{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T10:46:35Z","timestamp":1788173195705,"version":"build-2803163510"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2023,12,6]],"date-time":"2023-12-06T00:00:00Z","timestamp":1701820800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"ENVOSH","award":["1000"],"award-info":[{"award-number":["1000"]}]},{"name":"RAO SCHOLARSHIP","award":["3000"],"award-info":[{"award-number":["3000"]}]},{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["T37MD01425"],"award-info":[{"award-number":["T37MD01425"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:p>In the course of infectious disease outbreaks, barriers to accessing health care can contribute to preventable mortality. According to the Ministry of Health of Haiti (Minist\u00e8re de la Sant\u00e9 Publique et de la Population [MSPP]), the 2010 cholera epidemic caused 7,936 deaths from October 2010 to December 2012 in Haiti alone. We seek to quantify the excess mortality attributable to patients not seeking care during the cholera outbreak in the Nord Department in 2010\u20132012. Using data from a community-based retrospective survey conducted by Doctors Without Borders (M\u00e9decins Sans Fronti\u00e8res [MSF]) in Northern Haiti, we used logistic regression to examine the association between healthcare utilization and fatality among household members with watery diarrhea in the Communes of Borgne, Pilate, Plaisance, and Port-Margot in the Nord Department. We found that failing to seek care resulted in a 5-fold increase in the case fatality ratio among infected individuals (26%) versus those who sought care (5%). Common concerns noted for why care was not sought included travel distance to treatment centers, not attributing watery diarrhea episodes to cholera, and being unsure where to seek health care for their watery diarrhea episodes within their Communes. In conclusion, addressing transportation and information needs could increase healthcare utilization and reduce lives lost during an outbreak.<\/jats:p>","DOI":"10.1371\/journal.pntd.0011750","type":"journal-article","created":{"date-parts":[[2023,12,6]],"date-time":"2023-12-06T18:28:16Z","timestamp":1701887296000},"page":"e0011750","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Excess mortality in northern Haiti during the 2010 cholera epidemic"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7448-5467","authenticated-orcid":true,"given":"Macceau","family":"Medozile","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina S.","family":"Lovasi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergios-Orestis","family":"Kolokotronis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori A.","family":"Hoepner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,12,6]]},"reference":[{"issue":"10","key":"pntd.0011750.ref001","doi-asserted-by":"crossref","first-page":"e0005077","DOI":"10.1371\/journal.pntd.0005077","article-title":"Fears and misperceptions of the ebola response system during the 2014\u20132015 outbreak in Sierra Leone.","volume":"10","author":"T Yamanis","year":"2016","journal-title":"PLoS neglected tropical diseases"},{"key":"pntd.0011750.ref002","unstructured":"CDC- 2014\u20132016 Ebola outbreak in West Africa - https:\/\/www.cdc.gov\/vhf\/ebola\/history\/2014-2016-outbreak\/index.html"},{"issue":"6","key":"pntd.0011750.ref003","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.4269\/ajtmh.2009.09-0400","article-title":"High mortality in a cholera outbreak in western Kenya after post-election violence in 2008","volume":"81","author":"OT Shikanga","year":"2009","journal-title":"American Journal of Tropical Medicine and Hygiene"},{"issue":"2","key":"pntd.0011750.ref004","doi-asserted-by":"crossref","first-page":"020406","DOI":"10.7189\/jogh.06.020406","article-title":"Predictors of diarrheal mortality and patterns of caregiver health seeking behavior in in Karachi, Pakistan.","volume":"6","author":"FN Qamar","year":"2016","journal-title":"J Glob Health.Dec"},{"key":"pntd.0011750.ref005","unstructured":"Minist\u00e8re de la Sant\u00e9 Publique et de la Population (MSPP), Center d\u2019Op\u00e9ration d\u2019Urgence Nationale (COUN), novembre 24, 2010."},{"key":"pntd.0011750.ref006","first-page":"1","article-title":"High-resolution spatial analysis of cholera patients reported in Artibonite department, Haiti in 2010\u20132011.","volume":"14","author":"M Allan","year":"2015","journal-title":"Epidemics. 2016 Mar"},{"issue":"4","key":"pntd.0011750.ref007","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1177\/0272684X16666430","article-title":"Book Review (Deadly River: Cholera and Cover-Up in Post-Earthquake Haiti","volume":"36","author":"L. 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