Cholera Epidemics, War and Disasters around Goma and Lake Kivu: An Eight-Year Survey

Abstract

During the last eight years, North and South Kivu, located in a lake area in Eastern Democratic Republic of Congo, have been the site of a major volcano eruption and of numerous complex emergencies with population displacements. These conditions have been suspected to favour emergence and spread of cholera epidemics. In order to assess the influence of these conditions on outbreaks, reports of cholera cases were collected weekly from each health district of North Kivu (4,667,699 inhabitants) and South Kivu (4,670,121 inhabitants) from 2000 through 2007. A geographic information system was established, and in each health district, the relationships between environmental variables and the number of cholera cases were assessed using regression techniques and time series analysis. We further checked for a link between complex emergencies and cholera outbreaks. Finally, we analysed data collected during an epidemiological survey that was implemented in Goma after Nyiragongo eruption. A total of 73,605 cases and 1,612 deaths of cholera were reported. Time series decomposition showed a greater number of cases during the rainy season in South Kivu but not in North Kivu. Spatial distribution of cholera cases exhibited a higher number of cases in health districts bordering lakes (Odds Ratio 7.0, Confidence Interval range 3.8–12.9). Four epidemic reactivations were observed in the 12-week periods following war events, but simulations indicate that the number of reactivations was not larger than that expected during any random selection of period with no war. Nyiragongo volcanic eruption was followed by a marked decrease of cholera incidence. Our study points out the crucial role of some towns located in lakeside areas in the persistence of cholera in Kivu. Even if complex emergencies were not systematically followed by cholera epidemics, some of them enabled cholera spreading. With the number of cholera cases up to 73,000 during the last eight years and successive wars that have persisted for fifteen years, the North and South Kivu provinces of the Democratic Republic of Congo are currently heavily hit by both cholera outbreaks and war-related population displacements. Prior to this study, no research had been done to identify the sources of epidemics and the pathways used by cholera to spread throughout the Kivu provinces. Here we show that a few cities located on the lakeshore of Lake Kivu and Lake Tanganyika act as the main sources of cholera epidemics and that the number of cholera cases tends to increase during the rainy season. We also found that only a minority of population displacements were followed by cholera outbreaks. Finally, we think that the low number of cholera cases recorded after the Nyiragongo eruption is one more argument to implement programs aiming at restoring, and if possible improving, drinking water access following natural disasters