{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T17:54:46Z","timestamp":1785779686462,"version":"3.56.0"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Cholera remains a public health concern in Rumonge Health District. The area is regularly affected by the disease outbreaks despite control measures that are periodically taken after the outbreaks occur. The last outbreak started in late 2018 and ended in February 2019, with a cumulative of 234 cases, and one death. This study aimed to identify the risk factors associated with the 2019 cholera outbreak in Rumonge Health District. We conducted a retrospective unmatched (1:2) case-control study to investigate risk factors associated with the 2019 cholera outbreak. This was carried out from 5 March 2021\u201330 April 2021 in 150 households, comprising 50 cases and 100 controls. Cholera cases were drawn from the admission register of cholera patients at Rumonge referral hospital. Stratified proportional allocation sampling followed by simple random selection were used to select the cases. Afterwards, we visited the households of the selected cases and controls that were chosen among the neighborhood of the cases. An interviewer-administered questionnaire was administered to the head of each household to collect sociodemographic, water, sanitation, and hygiene practice data. Multivariate analysis with logistic regression model was used to analyze the data. A multivariate analysis revealed that drinking lake\/river water (OR=3.6 [1.46\u20138.87]), utilizing untreated water for domestic purposes (OR=5.2 [1.31\u201320.59]), consuming unwashed raw fruit (OR=2.9 [1.08\u20137.97]), eating without washing hands with soap (OR=3.2 [1.30\u20138.29]) and improper washing of hands after defecation (OR=2.7 [1.10\u20136.84]) were predictors of cholera outbreaks in Rumonge Health District. The study revealed that drinking lake or river water, using untreated water for domestic purposes, consuming unwashed raw fruits, eating without washing hands with soap, and improper handwashing after defecation were all strongly associated with increased risk of cholera. We recommend a community-based approach through the provision of safe water, strengthened hygiene education, and integrated WASH interventions in Rumonge Health District.<\/jats:p>","DOI":"10.1371\/journal.pone.0354969","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T17:22:31Z","timestamp":1785777751000},"page":"e0354969","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with the recurrence of cholera outbreaks in Rumonge Health District in Southern Burundi: An unmatched case-control study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8710-6907","authenticated-orcid":true,"given":"Emile","family":"Nkurunziza","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Kogi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"issue":"34","key":"pone.0354969.ref001","first-page":"477","article-title":"Cholera vaccines: WHO position paper\u2013August 2017","volume":"92","author":"World Health Organization WHO","year":"2017","journal-title":"Weekly Epidemiol Rec"},{"issue":"10101","key":"pone.0354969.ref002","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1016\/S0140-6736(17)30559-7","article-title":"Cholera","volume":"390","author":"JD Clemens","year":"2017","journal-title":"The Lancet"},{"issue":"6","key":"pone.0354969.ref003","article-title":"Updated global burden of cholera in endemic countries","volume":"9","author":"M Ali","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"pone.0354969.ref004","doi-asserted-by":"crossref","DOI":"10.2307\/j.ctvnjbgqd","volume-title":"Epidemics and the health of African nations","author":"Z Mazibuko","year":"2019"},{"key":"pone.0354969.ref005","first-page":"1","article-title":"Epidemiology of cholera","author":"J Deen","year":"2020","journal-title":"Vaccine"},{"issue":"5","key":"pone.0354969.ref006","doi-asserted-by":"crossref","first-page":"883","DOI":"10.3201\/eid2405.171651","article-title":"Cholera epidemic in South Sudan and Uganda and need for international collaboration in cholera control","volume":"24","author":"A Abubakar","year":"2018","journal-title":"Emerg Infect Dis"},{"key":"pone.0354969.ref007","doi-asserted-by":"crossref","first-page":"3","DOI":"10.11604\/pamj.supp.2017.28.1.9477","article-title":"Supplement article an outbreak of cholera in western Kenya, 2015: a case control study","volume":"28","author":"EO Oyugi","year":"2017","journal-title":"Pan Afr Med J"},{"issue":"1","key":"pone.0354969.ref008","first-page":"1","article-title":"Cholera hotspots and surveillance constraints contributing to recurrent epidemics in Tanzania","volume":"12","author":"YMG Hounmanou","year":"2019","journal-title":"BMC Res Notes"},{"issue":"4","key":"pone.0354969.ref009","first-page":"184","article-title":"Factors associated with the recurring cholera outbreaks in Sinazongwe district of southern Zambia","volume":"42","author":"P Phiri","year":"2015","journal-title":"Med J Zambia"},{"key":"pone.0354969.ref010","doi-asserted-by":"crossref","DOI":"10.1016\/j.vaccine.2020.01.015","article-title":"Oral cholera vaccination coverage in an acute emergency setting in Somalia, 2017","volume":"38","author":"M Lubogo","year":"2020","journal-title":"Vaccine"},{"issue":"1","key":"pone.0354969.ref011","first-page":"1","article-title":"Politique sanitaire, acteurs, strat\u00e9gies et contenu des interventions de lutte contre le chol\u00e9ra dans la zone de sant\u00e9 d\u2019Uvira en R\u00e9publique D\u00e9mocratique du Congo","volume":"3","author":"N Mudekereza","year":"2019","journal-title":"Rev Infirm Congo"},{"issue":"12","key":"pone.0354969.ref012","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pntd.0002545","article-title":"The burden of cholera in Uganda","volume":"7","author":"G Bwire","year":"2013","journal-title":"PLoS Neglected Trop Dis"},{"issue":"7365","key":"pone.0354969.ref013","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1038\/nature10392","article-title":"Evidence for several waves of global transmission in the seventh cholera pandemic","volume":"477","author":"A Mutreja","year":"2011","journal-title":"Nature"},{"key":"pone.0354969.ref014","unstructured":"Nkoko DB, et al. Dynamics of cholera outbreaks in Great Lakes region of Africa, 1978\u20132008."},{"issue":"9057","key":"pone.0354969.ref015","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1016\/S0140-6736(96)08478-4","article-title":"Epidemic cholera in Burundi: patterns of transmission in the Great Rift Valley Lake region","volume":"349","author":"ME Birmingham","year":"1997","journal-title":"Lancet"},{"issue":"6","key":"pone.0354969.ref016","first-page":"1","article-title":"Cholera hot-spots and contextual factors in Burundi, planning for elimination","volume":"76","author":"AK Debes","year":"2021","journal-title":"Trop Med Infect Dis"},{"key":"pone.0354969.ref017","article-title":"Model-based estimation of the economic burden of cholera in Africa","author":"V Mogasale","year":"2021","journal-title":"BMJ Open."},{"key":"pone.0354969.ref018"},{"key":"pone.0354969.ref019","volume-title":"Cholera Management Guidelines Final 20.11.2023"},{"key":"pone.0354969.ref020","doi-asserted-by":"crossref","unstructured":"Asantewaa. Cholera outbreaks in low- and middle-income countries in the last decade a systematic review and me. 2024.","DOI":"10.3390\/microorganisms12122504"},{"key":"pone.0354969.ref021","doi-asserted-by":"crossref","first-page":"845057","DOI":"10.3389\/fpubh.2022.845057","article-title":"Inadequate hand washing, lack of clean drinking water and latrines as major determinants of cholera outbreak in Somali Region, Ethiopia in 2019","volume":"10","author":"JM Challa","year":"2022","journal-title":"Front Public Health"},{"key":"pone.0354969.ref022","article-title":"Understanding cholera dynamics in African countries with persistent outbreaks: a mathematical modeling approach","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0354969.ref023","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1186\/s12879-025-11533-x","article-title":"Associations of water quality with cholera in case-control studies: a systematic review and meta-analysis","volume":"25","author":"TT Nguyen","year":"2025","journal-title":"BMC Infect Dis"},{"issue":"5","key":"pone.0354969.ref024","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":"D Bompangue","year":"2008","journal-title":"Emerg Infect Dis"},{"issue":"1","key":"pone.0354969.ref025","first-page":"1","article-title":"A cholera outbreak in a rural north central Nigerian community: an unmatched case-control study","volume":"19","author":"CC Dan-Nwafor","year":"2019","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0354969.ref026","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40249-020-00761-9","article-title":"A prolonged cholera outbreak caused by drinking contaminated stream water, Kyangwali refugee settlement, Hoima District, Western Uganda: 2018","volume":"9","author":"F Monje","year":"2020","journal-title":"Infect Dis Poverty"},{"key":"pone.0354969.ref027","first-page":"1","article-title":"Knowledge, attitude and practices on cholera in an arid county, Kenya, 2018: a mixed- methods approach","volume":"428","author":"E Otieno","year":"2020","journal-title":"PLoS One"},{"issue":"3","key":"pone.0354969.ref028","doi-asserted-by":"crossref","first-page":"116","DOI":"10.55320\/mjz.43.3.322","article-title":"Successful multi-partner response to a cholera outbreak in Lusaka, Zambia 2016: a case control study","volume":"43","author":"B Matapo","year":"2016","journal-title":"mjz"},{"key":"pone.0354969.ref029","doi-asserted-by":"crossref","DOI":"10.4178\/epih.e2019015","article-title":"Risk factors associated with the recent cholera outbreak in Yemen: a case-control study","volume":"41","author":"F Dureab","year":"2019","journal-title":"Epidemiol Health"},{"key":"pone.0354969.ref030","doi-asserted-by":"crossref","DOI":"10.4178\/epih.e2016018","article-title":"A cholera outbreak in Alborz Province, Iran: a matched case-control study","volume":"38","author":"G Moradi","year":"2016","journal-title":"Epidemiol Health"},{"key":"pone.0354969.ref031","first-page":"1","article-title":"Cholera outbreak in a na\u00efve rural community in Northern Nigeria: the importance of hand washing with soap","volume":"8688","author":"S Gidado","year":"2018"},{"issue":"6","key":"pone.0354969.ref032","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1017\/S0950268806006273","article-title":"Epidemic cholera in urban Zambia: Hand soap and dried fish as protective factors","volume":"134","author":"AE Dubois","year":"2006","journal-title":"Epidemiol Infect"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0354969","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T17:22:38Z","timestamp":1785777758000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0354969"}},"subtitle":[],"editor":[{"given":"Alison","family":"Parker","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,3]]},"references-count":32,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,3]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0354969","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,3]]}}}