Outbreak of Unknown Outbreak of Unknown Diseases in Cafunfo Diseases in Cafunfo District, Angola 2012District, Angola 2012

Pedro Lusukamu, C. Teixeira, A. Kapapelo, L. Miguel, C. Sicato, A. Makaia , R. Moreira

Introduction Febrile illness:

- A public health challenge

- Health care systems with clinical diagnosis

- Common practice due to scarcity of laboratory

diagnostic facilitiesAugust 2012 :

• National Public Health Directorate alerted on a

strange disease in Cafunfo district which had

resulted in 89 deaths among children

Objectives

Broad

•To investigate the outbreak of an unknow disease in

Cafunfo during November - 2012

Specifics

•To describe the outbreak in person, time and place

•To identify the possible agent causing the disease

•To identify risk factors associated with the disease

MethodsStudy Design:

Unmatched 1:1case – control study

Study Settings

District Hospital, Cafunfo• Case : Any patient who had presented to the

health facility with an onset of one the following symptoms: intermittent fever, headache, shivering and abdominal pains

during the outbreak period

• Control: neighbour to the case who did not suffer from the disease during the past one month

MethodsSample size - 125 cases and 125 controlsSampling Methods

Cases were systematically selected from the line list used in the hospital

Controls conveniently selected from neighbourhood of the case

Data Analises

Epi Info 7.1.1.0 Frequencies Univariate Multivariate

Results

Environmental Assessment

•High of mosquitos density (larvae and adults)

•Anopheles gambiae s.s and funestus

•Breakdown of malaria vector control measures since May 2012•LLINs coverage < 5%

Hospital Assessment • High number of Febril

Illness cases: 7108/last month

• High blood transfusion 15/ day

• Lack of skilled staff at hospital and Health Centers

• Lab results: 54 positive P. falciparum

• All other tests negative.

Demographic Characteristic of Study Subjects

Variable Cases n= 125 (%) Controls n=125 (%)

Sex : Male: Female :

71 (56.8)54 (43.2)

45 (36)80 (64)

Age group: < 5 5 - 10 11- 16 17 - 22 23 - 28 29 - 34 35 - 40 41 - 46 +46

 77 (61.5)20 (16) 2 (1.6) 8 (6.5)6 (4.8)6 (4.8)3 (2.4)1 (0.8)2 (1.6)

 43 (34.4) 22 (17.6) 7 (5.6) 12 (9.6) 9 (7.2) 15 (12)2 (1.6)6 ( 4.8)9 (7.2)

Education Level: None Primmary Secondary

  81 (65.3)  39 (31.5)   4 (3.2)

 61 (48.8)  55 (44) 9 (7.2)

Occupation: Self employed Student Civil Servents

 113 (90.4)10 (8)2 (1.6)

 102 (93.4)3 (2.8)4 (3.8)

Epi Curve Cafunfo, 2012

at the end of outbreak 17.770 cases, 197 deaths ( CFR 1.1%)

Variable UnivariateOR 95% CI

MultivariateOR 95% CI

No use of repelent 1.4 0.5 – 3.9

Vegetation around house 3.9 2.3 – 4.1 2.6 2.7 – 4.2

Living in area not sprayed in past six months

4.2 5.4 – 7.8 2.8 1.5 – 4.2

Living in an house not sprayed in the past year

4.9 2.1 - 5.7 3.9 2.1 – 5.7

Sleeping under LLINs in the last 24hrs

0.3 0.2– 0.8 0.7 0.4 – 0.9

Risk Factors

Discussion• The causing agent was Plasmodium falciparum

• Children 0-5 years of age were the most affected

• Breakdown of malaria control activities in the study area were the main risk factor for contracting malaria.

(Puran KS 2005), (A. Woyessa 2011)

• More than ¼ of cases the diagnostic was not clarified.• There was need for further diagnosis methods.

Acknowledgement

• MOH• Army Health Service • Provincial Government of Lunda Norte• Local Administration• Distrital Hospital team of Cafunfo• Community leaders • Other stakeholders

Thank You