EPIDEMIC CHOLERA DURING REFUGEE RESETTLEMENT IN MALAWI

Background. In June 1988 a cholera epidemic occurred in a Mozambican refugee population resettling in southern Malawi. Methods. A case-control study was conducted to determine possible risk factors for disease. The characteristics of 48 refugee households with any member(s) hospitalized for suspected cholera were compared to 441 randomly sampled refugee households without hospitalizations. Results. Vibrio cholerae 01 was isolated from 50% (5/10) of case-patient stool cultures. Having any water containers with greater than or equal to 10 I capacity was associated with a significantly lower odds of suspected cholera in households (adjusted odds ratio [aOR] = 0.02, 95% confidence interval [CI] : 0.003-0.12), as was having metal cooking pots (aOR = 0.3, 95% CI : 0.12-0.7), after adjusting for length of residence and socioeconomic status (logistic regression model). Households with two or more children <5 years old were at markedly increased odds of suspected cholera (P < 0.0001). These results suggest that water containers and cooking pots served important preventive functions during this cholera outbreak. Young children may have contributed to cholera transmission, but the reason(s) remains undetermined.