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Open Access Highly Accessed Research article

Cholera risk factors, Papua New Guinea, 2010

Alexander Rosewell12*, Benita Addy3, Lucas Komnapi3, Freda Makanda3, Berry Ropa4, Enoch Posanai4, Samir Dutta5, Glen Mola6, WY Nicola Man2, Anthony Zwi2 and C Raina MacIntyre2

Author affiliations

1 World Health Organization, Port Moresby, Papua New Guinea

2 School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia

3 Angau Memorial Hospital, Lae, Papua New Guinea

4 National Department of Health, Port Moresby, Papua New Guinea

5 Pathology Department, Port Moresby General Hospital, Port Moresby, Papua New Guinea

6 University of Papua New Guinea, Port Moresby, Papua New Guinea

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Citation and License

BMC Infectious Diseases 2012, 12:287  doi:10.1186/1471-2334-12-287

Published: 5 November 2012

Abstract

Background

Cholera is newly emergent in Papua New Guinea but may soon become endemic. Identifying the risk factors for cholera provides evidence for targeted prevention and control measures.

Methods

We conducted a hospital-based case–control study to identify cholera risk factors. Using stool culture as the standard, we evaluated a cholera point of care test in the field.

Results

176 participants were recruited: 54 cases and 122 controls. Independent risk factors for cholera were: being over 20 years of age (aOR 2.5; 95%CI 1.1, 5.4), defecating in the open air (or river) (aOR 4.5; 95% CI 1.4, 14.4) and knowing someone who travelled to a cholera affected area (aOR 4.1; 95%CI 1.6, 10.7); while the availability of soap for handwashing at home was protective (aOR 0.41; 95%CI 0.19, 0.87). Those reporting access to a piped water distribution system in the home were twice as likely to report the availability of soap for handwashing. The sensitivity and specificity of the rapid test were 72% (95% CI 47–90) and 71% (95%CI 44–90%).

Conclusions

Improving population access to the piped water distribution system and sanitation will likely reduce transmission by enabling enhanced hygiene and limiting the contamination of water sources. The One step V. cholerae O1/O139 Antigen Test is of limited utility for clinical decision making in a hospital setting with access to traditional laboratory methods. Settlement dwellers and mobile populations of all age groups should be targeted for interventions in Papua New Guinea.

Keywords:
Cholera; Risk factor; Sensitivity and specificity; Diagnostic accuracy; Rapid diagnostic test; Papua New Guinea