[Epidemiologic and medico-clinical aspects of the cholera outbreak in the Littoral department of Benin in 2008]. / Aspects épidémiologiques et médico-cliniques de l'épidémie de choléra dans le département du Littoral au Bénin en 2008.

ABSTRACT

OBJECTIVE: The purpose of this study was to determine epidemiological and medico-clinical features of the cholera outbreak that occurred in the Littoral department of Benin in 2008. METHODS: This cross-sectional descriptive analytic study was based on review of a total of 404 patient files. Study data included patient identity, clinical and therapeutic features and treatment outcome. Ten randomly selected patients participated in a focus group discussion. Decision-makers in charge of managing the outbreak and medical personnel that provided care were thoroughly debriefed and 10 affected areas were visited. Data were analyzed using EPI INFO 3.3.2 and EXCEL 2007. RESULTS: The outbreak started in Cotonou on 26 July 2008 and lasted for 21 weeks. Mean patient age was 23.72 +/- 14.80 years. Attack rates per district ranged from 15.86 to 172.98 per 100.000. Attack rates in Agbodjèdo, Hlacomey and Enagnon districts were significantly higher (p<10(-4)) than in other districts. The case fatality rate was 0.24 per 100. Crowded living conditions along the banks of the Cotonou lagoon along with poor sanitation and inadequate drinking water supply explain the endemicity of cholera in Cotonou. Vibrio cholerae O1 was detected in 19 out of 36 stool samples. All strains were sensitive to ciprofloxacine but resistant to cotrimoxazole. Diarrhea was a consistent feature in all patients, along with vomiting in 88.11% and severe dehydration in 39.35%. Treatment involved oral rehydration, parenteral rehydration and antibiotherapy in 99.50%, 85% and 97.77% patients respectively. Antibiotherapy consisted of doxycycline for adult cases and amoxicilline for pregnant women and children. The duration of stay at the treatment center was significantly longer for patients with severe dehydration (p<10(-4)). CONCLUSION: Enhancing basic sanitation and access to drinking water and intensifying information campaigns on the need for healthy living behavior especially in districts located near the banks of Cotonou lagoon are needed to improve cholera prevention in the Littoral department in Benin.