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PLOS BLOGS Speaking of Medicine and Health

Taking Down Cholera Means Raising Socioeconomically Depressed Populations Up

International news was thick recently with reports of a cholera outbreak in Havana, Cuba that apparently stemmed from tainted concessions sold at a baseball game there in early January. The resulting number of cases – just over fifty in all – pale in comparison to the situation last year, when Cuban health officials scrambled to contain a surge of infections in southeast Cuba’s Granma Province, in the seaside city of Manzanillo. This outbreak resulted in over 500 reported infections and three deaths by November 2012.

Both outbreaks, this year and last, were unusual in that Cuba had been virtually cholera-free for over one hundred years due to its modern water and sewage treatment infrastructure. This resurgence of the disease ties in with the World Health Organization’s data that shows cholera diagnosis are actually trending upward once again.

But while these flare-ups in Havana and Manzanillo account for only a tiny (and hopefully temporary) fraction of the 3-5 million cholera cases reported annually worldwide, other locales grapple regularly with the challenge that this bacterial infection poses. The situation in Cuba reminded me of a recent research article by Dr. Elisabeth Dowling Root and colleagues published in PLOS Neglected Tropical Diseases, “The Role of Socioeconomic Status in Longitudinal Trends of Cholera in Matlab, Bangladesh, 1993–2007,” that highlights a critical piece of the puzzle in our understanding of why and how outbreaks still occur around the world.

What sets this paper apart from its contemporaries is that, while many cholera studies examine cross-sectional, transnational comparisons, the Dowling research goes into much more granular detail to describe the role of local-area socioeconomic status in cholera dynamics over time. This data was collected for fourteen years (since the outbreak of the O139 cholera biotype in 1993) on the household-level in the rural district of Matlab, southeast of the capital of Bangladesh, Dhaka.

Image Credit: Stichting Pani

The results indicated that areas with higher socioeconomic levels experienced a lower rate of initial cholera infection, if any cases were reported at all. Obtaining such granular data was key in understanding precisely how cholera affected populations living at different socioeconomic levels, as raising these levels overall, combined with improving living conditions, is known to be the ultimate solution for control of this disease.

This paper is solid research for advocates and policy makers alike who are working toward the long-term mitigation of cholera by pushing for increased funding of not only modern sanitation infrastructure, but higher levels of education as well. From Bangladesh to Cuba and beyond, its long-term impact could affect the health of many.

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