Epidemiology and Infection


A cholera outbreak among semi-nomadic pastoralists in northeastern Uganda: epidemiology and interventions

M. J. CUMMINGSa1 c1, J. F. WAMALAa2, M. EYURAa3, M. MALIMBOa2, M. E. OMEKEa3, D. MAYERa1 and L. LUKWAGOa2a4

a1 Albany Medical College, Albany, NY, USA

a2 Epidemiology and Surveillance Division, Ministry of Health, Kampala, Uganda

a3 Moroto District Health Office, Moroto, Uganda

a4 Makerere University School of Public Health, Kampala, Uganda


In sub-Saharan Africa, many nomadic pastoralists have begun to settle in permanent communities as a result of long-term water, food, and civil insecurity. Little is known about the epidemiology of cholera in these emerging semi-nomadic populations. We report the results of a case-control study conducted during a cholera outbreak among semi-nomadic pastoralists in the Karamoja sub-region of northeastern Uganda in 2010. Data from 99 cases and 99 controls were analysed. In multivariate analyses, risk factors identified were: residing in the same household as another cholera case [adjusted odds ratio (aOR) 6·67, 95% confidence interval (CI) 2·83–15·70], eating roadside food (aOR 2·91, 95% CI 1·24–6·81), not disposing of children's faeces in a latrine (aOR 15·76, 95% CI 1·54–161·25), not treating drinking water with chlorine (aOR 3·86, 95% CI 1·63–9·14), female gender (aOR 2·43, 95% CI 1·09–5·43), and childhood age (10–17 years) (aOR 7·14, 95% CI 1·97–25·83). This is the first epidemiological study of cholera reported from a setting of semi-nomadic pastoralism in sub-Saharan Africa. Public health interventions among semi-nomadic pastoralists should include a two-faceted approach to cholera prevention: intensive health education programmes to address behaviours inherited from insecure nomadic lifestyles, as well as improvements in water and sanitation infrastructure. The utilization of community-based village health teams provides an important method of implementing such activities.

(Accepted August 31 2011)

(Online publication September 27 2011)


c1 Author for correspondence: Mr M. J. Cummings, Albany Medical College, Box 048, 47 New Scotland Avenue, Albany, NY 12208, USA. (Email: CumminM@mail.amc.edu).