ArticleBMC public health2012
Elevation and cholera: an epidemiological spatial analysis of the cholera epidemic in Harare, Zimbabwe, 2008-2009.
Article in BMC public health, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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14 citing papers in PubMed, 1 synthesis or guideline pooled it, 49 citations in OpenAlex.
- The Cholera Epidemic in Zimbabwe, 2008-2009: A Review and Critique of the Evidence.Health and human rights · 2017Pooled it
- The spatio-temporal patterns and formation mechanisms of cholera epidemics in Hubei Province, China from 1949 to 2020.PLoS neglected tropical diseases · 2026Article
- Epidemiologic Characteristics and Predictors of Mortality in Somalia's 2024 Cholera Outbreak.Journal of epidemiology and global health · 2026Article
- Satellite-Derived, Smartphone-Delivered Geospatial Cholera Risk Information for Vulnerable Populations.GeoHealth · 2024Article
- Article
- Spatial distribution of suspected and confirmed cholera cases in Mwanza City, Northern Tanzania.PLOS global public health · 2023Article
- Mapping climate change's impact on cholera infection risk in Bangladesh.PLOS global public health · 2022Article
- Delineating and Analyzing Locality-Level Determinants of Cholera, Haiti.Emerging infectious diseases · 2021Article
- Risk Factors for Infectious Diseases in Urban Environments of Sub-Saharan Africa: A Systematic Review and Critical Appraisal of Evidence.Tropical medicine and infectious disease · 2019Review
- Cholera Incidence and Mortality in Sub-Saharan African Sites during Multi-country Surveillance.PLoS neglected tropical diseases · 2016Article
- Satellite Based Assessment of Hydroclimatic Conditions Related to Cholera in Zimbabwe.PloS one · 2015Article
- Spatio-temporal epidemiology of the cholera outbreak in Papua New Guinea, 2009-2011.BMC infectious diseases · 2014Article
- Descriptive epidemiology of typhoid fever during an epidemic in Harare, Zimbabwe, 2012.PloS one · 2014Article
- First outbreak response using an oral cholera vaccine in Africa: vaccine coverage, acceptability and surveillance of adverse events, Guinea, 2012.PLoS neglected tropical diseases · 2013Article
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn highly populated African urban areas where access to clean water is a challenge, water source contamination is one of the most cited risk factors in a cholera epidemic. During the rainy season, where there is either no sewage disposal or working sewer system, runoff of rains follows the slopes and gets into the lower parts of towns where shallow wells could easily become contaminated by excretes. In cholera endemic areas, spatial information about topographical elevation could help to guide preventive interventions. This study aims to analyze the association between topographic elevation and the distribution of cholera cases in Harare during the cholera epidemic in 2008 and 2009.
methodsWe developed an ecological study using secondary data. First, we described attack rates by suburb and then calculated rate ratios using whole Harare as reference. We illustrated the average elevation and cholera cases by suburbs using geographical information. Finally, we estimated a generalized linear mixed model (under the assumption of a Poisson distribution) with an Empirical Bayesian approach to model the relation between the risk of cholera and the elevation in meters in Harare. We used a random intercept to allow for spatial correlation of neighboring suburbs.
resultsThis study identifies a spatial pattern of the distribution of cholera cases in the Harare epidemic, characterized by a lower cholera risk in the highest elevation suburbs of Harare. The generalized linear mixed model showed that for each 100 meters of increase in the topographical elevation, the cholera risk was 30% lower with a rate ratio of 0.70 (95% confidence interval=0.66-0.76). Sensitivity analysis confirmed the risk reduction with an overall estimate of the rate ratio between 20% and 40%.
conclusionThis study highlights the importance of considering topographical elevation as a geographical and environmental risk factor in order to plan cholera preventive activities linked with water and sanitation in endemic areas. Furthermore, elevation information, among other risk factors, could help to spatially orientate cholera control interventions during an epidemic.
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