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Abstract
Background: The seasonality of diarrheal diseases is often well characterized in temperate climates but has not been the subject of substantial research in tropical climates, including in sub-Saharan Africa. In Kenya, information on the burden, etiologies, and seasonality of diarrheal illness among refugees living at the Dadaab Refugee Complex, one of the largest refugee camps in the world, was collected between 2010-2014 as part of an enhanced disease surveillance and testing program. Methods: Descriptive analyses were conducted to characterize the incidence of diarrhea by person, place, time, symptomatology, and diagnosis. Seasonality analyses were done to assess for associations between the occurrence of diarrhea and climatic conditions among residents of the Dadaab Refugee Complex. Results: A total of 3,097 diarrhea cases were captured by the surveillance system, 64% of whom were children under 5 years of age (mean = 11 years (SD = 17.8); range: 0-95 years). Cases were evenly divided among males and females. Over 40% of cases were hospitalized, with three deaths in children under 5. Shigella spp., rotavirus, and Entamoeba histolytica accounted for 60% of total cases. The climate and weather factors that were significantly associated with acute diarrhea were rainfall, temperature, air pressure, and humidity. Discussion: This study provides insight into the pathogens that may have been the most important sources of diarrheal illness among Dadaab residents. It also furthers the understanding of how seasonal changes in climate/weather factors influence the occurrence of diarrheal disease in an equatorial climate. Based on our findings, we have proposed policy recommendations for Dadaab Complex stakeholders related to ensuring ongoing diarrheal disease surveillance in this population, using our seasonality model for forecasting purposes, providing vaccinations for certain diarrheal pathogens, developing risk communication strategies, and shoring up critical water, sanitation, and hygiene infrastructure. Our work may assist Kenyan healthcare facilities, camp managers, as well as local and national public health authorities, to plan for and respond to diarrheal illness among refugees living at the Dadaab Refugee Complex.