeida M, Li S, Voeglein JB, Debes AK, et al. Molecular characterization of Vibrio cholerae responsible for cholera epidemics in Uganda by PCR, MLVA and WGS. PLOS Neglected Trop Dis. 2018;12.","DOI":"10.1371\/journal.pntd.0006492"},{"key":"761_CR31","doi-asserted-by":"crossref","unstructured":"Golicha Q, Shetty S, Nasiblov O, Hussein A, Wainaina E, Obonyo M, et al. Cholera Outbreak in Dadaab Refugee Camp, Kenya \u2014 November 2015\u2013June 2016. 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Cholera outbreak caused by drinking lake water contaminated with human faeces in Kaiso Village, Hoima District, Western Uganda, October 2015. Inf Dis Pov. 2017;6:146.\u00a0.","DOI":"10.1186\/s40249-017-0359-2"},{"key":"761_CR35","doi-asserted-by":"crossref","unstructured":"Kwesiga B, Pande G, Ario AR, Tumwesigye NM, Matovu JKB, Zhu B-P. A prolonged, community-wide cholera outbreak associated with drinking water contaminated by sewage in Kasese District, western Uganda. BMC Public Health. 2017;18:30.","DOI":"10.1186\/s12889-017-4589-9"},{"key":"761_CR36","doi-asserted-by":"crossref","unstructured":"Eisenberg MC, Kujbida G, Tuite AR, Fisman DN, Tien JH. Examining rainfall and cholera dynamics in Haiti using statistical and dynamic modeling approaches. Epidemics. 2013;5:197\u2013207.\u00a0.","DOI":"10.1016\/j.epidem.2013.09.004"},{"key":"761_CR37","doi-asserted-by":"publisher","unstructured":"Mengel MA, Delrieu I, Heyerdahl L, Gessner BD. Cholera Outbreaks in Africa. 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This investigation was conducted in response to a public health emergency and was therefore determined by the United States Centers for Disease Control and Prevention to be non-research. Thus, we do not need any other permission from Institutional Review Board according to the Ugandan policies and guidelines and are free to publish the work. Verbal informed consent in the local language was sought from respondents or care-takers of case-patients. They were informed that their participation was voluntary and their refusal would not result in adverse consequences. All case-patients identified in the community were referred for free treatment at the cholera treatment centers. To ensure confidentiality of the respondents, each case-patient, case-household, and control household was assigned a unique identifier which was used instead of their names during data analysis.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"154"}}