Re. Quick et al., EPIDEMIC CHOLERA IN THE AMAZON - THE CHALLENGE OF PREVENTING DEATH, The American journal of tropical medicine and hygiene, 48(5), 1993, pp. 597-602
Citations number
15
Categorie Soggetti
Public, Environmental & Occupation Heath","Tropical Medicine
Epidemic cholera struck Peru in January 199 1, and spread rapidly. The
national cholera case-fatality rate (CFR) was less than 1% in the fir
st six months of the epidemic, but in some rural areas, the CFR exceed
ed 10%. We investigated cholera mortality in the rural Amazon region,
an area with a CFR of 6.3%. We conducted a case-control study, compari
ng 29 decedents with 61 survivors of recent cholera-like diarrheal ill
ness in 12 villages with a combined CFR of 13.5%. Of 29 decedents, 28
(96%) died in the village or en route to a health facility. Death occu
rred within 36 hours of illness onset for 83% of the decedents. In 11
(92%) villages, the first or second recognized case was fatal. Death w
as associated with receiving treatment only at home (odds ratio indete
rminate; 95% confidence interval 3.5, indeterminate). Treatment with o
ral rehydration salts (ORS) was not protective against death for patie
nts who received treatment only at home. Treatment with homemade sugar
-salt solution (SSS) was also not protective; fewer than one-third of
respondents knew the correct SSS recipe. Most decedents experienced mu
ltiple barriers to health care. Cholera victims died rapidly and early
in village outbreaks, and few patients had access to health care. Pro
vision of threatened villages with ORS supplies and education in their
use before cholera strikes is essential to reducing cholera mortality
in this region.