We defined cholera decedents as persons who died of suspected cholera (acute watery diarrhea in persons >
5 years of age [5
]) with illness onset after October 16, 2010, three days before the first case-patients were seen at the hospital (reflecting the 3-day average incubation period [6
]). To locate decedents, we obtained reports of cholera-related deaths from 2 sources: admission records from 2 hospitals in Artibonite that had cholera treatment centers (Hôpital Albert Schweitzer and Hôpital Charles Colimon) and verbal reports from community health workers (CHWs). We attempted to locate households of all decedents from hospital records and verbal reports. Logistic and time constraints limited case finding to communities within 2 hours’ travel from the hospitals. We visited decedents’ households; obtained informed consent; and interviewed families about demographics, symptoms, health-seeking behavior, treatment, type of health facility, and knowledge about cholera. We also asked decedents’ household members and local CHWs about other cholera-related deaths. If additional decedents were identified, we visited their homes and interviewed household members. The Centers for Disease Control and Prevention Institutional Review Board (Atlanta, GA, USA) and MSPP determined that this emergency response activity was nonresearch.
We enrolled 87 decedents. Of 28 decedents identified from hospital records, we found homes of 22 (79%); homes of 6 decedents could not be located or were too remote for inclusion. Illness onset ranged from October 16 through November 14; a total of 29 (33%) persons died during the first week of the epidemic (). Median age of decedents was 50 years (range 5–100 years); 58 (67%) were male. Forty-eight (55%) decedents died in a health facility (health facility decedents) and 39 (45%) died at home or en route to a facility (community decedents). We identified 17 (35%) health facility decedents from hospital records and 31 (65%) from community interviews; we identified 5 (13%) community decedents from hospital records and 34 (87%) from community interviews.
Number of persons who died of cholera, Artibonite Department, Haiti, October 16–November 14, 2010.
Twenty-three (48%) health facility decedents and 9 (23%) community decedents had used oral rehydration solution (ORS) at home before seeking care (). ORS use at home was lower for persons who died during the first week of the outbreak (7 [27%]) than during the second (8 [40%]) or third (17 [46%]) weeks. We observed ORS sachets in homes of 17 (35%) health facility decedents and 14 (36%) community decedents. No respondents reported use of homemade sugar–salt solution by decedents.
Reported cholera treatment received at home for health facility versus community decedents, Haiti, October–November 2010*
Median time from illness onset to death was 20 hours (range 3 hours–7 days) for health facility decedents and 12 hours (range 2 hours–8 days) for community decedents. Twenty-two (46%) health facility decedents died on day of admission and 26 (54%) died after spending >1 night in the facility (). Twenty-three (59%) community decedents never sought care, 8 (21%) died en route to care, and 8 (21%) died after discharge. Of those who sought care, 29 (60%) health facility decedents and 7 (44%) community decedents waited <2 hours to visit a health facility. Family members of community decedents reported the following reasons for not seeking care: no need for care (19 [69%]), long distance to the health facility (6 [26%]), too ill to travel (4 [17%]), lack of transport (3 [13%]), unsafe to travel at night (3 [13%]), and cost of transport (1 [4%]).
Time and location of death from cholera for health facility versus community decedents, Haiti, October–November, 2010
Of 48 health facility decedents, 38 (79%) were treated in hospital and 10 (21%) at a health center or dispensary. Decedents received intravenous fluids (35 [73%]), ORS (27 [56%]), both (20 [42%]), or neither (3 [9%]).
Household members of 33 (69%) health facility decedents and 30 (81%) community decedents reported receiving information about cholera after the outbreak started. The most common information sources for families of health facility and community decedents, respectively, were radio (26 [79%] vs. 26 [89%]), friend (6 [18%] vs. 8 [27%]), cellular telephone text message from MSPP (4 [12%] vs. 4 [13%]), community meeting (2 [6%] vs. 2 [7%]), and CHWs (1 [3%] vs. 3 [10%]). Fewer than half of family members of health facility (23 [48%]) and community (19 [49%]) decedents believed cholera was treatable. Of these, 16 (70%) health facility decedents and 17 (90%) community decedents knew to seek care at a health facility.