Research ArticleGeospatial Assessment of Cholera ina Rapidly Urbanizing Environment

Olajumoke Esther Olanrewaju and Kayode Adewale Adepoju

Institute of Ecology and Environmental Studies OAU Ile-Ife Osun State Nigeria

Correspondence should be addressed to Olajumoke Esther Olanrewaju jumseejumseeyahoocom

Received 30 December 2016 Accepted 6 March 2017 Published 11 April 2017

Academic Editor Mynepalli K C Sridhar

Copyright copy 2017 Olajumoke Esther Olanrewaju and Kayode Adewale AdepojuThis is an open access article distributed under theCreative Commons Attribution License which permits unrestricted use distribution and reproduction in any medium providedthe original work is properly cited

This study mapped out and investigated the spatial relationship between cholera incidences and environmental risk factors in thestudy area The study area was stratified into eight zones Water samples from each zone were collected and analyzed to determinethe colony forming units GIS layers including housing density digitized roads rivers buildings and cholera incidence data fromhospital archives were also collected and analyzed usingArcGIS 101 It was observed that there was an association between the ERFs(119901 lt 0001) Similarly 18 out of the 44 waste dump sites seven out of 18 markets and two out of 36 abattoirs were found near thehistorical cholera cases Similarly 4 (211) locations were traced to be predominantly close to rivers and waste dump site All thehistorical cholera cases were found adjoining to roads and buildings Highest CFU count was found in the wells and streams of areaswith a cluster of all the environmental risk factors and high housing density This study revealed that waste dump sites and markethad the highest predisposing attribute while the least was abattoir The uniqueness of the study lies in the combination of mappingand microbial analyses to identify and assess the pattern of cholera risk and also to provide clear information for development ofstrategies for environmental supervision

1 Introduction

Cholera is an acute intestinal infection caused by the inges-tion of food or water contaminated with the bacteriumVibriocholerae [1] Cholera has a short incubation period froma fewhours to 5 days but commonly 1-2 days [2] Cholera affects allages and both genders [2] The bacterium can live naturallyin any environment especially in brackish rivers and coastalwaters [3] Human behaviours related to environmentalhygiene personal hygiene and food preparation contributegreatly to the occurrence and severity of cholera [4] Trans-mission is usually due to fecal contamination of food andwater as a result of poor hygiene Inappropriately managedwastes can attract rodents and insects which can harborgastrointestinal parasites yellow fever virus worms and theplague pathogen Wastes dump sites markets abattoirs andvulnerable elements such as rivers roads and buildings havebeen found to be associated with the occurrence of diseases[1]

Cholera as a disease is endemic in Africa parts of Asiathe Middle East and South and Central America [5] Inendemic areas outbreaks usually occur when war or civilconflict disturbs public sanitation services Also the normalbalance of nature is being interrupted by natural disasterslike earthquake tsunami volcanic eruptions landslides andflood [6] Therefore many health problems are created foodand water supplies can become contaminated by parasitesand bacteria when essential schemes like those for waterand sewage get compromised Due to the increasing size ofvulnerable populations living under unhygienic and deprivedenvironmental conditions the numbers of cholera casesreported in developing countries continue to rise [7] Most ofthe vulnerable populations remain in locations where accessto safe drinking water and good hygiene practices are not inplace [5] Markets waste dump sites and abattoirs are majorsocioeconomic factors that often expose water sources roadsand residents in their neighborhoods to danger of contami-nation and disease In Nigeria the infection is endemic and

HindawiJournal of Environmental and Public HealthVolume 2017 Article ID 6847376 8 pageshttpsdoiorg10115520176847376

2 Journal of Environmental and Public Health

outbreaks are not rare The first series of cholera outbreakwas reported between 1970 and 1990 [8] Additionally morethan 260 individuals were speculated to have died of cholerain four Northern states of Nigeria with over 96 individualsin Maiduguri Biu Gwoza Dikwa and Jere council areas ofBauchi state [9] The last outbreak of cholera in Ile-Ife OsunState in Nigeria resulted in ill-health of many residents andloss of lives Despite this long experience with cholera anunderstanding of the epidemiology of the disease aiding itspersistence in outbreak situations is still lacking This studywas therefore borne out of a need to understand the relation-ship between the spatial pattern of cholera risk and the asso-ciated socioeconomic and environmental factors in affectedcommunities in Ile-Ife

2 GIS and Cholera Mapping

New approaches in geography and related fields capitalizingon advances in technologies such as geographic informationsystems (GIS) the global positioning system (GPS) satelliteremote sensing and computer cartography make it possibleto integrate highly accurate geographic locations and timewith virtually any observation [10 11] GIS provides themeansto store analyze share and visualize real time and archivedspatial data It also permits the integration of multiple layersof interdisciplinary spatial data such as health environ-mental genomic social or demographic data for interactivespatial analyses and modeling Satellite images can greatlyenhance mapping of the environmental factors associatedwith cholera risk just like some other infectious diseasesIntegrating satellite images spatial statistics andGIS can pro-vide ways of relating health and diseases to specific geneticepigenetic and environmental factors [12] GIS has beenused extensively in epidemiology for disease surveillance andinterventionmonitoring [13ndash15] Bymapping disease cases ingeographic space local and national governments can easilyidentify the triggers distribution and spread of disease acrossgeographic regions optimize planning of intervention loca-tions and monitor their effectiveness

3 Methodology

31 Study Area Geographically Ile-Ife is located betweenLatitude 07∘281015840N and 07∘451015840N and Longitude 04∘301015840E and04∘341015840E [16] The climate is tropical Like every other South-west area the raining season extends from April to Octoberwhile the dry season lasts from October to March Ile-Ifehas two major local governments namely Ife Central and IfeEast The town has been witnessing population and physicalgrowth [17] As a result of such growth many abattoirs werecreated because the meat needs of people are on the increaseand more waste dump sites were generated The study wascarried out in Ife East and Ife Central areas of Ile-Ife (Fig-ure 1) Ife East LGA has an area of 172 km2 while Ife CentralLGA has an area of 111 km2 The LGAs populations havetremendously increased over time Ife East population was188 087 as at the 2006 census while that of Ife central popula-tion was 167254 as at 2006

N

0 150 300 600 900 1200Kilometers

NigeriaOsun stateStudy area

Ife Central

Ife East

Figure 1 Map of the study area

4 Data Acquisition SamplingDesign and Processing

Primary data utilized for this study was obtained with the useof a global positioning system (GPS) between May and June2015 and the environmental risk factors were selected basedon WHO predisposing factors to cholera [18] These includecoordinates of abattoirs waste dump sites andmarkets Alto-gether 34 abattoirs (A) 42 waste dump sites (WDS) and 18markets (M) were mapped during this study The secondarydata utilized for this study include recent high resolutionimage of the study area (Google earth) a land-useland-covermap digitized roads rivers and buildings Spatial analysiswas carried out to stratify the areas into eight (8) differentenvironmental risk zones based on density analysis usingArcGIS software version 101 Cholera incidence data wereobtained from Ife East and Ife Central local government areasat the Monitoring and Evaluation Department for the years2010 and 2011 when the prevalence was very high (Table 1)Spatial analysis tool of proximity function in ArcGIS soft-ware 101 was used to determine the relationship betweencholera incidences and the associated socioeconomic andenvironmental risk factors Also inferential statistics (Chi-square) was used to determine association between the ERFsA purposive sampling technique was used to determinewhere water samples were gotten though the sampling wasbased on the proximity to the ERFs identified for this studyTherefore a total number of 59 water samples were collectedfor this study Thirty-six water samples were collected fromwells while twenty-three water samples were collected fromstreams Water samples for microbial analysis were collectedin sterile universal bottles The samples were kept in an icepack transported to the laboratory immediately and somethat were not used immediately were kept in the refrigeratorto prevent contamination and this was done according toGolterman et al [19] and WHO [20] methods for water

Journal of Environmental and Public Health 3

Table 1 Locations of reported cholera cases at Ife Central LGA (August 2010) and Ife East (October 2011) local government areas

Ife Central LGA Long (0E) Lat (0N) Ife East LGA Long (0E) Lat (0N)Sabo 004554862 07491038 14 Igbo Itapa 004562142 0748071513 Ogbingbin 004552293 07484630 29 Lafogido junction 004561255 07479310Seminary opa 004570465 07521842 Bk 17 Ajamopo 004563903 07477990Ilare 004556458 07490795 26 Ayegbaju street 004565123 07482660Olubuse 004558130 07497465 48 Odi-Olowo street 004572768 07468603Ajegunle 004563083 07497032 42 Mokuro road 004569990 07493120Agric Area 004573732 07533373 50 Ile-Lami compound 004565858 07479435Mount Zion 004589283 07498228Moore 004566738 07490868Eleyele 004545620 07490347Iredunmi 004558257 07482020

analysis Water samples were collected in the morning withinthe period of 0630 to 0830 Nigerian local standard timeSterile distilled water was placed in test tubes representingthe dilution from 10minus1 to 10minus10 and serial dilution was doneby introducing the samples in the correct proportion to thesterile distilled water Serial dilutions of 10minus4 10minus5 and 10minus6were chosen Furthermore 1mL each of the dilution waspoured in the plates and prepared blood agar medium waspoured into it It was thereafter evenly spread throughoutthe plates according to Chessbrough directive [21]The plateswere thereafter incubated at 37∘C for 24 hours after whichthe colonies were counted and recorded The degree of con-tamination of water samples was ranked according toMonicaspecification [21] The period for the collection and the labo-ratory analysis lasted from July to August 2015 The labora-tory analysis of the water samples for Vibrio cholerae wasdone thrice for quality assurance sake Some tests that werecarried out on each isolate to determine the presence ofVibriocholerae after culturing in alkaline peptone water and there-after subculturing in Thiosulphate Bile Salt Sucrose (TCBS)and a nutrient agar included Sulfide Indole Motility (SIM)Triple Sugar Iron (TSI) citrate utilization test urease test andoxidase tests Results were interpreted using Bergreyrsquosmanualof determinative bacteriology [22] to determine the presenceof Vibrio cholerae

5 Conceptual and Statistical Analyses

The georeferenced cholera cases were plotted on the databasemap The distance of each environmental risk zone to thecholera incidences was geovisualized to check the proximity(relationship) between them The result was presented in theform of a map Also proximity analysis which required abuffering of 300 meters from the environmental risk factorsto the historical cholera incidences was done with ArcGISsoftware 101 The result of the Vibrio cholerae and the CFUcount per sample were used to build up the attribute for eachof the water sample points on GIS map The level of contam-ination was displayed on the map and integrated with thecholera database to produce a compositemap of cholera caseshousing density and predisposing factors in the study area

The highest CFU count was given gt100 followed by 101ndash100while the lowest count was given the range of 1 to 10 [2021] Spatial analysis was performed to stratify the areas intodifferent disease hot spot density from very high to very lowDescriptive and inferential statistics (Chi-square) was used tointerpret the questionnaire Inferential statistics (Chi-square)was used to determine the association between differentvariables in the study All statistics were discussed at 95confidence level (119901 lt 005)

6 Result

The different rings with intersections depict areas of highestdensities of each of the risk factors The red ring depictsa zone of high concentration of abattoirs while the yellowring depicts zones on highest concentrations of markets andthe green zone represents areas with highest concentrationsof waste dumps The various intersections between abattoirand market abattoirs and waste dump and waste dumpand markets are zones of interactions among the factorsAnother zone which is central to all the rings depicts areasof intersection among abattoir market and waste dumpsThe other zones that fall outside the rings are areas of lowdensity of environmental risk factors The rivers and streamsflowed through all the designated areas of the environmentalrisk factors (ERFs) Most of the abattoirs were located aroundthe streams and rivers Abattoirs were generally found to belocated along the river bodies and towards the northwesternpart of the study area such as Old-Nepa and Ope-OluwaWastes were generally found to be distributed mainly alongthe road sides and riverswhichwere towards the northeasternpart of the study area (Ojoyin Lafogido and Iyana-Oja) Thewaste dump sites observed in the study were found to beclustered around the roadside andmainly in the northeasternpart of the study area especially around Ojoyin StreetLafogido Igbo-Itapa Ajamopo and Ile-Lami compoundsThese areas are mostly characterized by housing densitywhich is typical of inner city core found in many developingcountries This development can contribute to overcrowdingcausing the easy spread of diseases

4 Journal of Environmental and Public Health

4∘31

99840030

998400998400E 4∘33

9984000998400998400E 4

∘34

99840030

998400998400E

4∘31

99840030

998400998400E 4∘33

9984000998400998400E 4

∘34

99840030

998400998400E

7∘309984000998400998400N

7∘2899840030998400998400N

7∘279984000998400998400N

7∘309984000998400998400N

7∘2899840030998400998400N

7∘279984000998400998400N

N

Recent choleraHistorical choleraAbattoir Waste dumpMarket

RoadRiverShape boundaryBuildings

Figure 2 Spatial relationship of cholera incidences and the environ-mental risk factors

The 19 historical occurrences of cholera in Ife East andIfe Central LGA in the years 2010 and 2011 can be traced tothe presence of markets which contained bulk of waste dumpsites proximate to the residential areas (Figure 2) Spatialanalysis of 300-meter buffer showed the different hot spotsfor cholera incidences It was observed that 18 out of the 44waste dump sites located in this study were near the historicalcholera cases These areas are Sabo 1 Sabo 2 Sabo 3 Ojoyin3 Ojoyin 4 Ojoyin Ayegbaju Ayegbaju 2 Ilode AjamopoIle-Lami compound Ile-Lami Oke-Atan AyetoroIloroAjamopo 2 Esinmirin Otutu and Odi-Olowo Similarlyusing the same approach 7 out of the 18 markets in the studywere observed to be near the historical cholera incidences andthese areas areOja Ife Ojatutunmarket Itakogunmarket Isoobi market and Oduduwa street market Finally Sabo abat-toir and Oduduwa street abattoir were the two (2) abattoirsselected out of 36 abattoirs that were found to be proximalto the historical cholera cases (Figure 2 and Tables 2 and 3)Summarily from this studywaste dump sites andmarketwereidentified as the major factors associated with the historicalcholera cases This is because majority of the cholera caseswere found proximate to waste dump sites in the zone ofmar-ket It was also deduced from this study that there is an inter-link between cholera prevalence and proximity to waterbodies The least was the proximity to abattoir Also Vibriocholeraewere isolated in the stream at Iyana-Oja Famia roadOjoyin and Olanrewaju street

7 Environmental Risk Map for the Study Area

When the CFU count was overlaid on housing density layerin ArcGIS the CFU count was found to decrease in order of

Table 2 Proximity (300-meter buffer) from the ERFs to the choleraincidences

ERFs Total number of ERFs Hot spotsWaste dump site 42 18Market 18 7Abattoir 34 2Total 94 27

7∘309984000998400998400N

7∘2899840030998400998400N

7∘279984000998400998400N

N

Recent choleraHistorical choleraAbattoir Waste dumpMarketRoadRiver

4∘31

99840030

998400998400E 4∘33

9984000998400998400E 4

∘34

99840030

998400998400E4∘30

9984000998400998400E 4

∘36

9984000998400998400E

4∘31

99840030

998400998400E 4∘33

9984000998400998400E 4

∘34

99840030

998400998400E4∘30

9984000998400998400E 4

∘36

9984000998400998400E

7∘3199840030998400998400N

7∘309984000998400998400N

7∘2899840030998400998400N

7∘279984000998400998400N

7∘3199840030998400998400N

Kilometers0 051 2 3 4

CFU count

Shape boundary

1ndash10101ndash100gt100

House densityVery high

HighLowVery low

Figure 3 Composite map of cholera cases housing density andpredisposing factors in the study area

reducingmagnitude of housing density from high to lowThehighest CFU count was found in thewells and streams at Sabocommunity Olanrewaju dump site and Iyana-Oja dump siteHigh CFU counts were found in Oduduwa street OjoyinStreet and Famia Street This is followed by Better-Life Ola-Olu Oduduwa Slum Olonode Akaui Street Lafogido Igbo-Itapa and Ile-Lami (Figure 3)

8 Discussion

Themain socioeconomic factors (markets waste dumps andabattoirs) were generally found to be located alongwater bod-ies roads open lands and high density neighborhoods Thenature of their proximity could cause contamination alongwater courses and major roads and also constitute majorhealth challenge to the residents in their neighborhoodsespecially during flood and other forms of emergenciesWastes also constitute nuisance to the environment and formthemajor breeding site for rodents and other diseases causingorganisms These nuisances could also constitute a major

Journal of Environmental and Public Health 5

Table 3 Statistical relationship between ERFs and incidences of cholera

ERF sites Proximity to historic cholera cases No proximity to historic cholera cases Total 1205942 119901 valueWDS 18 (409) 26 (591) 44Market 7 (389) 11 (611) 18 13813 0001lowast

Abattoir 2 (56) 34 (944) 36Total 27 (276) 71 (724) 98lowast indicates significance

health challenge to the residents within the locations becauseit is likely for the disease to propagate from its origin to proxi-mal communities earlier than communities which are fartheraway References [23ndash25] corroborate these verdicts Povertyand ineffective provision of adequate waste disposal methodscan contribute greatly to the indiscriminate disposal practicesin which the indigenous people engaged Meanwhile gov-ernment policies or institutions responsible for communityhealth are usually underfunded or not motivated to controlthe situation References [26ndash28] identified that the occur-rence is rampant in many developing countries A study car-ried out in the eastern area ofNigeria on proximity ofmunici-pal waste and rate of hospitalization formalaria indicated thatproximity of waste dump to roads and residential areas hasimparted negativity on the health of the public [29]

From this study waste dump sites were identified as themajor factor associated with the historical cholera cases Thisis becausemajority of the cholera cases were found proximateto waste dump sites Therefore the cholera outbreak at theseplaces might be due to the high rate of breeding of flies whichcould serve as a carrier of V cholerae from the waste dumpsites polluted by excreta and human garbage to manrsquos foodand water Reference [30] also identified the occurrence ofthese flies in waste dump sites Research has also proven thatthe common housefly (Musca domestica) and flies generallyare mechanical vectors of many kinds of pathogens such asbacteria protozoa viruses and helminth eggs [31] Reference[32] undertook a study on vector potential houseflies (Muscadomestica) in a transmission of V cholerae in India and thisstudy ascertained the vector potential of the domestic house-fly as a carrier ofV cholerae inDelhi India where an outbreakof cholera was encountered Flooding could occur during theheavy outpour of rain thereby causing contaminated waterto flow into the water sources used for human daily activitiesAlso surface run-offs from these dumps sites serve as amajorpathway for fecal and bacterial contamination of rivers andstreamsThe run-offs also carry high organic loads leading tostagnation and increased salinity of rivers and streams thusproducing appropriate environmentally friendly sites for thecholera Vibrio This was supported in the study conductedon the influence of environmental factors on the presence ofV cholerae in the marine environment a climate link [33] Aresearch undertaken in Kumasi Ghana on the spatial depen-dency ofV cholerae on open space refuse dumpswith a spatialstatisticalmodeling suggests that cholera risk is relatively highwhen inhabitants live in close proximity to waste dumps andwhere there are numerous refuse dumps [34]

Specifically themajor outbreak of cholera in Ile-Ife whichwas found to occur at Sabo could be further associated

with the presence of abattoir in this community Ideallyabattoirs should be located few meters away from residentialareas and where there would be ample supply of water forcleansing and a means of transporting the treated remnantsHowever for Sabo community the abattoir is located insidethe community which made the wastes from this activity tobe poorly handled hence serving as a breeding place for flieswhich could predispose them to various diseases especiallycholera Also other environmental factors like markets andwaste dump sites were found near this community Thiscluster of factors could further enhance the spread once thereis an outbreak

It was also deduced from this study that there is an inter-link between cholera prevalence and proximity to water bod-ies This is because water bodies are generally being pollutedby refuses and human excreta due to the indiscriminate defe-cation practices of inhabitants inside water bodies The riskof cholera incidence is assumed to be greater for people wholive closer to them and thus will possibly tend to have highercholera prevalence than those who live farther This findingwas corroborated by the finding of Ali et al who reportedthat cholera infection is enhanced by proximity to potentiallypolluted surfacewater bodies [35]Thus this is also an indica-tion that the effects of dump sites on cholera infection requiresurface water as an intermediate pathway Therefore anyattempt to prevent defecation at dump sites will reduce fecalcontamination of rivers and streams This will in turn reducecholera infection during any outbreakAlso the epidemiolog-ical work of John Snow in London revealed the associationbetween cholera and contaminated water even before anybacteria were known to exist [36] Odi-OlowoMokuro Sem-inary Opa Mount Zion and Olubuse from the southwesternpart of the study area are areas which are positioned nearwater bodies and thus the cholera cases in these communitiesmay be attributed to proximity to water bodies

In a similar manner proximity to market was identifiedto be associated with incidences of cholera in the study areaThis is because market is associated with bulk of wastes andalso someof thesemarketswere found to be proximal towaterbodies These made dumping of wastes inside the nearbystreams very easy The markets which were found to be closeto waste dump sites were mostly located in the northeasternpart of the study area which has a very high housing density

More so market sites were found running parallel tomajor transportation routes as the sites were characterizedwith a lot of road networks which make them generally acenter of commerce Also markets are known to be close toresidential areas for easy accessibility Oja-Tutun market inthe study area is the largest market in Ile-Ife and a major

6 Journal of Environmental and Public Health

center of commerce in the town which lacked adequatesanitationmeasures especially in the deposition of waste Dueto lack of waste collection systems in this place people foundit convenient to deposit their waste inside the stream close tothemarket Cholera outbreaks could have occurred due to thefact thatmicroorganisms found their way to the variouswastedump sites around the market During wet seasons watercould percolate through the soil carrying these organismsto local surface water ground water or sea [37] Thereforeproximity to themarket also plays a significant role in choleratransmission because of the large amount ofwastes generated

The composite cholera riskmap produced from this studyserves as a prediction to the future outbreak of pathogenicdiseasesThe high level of contamination of the water sourcesis due to the presence of pathogenic bacteria and highercolony forming unit (CFU) counts present in them Thereason for the high CFU concentration in Sabo communityis because there is a cluster of abattoirs waste dump sites andmarkets around the location The combination of the threeenvironmental risk factors in the same region further aggra-vates the situation andmakes the areas to be more vulnerableto cholera infection and other bacteria diseases caused bypoor sanitation Other locations with higher CFU countswereOla-Oluwa Iyana-OduduwaOjoyinOlanrewaju Isale-Agbara Famia Better-Life Akaui Oja-Titun Iyana-OjaOlorunsogo Olonode Lafogido Igbo-Itapa and Ile-Lamicompounds with or without history of cholera incidencesThese areas could be predisposed to outbreak of diseasesbecause their CFU count exceeded the WHO permissiblelimits for drinking water [38 39] The work of Obiri-Dansoet al [40] on the spatial dependency of cholera prevalenceon potential cholera reservoirs in an urban area in KumasiGhana deduced that the spatial distribution of cholera preva-lence is dependent on higher bacterial counts found in waterThis signifies that areas with the highest CFU counts are athigher risk of outbreak of diseases It was also observed fromthe study that the new detected cases of V cholerae arespreading towards the northwestern part of the study areaThese areas are Famia road Olanrewaju street and Ojoyincommunity and the last one is at the northeastern part of thestudy area (Iyana-Oja market) in proximity to where choleraoutbreak had occurred beforeThis poses a serious risk to theinhabitants of these communities because any contact withthe water source could lead to an outbreak of cholera andother pathogenic diseases Similarly the hot spots clusters ofcholera cases were seen mainly in areas of very high to highpopulation densities These areas are Iyana-Oja AjamopoIle-Lami Oke-Atan Igbo-Itapa Sabo Iyana-Oduduwa Oja-Titun Old-Nepa Oke-Ola Ilode Ojoyin Aba-Iya Gani OpaKojumole AP and Eleyele If proper interventions are nottaken the proximity of residential buildings to disease hotspots could play an important role in transmission of thedisease to human

9 Conclusion

The spatial relationship between cholera incidences and ERFsgenerated in this study showed that areas with historicalcholera cases were close to waste dump sites near market

riversstreams and abattoirs with waste dump sites andmarkets having the highest predisposing attributes while theleast was abattoir The composite cholera risk map indicatedthe relationship between historical cholera cases and CFUcount (Sabo Ola-Oluwa Iyana-Oduduwa Ojoyin Olan-rewaju Isale-Agbara Famia Better-Life Akaui Oja-TitunIyana-Oja Olorunsogo Olonode Lafogido Igbo-Itapa andIle-Lami compounds) and medium CFU count and low CFUcount Also behaviour and socioeconomic conditions maypromote the contamination of water with cholera Sabo isusually associated with cholera contamination for other rea-sons apart from waste dump site Based on the findings fromthis study the environmental factors identified in this studyhad a significant pollution effect which could pose a severerisk to the health and wellbeing of users and this calls forurgent intervention

10 Recommendations

Communities such as Ajamopo Igbo-Itapa Ile-Lami Ayeg-baju Ojoyin Sabo Ola-Olu and Iyana-Oduduwawhich havewaste dump sites proximate to them should be given quickintervention by removing the wastes and providing refusevans to eliminate such nuisances Also communities that areproximal to markets should be properly observed becauseof the huge amount of wastes markets generate Also indis-criminate dumping of wastes should be highly prohibited andanybody that dumps wastes indiscriminately should be sanc-tioned by health authorities in the region Also governmentshould make sure that markets and abattoirs are sited at least300 meters away from residential areas

Furthermore communities such as Seminary OpaMokuro Odi-Olowo Sabo and Mount Zion that have riversand streams close to them should be properly monitoredmore importantly by creating good drainages for the free-flow of water in order to control them from overflowing toresidential buildings which could cause flooding and leadsto outbreak of diseases Also Sabo community that has anabattoir in her community should be banned from operatingby appropriate health authorities in the region

It is also recommended that water sources in communi-ties such as Sabo Ola-Oluwa Iyana-Oduduwa Ojoyin Olan-rewaju Isale-Agbara Famia Better-Life Akaui Oja-TitunIyana-Oja Olorunsogo Olonode Lafogido Igbo-Itapa andIle-Lami compounds with higher CFU counts should betreated Communities such as Ojoyin Iyana-OduduwaFamia and Olanrewaju with their water sources being con-taminated with the presence ofV cholerae should be properlymonitored to prevent outbreak of diseases Also periodicwater testing should be undertaken by health authorities inthe regions every threemonths to detect anymicroorganismsthat may be present in order to apply treatment accordingly

Conflicts of Interest

The authors declare that there are no conflicts of interestregarding the publication of this paper

Journal of Environmental and Public Health 7

References

[1] WHO ldquoVibrio choleraerdquo inGuidelines for DrinkingWater Qual-ity 2nd Edition Addendum Microbiological Agent in DrinkingWater pp 119ndash142 WHO Geneva Switzerland 2nd edition2002

[2] D A Sack R B Sack and C-L Chaignat ldquoGetting seriousabout cholerardquo The New England Journal of Medicine vol 355no 7 pp 649ndash651 2006

[3] Centers for Disease Control and prevention (CDC) Generalinformation onCholera-Vibrio Cholerae Infection CDCAtlantaGa USA 1987

[4] K J Ryan andCG Ray SherrisMedicalMicrobiologyMcGraw-Hill New York NY USA 4th edition 2004

[5] World Health Organization (WHO) ldquoCholera vaccines WHOposition paperrdquo Weekly Epidemiological Record vol 85 no 13pp 117ndash128 2010

[6] F Qadri A I Khan A S G Faruque et al ldquoEnterotoxigenicEscherichia coli andVibrio cholerae diarrhea Bangladesh 2004rdquoEmerging Infectious Diseases vol 11 no 7 pp 1104ndash1107 2005

[7] WHO ldquoCholera fact sheetrdquo 2016 httpwwwwhointmedia-centrefactsheetsfs107en

[8] T O Lawoyin N A Ogunbodede E A A Olumide andM OOnadeko ldquoOutbreak of cholera in Ibadan Nigeriardquo EuropeanJournal of Epidemiology vol 15 no 4 pp 367ndash370 1999

[9] T Igomu ldquoCholera epidemic far from being over In a rapidlyurbanizing state capital in south western Nigeriardquo Journal onSustainable Development in Africa vol 12 no 2 pp 322ndash3372011

[10] M F Goodchild ldquoSpatial turn in health researchrdquo Journal ofSpatial Information Science vol 1 no 3 2010

[11] D Richardson ldquoTransforming science and societyrdquo in Geo-graphic Information Science and Technology Body of KnowledgeD DiBiase M DeMers A Johnson et al Eds pp 7ndash10Association of American Geographers Washington DC USA2006

[12] R Feil and M F Fraga ldquoEpigenetics and the environmentemerging patterns and implicationsrdquo Nature Reviews Geneticsvol 13 no 2 pp 97ndash109 2012

[13] K C Clarke S L McLafferty and B J Tempalski ldquoOn epi-demiology and geographic information systems a review anddiscussion of future directionsrdquo Emerging Infectious Diseasesvol 2 no 2 pp 85ndash92 1996

[14] M Palaniyandi P H Anand and R Maniyosai ldquoSpatialcognition a geospatial analysis of vector borne disease trans-mission and the environment using remote sensing and GISrdquoInternational Journal of Mosquito Research vol 1 no 3 pp 39ndash54 2014

[15] A E Olajuyigbe P Alinaitwe S A Adegboyega and E SalubildquoSpatial analysis of factors responsible for incidence of waterborne diseases in Ile-Ife Nigeriardquo Journal of Sustainable Societyvol 1 no 4 pp 96ndash113 2012

[16] O A Ajala and A M Olayiwola ldquoAn assessment of the growthof Ile-Ife Osun State Nigeria using multi-temporal imageriesrdquoJournal of Geography and Geology vol 5 no 2 pp 43ndash54 2013

[17] OA Ajala S Lekan and S A Adeyinka ldquoAccessibility to healthcare facilities a panacea for sustainable rural development inOsun state southwestern Nigeriardquo Journal of Human Ecologyvol 18 no 2 pp 121ndash128 2005

[18] WHO ldquoWorld Health Organization the global burden ofcholerardquo Bulletin of the WHO vol 90 pp 209ndash218 2012

[19] ldquoMethods for physical and chemical analysis of fresh watersrdquoin IBP Handbook H L Golterman R S Clymo and M A MOhmstad Eds vol 8 pp 211ndash213 Blackwell Scientic BostonMass USA 1978

[20] WHO Guidelines for Drinking Water Quality vol III Surveil-lance and Control of Community Supplies Geneva Switzer-land 2nd edition 1997

[21] M Chessbrough District Laboratory Practice in Tropical Coun-tries Part 2 Cambridge University Press Cambridge UK 2ndedition 2006

[22] J G Holt Ed Bergreyrsquos Manual of Determinative BacteriologyWilliams and Wilking Baltimore Md USA 9th edition 1994

[23] M Smallman-Raynor and A D Cliff ldquoThe Philippines insur-rection and the 1902ndash4 cholera epidemic part IImdashdiffusionpatterns in war and peacerdquo Journal of Historical Geography vol24 no 1-2 pp 188ndash210 1998

[24] B Trevelyan M Smallman-Raynor and A D Cliff ldquoThespatial structure of epidemic emergence geographical aspectsof poliomyelitis in north-eastern USA JulyndashOctober 1916rdquoJournal of the Royal Statistical Society Series A Statistics inSociety vol 168 no 4 pp 701ndash722 2005

[25] F Pyle Gerald ldquoStudies of disease diffusion Applied medicalgeography VH Winston and sons WDC The diffusion ofcholera in the United States in the nineteenth centuryrdquo Geo-graphic Analysis vol 1 pp 59ndash79 2010

[26] P L Doan ldquoInstitutionalizing household waste collection theurban environmental management project in Cote drsquoIvoirerdquoHabitat International vol 22 no 1 pp 27ndash39 1998

[27] United Nations Environmental Protection (UNEP) Interna-tional Source Book on Environmentally Sound Technologiesfor Municipal IETC Technical Publication 53014-001 UNEPWashington DC USA 2002

[28] N J Ashbolt ldquoMicrobial contamination of drinking water anddiseases outcomes in developing regions Toxicology in theNewCentury Opportunities and ChallengesmdashProceeding of the 5thCongress of Toxicology inDeveloping RegionsrdquoToxicology vol198 no 1 pp 229ndash238 2004

[29] E E Nkwocha and R O Egejuru ldquoProximity of munici-pal waste and rate of hospitalization for malariardquo Journal ofResearch in National development vol 6 no 2 pp 1ndash11 2008

[30] F B Osei and A A Duker ldquoSpatial dependency of V choleraprevalence on open space refuse dumps in Kumasi Ghanaa spatial statistical modellingrdquo International Journal of HealthGeographics vol 7 no 1 article 62 2008

[31] O S Levine and M M Levine ldquoHouseflies (Musca domestica)as mechanical vectors of shigellosisrdquo Reviews of InfectiousDiseases vol 13 no 4 pp 688ndash696 1991

[32] R Fotedar ldquoVector potential of houseflies (Musca domestica) inthe transmission of Vibrio cholerae in Indiardquo Acta Tropica vol78 no 1 pp 31ndash34 2001

[33] T P S Violeta ldquoInfluence of environmental factors on thepresence ofVibrio cholerae in themarine environment a climatelinkrdquo Journal of Infection in Developing Countries vol 1 no 13pp 224ndash241 2007

[34] F B Osei A A Duker E-W Augustijn and A Stein ldquoSpatialdependency of cholera prevalence on potential cholera reser-voirs in an urban area Kumasi Ghanardquo International Journalof Applied Earth Observation and Geoinformation vol 12 no 5pp 331ndash339 2010

[35] M Ali M Emch J P Donnay M Yunus and R B SackldquoIdentifying environmental risk factors for endemic cholera

Journal of Environmental and Public Health 3

Table 1 Locations of reported cholera cases at Ife Central LGA (August 2010) and Ife East (October 2011) local government areas

Ife Central LGA Long (0E) Lat (0N) Ife East LGA Long (0E) Lat (0N)Sabo 004554862 07491038 14 Igbo Itapa 004562142 0748071513 Ogbingbin 004552293 07484630 29 Lafogido junction 004561255 07479310Seminary opa 004570465 07521842 Bk 17 Ajamopo 004563903 07477990Ilare 004556458 07490795 26 Ayegbaju street 004565123 07482660Olubuse 004558130 07497465 48 Odi-Olowo street 004572768 07468603Ajegunle 004563083 07497032 42 Mokuro road 004569990 07493120Agric Area 004573732 07533373 50 Ile-Lami compound 004565858 07479435Mount Zion 004589283 07498228Moore 004566738 07490868Eleyele 004545620 07490347Iredunmi 004558257 07482020

analysis Water samples were collected in the morning withinthe period of 0630 to 0830 Nigerian local standard timeSterile distilled water was placed in test tubes representingthe dilution from 10minus1 to 10minus10 and serial dilution was doneby introducing the samples in the correct proportion to thesterile distilled water Serial dilutions of 10minus4 10minus5 and 10minus6were chosen Furthermore 1mL each of the dilution waspoured in the plates and prepared blood agar medium waspoured into it It was thereafter evenly spread throughoutthe plates according to Chessbrough directive [21]The plateswere thereafter incubated at 37∘C for 24 hours after whichthe colonies were counted and recorded The degree of con-tamination of water samples was ranked according toMonicaspecification [21] The period for the collection and the labo-ratory analysis lasted from July to August 2015 The labora-tory analysis of the water samples for Vibrio cholerae wasdone thrice for quality assurance sake Some tests that werecarried out on each isolate to determine the presence ofVibriocholerae after culturing in alkaline peptone water and there-after subculturing in Thiosulphate Bile Salt Sucrose (TCBS)and a nutrient agar included Sulfide Indole Motility (SIM)Triple Sugar Iron (TSI) citrate utilization test urease test andoxidase tests Results were interpreted using Bergreyrsquosmanualof determinative bacteriology [22] to determine the presenceof Vibrio cholerae

5 Conceptual and Statistical Analyses

The georeferenced cholera cases were plotted on the databasemap The distance of each environmental risk zone to thecholera incidences was geovisualized to check the proximity(relationship) between them The result was presented in theform of a map Also proximity analysis which required abuffering of 300 meters from the environmental risk factorsto the historical cholera incidences was done with ArcGISsoftware 101 The result of the Vibrio cholerae and the CFUcount per sample were used to build up the attribute for eachof the water sample points on GIS map The level of contam-ination was displayed on the map and integrated with thecholera database to produce a compositemap of cholera caseshousing density and predisposing factors in the study area

The highest CFU count was given gt100 followed by 101ndash100while the lowest count was given the range of 1 to 10 [2021] Spatial analysis was performed to stratify the areas intodifferent disease hot spot density from very high to very lowDescriptive and inferential statistics (Chi-square) was used tointerpret the questionnaire Inferential statistics (Chi-square)was used to determine the association between differentvariables in the study All statistics were discussed at 95confidence level (119901 lt 005)

6 Result

The different rings with intersections depict areas of highestdensities of each of the risk factors The red ring depictsa zone of high concentration of abattoirs while the yellowring depicts zones on highest concentrations of markets andthe green zone represents areas with highest concentrationsof waste dumps The various intersections between abattoirand market abattoirs and waste dump and waste dumpand markets are zones of interactions among the factorsAnother zone which is central to all the rings depicts areasof intersection among abattoir market and waste dumpsThe other zones that fall outside the rings are areas of lowdensity of environmental risk factors The rivers and streamsflowed through all the designated areas of the environmentalrisk factors (ERFs) Most of the abattoirs were located aroundthe streams and rivers Abattoirs were generally found to belocated along the river bodies and towards the northwesternpart of the study area such as Old-Nepa and Ope-OluwaWastes were generally found to be distributed mainly alongthe road sides and riverswhichwere towards the northeasternpart of the study area (Ojoyin Lafogido and Iyana-Oja) Thewaste dump sites observed in the study were found to beclustered around the roadside andmainly in the northeasternpart of the study area especially around Ojoyin StreetLafogido Igbo-Itapa Ajamopo and Ile-Lami compoundsThese areas are mostly characterized by housing densitywhich is typical of inner city core found in many developingcountries This development can contribute to overcrowdingcausing the easy spread of diseases

4 Journal of Environmental and Public Health

4∘31

99840030

998400998400E 4∘33

9984000998400998400E 4

∘34

99840030

998400998400E

4∘31

99840030

998400998400E 4∘33

9984000998400998400E 4

∘34

99840030

998400998400E

7∘309984000998400998400N

7∘2899840030998400998400N

7∘279984000998400998400N

7∘309984000998400998400N

7∘2899840030998400998400N

7∘279984000998400998400N

N

Recent choleraHistorical choleraAbattoir Waste dumpMarket

RoadRiverShape boundaryBuildings

Figure 2 Spatial relationship of cholera incidences and the environ-mental risk factors

The 19 historical occurrences of cholera in Ife East andIfe Central LGA in the years 2010 and 2011 can be traced tothe presence of markets which contained bulk of waste dumpsites proximate to the residential areas (Figure 2) Spatialanalysis of 300-meter buffer showed the different hot spotsfor cholera incidences It was observed that 18 out of the 44waste dump sites located in this study were near the historicalcholera cases These areas are Sabo 1 Sabo 2 Sabo 3 Ojoyin3 Ojoyin 4 Ojoyin Ayegbaju Ayegbaju 2 Ilode AjamopoIle-Lami compound Ile-Lami Oke-Atan AyetoroIloroAjamopo 2 Esinmirin Otutu and Odi-Olowo Similarlyusing the same approach 7 out of the 18 markets in the studywere observed to be near the historical cholera incidences andthese areas areOja Ife Ojatutunmarket Itakogunmarket Isoobi market and Oduduwa street market Finally Sabo abat-toir and Oduduwa street abattoir were the two (2) abattoirsselected out of 36 abattoirs that were found to be proximalto the historical cholera cases (Figure 2 and Tables 2 and 3)Summarily from this studywaste dump sites andmarketwereidentified as the major factors associated with the historicalcholera cases This is because majority of the cholera caseswere found proximate to waste dump sites in the zone ofmar-ket It was also deduced from this study that there is an inter-link between cholera prevalence and proximity to waterbodies The least was the proximity to abattoir Also Vibriocholeraewere isolated in the stream at Iyana-Oja Famia roadOjoyin and Olanrewaju street

7 Environmental Risk Map for the Study Area

When the CFU count was overlaid on housing density layerin ArcGIS the CFU count was found to decrease in order of

Table 2 Proximity (300-meter buffer) from the ERFs to the choleraincidences

ERFs Total number of ERFs Hot spotsWaste dump site 42 18Market 18 7Abattoir 34 2Total 94 27

7∘309984000998400998400N

7∘2899840030998400998400N

7∘279984000998400998400N

N

Recent choleraHistorical choleraAbattoir Waste dumpMarketRoadRiver

4∘31

99840030

998400998400E 4∘33

9984000998400998400E 4

∘34

99840030

998400998400E4∘30

9984000998400998400E 4

∘36

9984000998400998400E

4∘31

99840030

998400998400E 4∘33

9984000998400998400E 4

∘34

99840030

998400998400E4∘30

9984000998400998400E 4

∘36

9984000998400998400E

7∘3199840030998400998400N

7∘309984000998400998400N

7∘2899840030998400998400N

7∘279984000998400998400N

7∘3199840030998400998400N

Kilometers0 051 2 3 4

CFU count

Shape boundary

1ndash10101ndash100gt100

House densityVery high

HighLowVery low

Figure 3 Composite map of cholera cases housing density andpredisposing factors in the study area

reducingmagnitude of housing density from high to lowThehighest CFU count was found in thewells and streams at Sabocommunity Olanrewaju dump site and Iyana-Oja dump siteHigh CFU counts were found in Oduduwa street OjoyinStreet and Famia Street This is followed by Better-Life Ola-Olu Oduduwa Slum Olonode Akaui Street Lafogido Igbo-Itapa and Ile-Lami (Figure 3)

8 Discussion

Themain socioeconomic factors (markets waste dumps andabattoirs) were generally found to be located alongwater bod-ies roads open lands and high density neighborhoods Thenature of their proximity could cause contamination alongwater courses and major roads and also constitute majorhealth challenge to the residents in their neighborhoodsespecially during flood and other forms of emergenciesWastes also constitute nuisance to the environment and formthemajor breeding site for rodents and other diseases causingorganisms These nuisances could also constitute a major

Journal of Environmental and Public Health 5

Table 3 Statistical relationship between ERFs and incidences of cholera

ERF sites Proximity to historic cholera cases No proximity to historic cholera cases Total 1205942 119901 valueWDS 18 (409) 26 (591) 44Market 7 (389) 11 (611) 18 13813 0001lowast

Abattoir 2 (56) 34 (944) 36Total 27 (276) 71 (724) 98lowast indicates significance

health challenge to the residents within the locations becauseit is likely for the disease to propagate from its origin to proxi-mal communities earlier than communities which are fartheraway References [23ndash25] corroborate these verdicts Povertyand ineffective provision of adequate waste disposal methodscan contribute greatly to the indiscriminate disposal practicesin which the indigenous people engaged Meanwhile gov-ernment policies or institutions responsible for communityhealth are usually underfunded or not motivated to controlthe situation References [26ndash28] identified that the occur-rence is rampant in many developing countries A study car-ried out in the eastern area ofNigeria on proximity ofmunici-pal waste and rate of hospitalization formalaria indicated thatproximity of waste dump to roads and residential areas hasimparted negativity on the health of the public [29]

From this study waste dump sites were identified as themajor factor associated with the historical cholera cases Thisis becausemajority of the cholera cases were found proximateto waste dump sites Therefore the cholera outbreak at theseplaces might be due to the high rate of breeding of flies whichcould serve as a carrier of V cholerae from the waste dumpsites polluted by excreta and human garbage to manrsquos foodand water Reference [30] also identified the occurrence ofthese flies in waste dump sites Research has also proven thatthe common housefly (Musca domestica) and flies generallyare mechanical vectors of many kinds of pathogens such asbacteria protozoa viruses and helminth eggs [31] Reference[32] undertook a study on vector potential houseflies (Muscadomestica) in a transmission of V cholerae in India and thisstudy ascertained the vector potential of the domestic house-fly as a carrier ofV cholerae inDelhi India where an outbreakof cholera was encountered Flooding could occur during theheavy outpour of rain thereby causing contaminated waterto flow into the water sources used for human daily activitiesAlso surface run-offs from these dumps sites serve as amajorpathway for fecal and bacterial contamination of rivers andstreamsThe run-offs also carry high organic loads leading tostagnation and increased salinity of rivers and streams thusproducing appropriate environmentally friendly sites for thecholera Vibrio This was supported in the study conductedon the influence of environmental factors on the presence ofV cholerae in the marine environment a climate link [33] Aresearch undertaken in Kumasi Ghana on the spatial depen-dency ofV cholerae on open space refuse dumpswith a spatialstatisticalmodeling suggests that cholera risk is relatively highwhen inhabitants live in close proximity to waste dumps andwhere there are numerous refuse dumps [34]

Specifically themajor outbreak of cholera in Ile-Ife whichwas found to occur at Sabo could be further associated

with the presence of abattoir in this community Ideallyabattoirs should be located few meters away from residentialareas and where there would be ample supply of water forcleansing and a means of transporting the treated remnantsHowever for Sabo community the abattoir is located insidethe community which made the wastes from this activity tobe poorly handled hence serving as a breeding place for flieswhich could predispose them to various diseases especiallycholera Also other environmental factors like markets andwaste dump sites were found near this community Thiscluster of factors could further enhance the spread once thereis an outbreak

It was also deduced from this study that there is an inter-link between cholera prevalence and proximity to water bod-ies This is because water bodies are generally being pollutedby refuses and human excreta due to the indiscriminate defe-cation practices of inhabitants inside water bodies The riskof cholera incidence is assumed to be greater for people wholive closer to them and thus will possibly tend to have highercholera prevalence than those who live farther This findingwas corroborated by the finding of Ali et al who reportedthat cholera infection is enhanced by proximity to potentiallypolluted surfacewater bodies [35]Thus this is also an indica-tion that the effects of dump sites on cholera infection requiresurface water as an intermediate pathway Therefore anyattempt to prevent defecation at dump sites will reduce fecalcontamination of rivers and streams This will in turn reducecholera infection during any outbreakAlso the epidemiolog-ical work of John Snow in London revealed the associationbetween cholera and contaminated water even before anybacteria were known to exist [36] Odi-OlowoMokuro Sem-inary Opa Mount Zion and Olubuse from the southwesternpart of the study area are areas which are positioned nearwater bodies and thus the cholera cases in these communitiesmay be attributed to proximity to water bodies

In a similar manner proximity to market was identifiedto be associated with incidences of cholera in the study areaThis is because market is associated with bulk of wastes andalso someof thesemarketswere found to be proximal towaterbodies These made dumping of wastes inside the nearbystreams very easy The markets which were found to be closeto waste dump sites were mostly located in the northeasternpart of the study area which has a very high housing density

More so market sites were found running parallel tomajor transportation routes as the sites were characterizedwith a lot of road networks which make them generally acenter of commerce Also markets are known to be close toresidential areas for easy accessibility Oja-Tutun market inthe study area is the largest market in Ile-Ife and a major

6 Journal of Environmental and Public Health

center of commerce in the town which lacked adequatesanitationmeasures especially in the deposition of waste Dueto lack of waste collection systems in this place people foundit convenient to deposit their waste inside the stream close tothemarket Cholera outbreaks could have occurred due to thefact thatmicroorganisms found their way to the variouswastedump sites around the market During wet seasons watercould percolate through the soil carrying these organismsto local surface water ground water or sea [37] Thereforeproximity to themarket also plays a significant role in choleratransmission because of the large amount ofwastes generated

The composite cholera riskmap produced from this studyserves as a prediction to the future outbreak of pathogenicdiseasesThe high level of contamination of the water sourcesis due to the presence of pathogenic bacteria and highercolony forming unit (CFU) counts present in them Thereason for the high CFU concentration in Sabo communityis because there is a cluster of abattoirs waste dump sites andmarkets around the location The combination of the threeenvironmental risk factors in the same region further aggra-vates the situation andmakes the areas to be more vulnerableto cholera infection and other bacteria diseases caused bypoor sanitation Other locations with higher CFU countswereOla-Oluwa Iyana-OduduwaOjoyinOlanrewaju Isale-Agbara Famia Better-Life Akaui Oja-Titun Iyana-OjaOlorunsogo Olonode Lafogido Igbo-Itapa and Ile-Lamicompounds with or without history of cholera incidencesThese areas could be predisposed to outbreak of diseasesbecause their CFU count exceeded the WHO permissiblelimits for drinking water [38 39] The work of Obiri-Dansoet al [40] on the spatial dependency of cholera prevalenceon potential cholera reservoirs in an urban area in KumasiGhana deduced that the spatial distribution of cholera preva-lence is dependent on higher bacterial counts found in waterThis signifies that areas with the highest CFU counts are athigher risk of outbreak of diseases It was also observed fromthe study that the new detected cases of V cholerae arespreading towards the northwestern part of the study areaThese areas are Famia road Olanrewaju street and Ojoyincommunity and the last one is at the northeastern part of thestudy area (Iyana-Oja market) in proximity to where choleraoutbreak had occurred beforeThis poses a serious risk to theinhabitants of these communities because any contact withthe water source could lead to an outbreak of cholera andother pathogenic diseases Similarly the hot spots clusters ofcholera cases were seen mainly in areas of very high to highpopulation densities These areas are Iyana-Oja AjamopoIle-Lami Oke-Atan Igbo-Itapa Sabo Iyana-Oduduwa Oja-Titun Old-Nepa Oke-Ola Ilode Ojoyin Aba-Iya Gani OpaKojumole AP and Eleyele If proper interventions are nottaken the proximity of residential buildings to disease hotspots could play an important role in transmission of thedisease to human

9 Conclusion

The spatial relationship between cholera incidences and ERFsgenerated in this study showed that areas with historicalcholera cases were close to waste dump sites near market

riversstreams and abattoirs with waste dump sites andmarkets having the highest predisposing attributes while theleast was abattoir The composite cholera risk map indicatedthe relationship between historical cholera cases and CFUcount (Sabo Ola-Oluwa Iyana-Oduduwa Ojoyin Olan-rewaju Isale-Agbara Famia Better-Life Akaui Oja-TitunIyana-Oja Olorunsogo Olonode Lafogido Igbo-Itapa andIle-Lami compounds) and medium CFU count and low CFUcount Also behaviour and socioeconomic conditions maypromote the contamination of water with cholera Sabo isusually associated with cholera contamination for other rea-sons apart from waste dump site Based on the findings fromthis study the environmental factors identified in this studyhad a significant pollution effect which could pose a severerisk to the health and wellbeing of users and this calls forurgent intervention

10 Recommendations

Communities such as Ajamopo Igbo-Itapa Ile-Lami Ayeg-baju Ojoyin Sabo Ola-Olu and Iyana-Oduduwawhich havewaste dump sites proximate to them should be given quickintervention by removing the wastes and providing refusevans to eliminate such nuisances Also communities that areproximal to markets should be properly observed becauseof the huge amount of wastes markets generate Also indis-criminate dumping of wastes should be highly prohibited andanybody that dumps wastes indiscriminately should be sanc-tioned by health authorities in the region Also governmentshould make sure that markets and abattoirs are sited at least300 meters away from residential areas

Furthermore communities such as Seminary OpaMokuro Odi-Olowo Sabo and Mount Zion that have riversand streams close to them should be properly monitoredmore importantly by creating good drainages for the free-flow of water in order to control them from overflowing toresidential buildings which could cause flooding and leadsto outbreak of diseases Also Sabo community that has anabattoir in her community should be banned from operatingby appropriate health authorities in the region

It is also recommended that water sources in communi-ties such as Sabo Ola-Oluwa Iyana-Oduduwa Ojoyin Olan-rewaju Isale-Agbara Famia Better-Life Akaui Oja-TitunIyana-Oja Olorunsogo Olonode Lafogido Igbo-Itapa andIle-Lami compounds with higher CFU counts should betreated Communities such as Ojoyin Iyana-OduduwaFamia and Olanrewaju with their water sources being con-taminated with the presence ofV cholerae should be properlymonitored to prevent outbreak of diseases Also periodicwater testing should be undertaken by health authorities inthe regions every threemonths to detect anymicroorganismsthat may be present in order to apply treatment accordingly

Conflicts of Interest

The authors declare that there are no conflicts of interestregarding the publication of this paper

Journal of Environmental and Public Health 7

References

[1] WHO ldquoVibrio choleraerdquo inGuidelines for DrinkingWater Qual-ity 2nd Edition Addendum Microbiological Agent in DrinkingWater pp 119ndash142 WHO Geneva Switzerland 2nd edition2002

[2] D A Sack R B Sack and C-L Chaignat ldquoGetting seriousabout cholerardquo The New England Journal of Medicine vol 355no 7 pp 649ndash651 2006

[3] Centers for Disease Control and prevention (CDC) Generalinformation onCholera-Vibrio Cholerae Infection CDCAtlantaGa USA 1987

[4] K J Ryan andCG Ray SherrisMedicalMicrobiologyMcGraw-Hill New York NY USA 4th edition 2004

[5] World Health Organization (WHO) ldquoCholera vaccines WHOposition paperrdquo Weekly Epidemiological Record vol 85 no 13pp 117ndash128 2010

[6] F Qadri A I Khan A S G Faruque et al ldquoEnterotoxigenicEscherichia coli andVibrio cholerae diarrhea Bangladesh 2004rdquoEmerging Infectious Diseases vol 11 no 7 pp 1104ndash1107 2005

[7] WHO ldquoCholera fact sheetrdquo 2016 httpwwwwhointmedia-centrefactsheetsfs107en

[8] T O Lawoyin N A Ogunbodede E A A Olumide andM OOnadeko ldquoOutbreak of cholera in Ibadan Nigeriardquo EuropeanJournal of Epidemiology vol 15 no 4 pp 367ndash370 1999

[9] T Igomu ldquoCholera epidemic far from being over In a rapidlyurbanizing state capital in south western Nigeriardquo Journal onSustainable Development in Africa vol 12 no 2 pp 322ndash3372011

[10] M F Goodchild ldquoSpatial turn in health researchrdquo Journal ofSpatial Information Science vol 1 no 3 2010

[11] D Richardson ldquoTransforming science and societyrdquo in Geo-graphic Information Science and Technology Body of KnowledgeD DiBiase M DeMers A Johnson et al Eds pp 7ndash10Association of American Geographers Washington DC USA2006

[12] R Feil and M F Fraga ldquoEpigenetics and the environmentemerging patterns and implicationsrdquo Nature Reviews Geneticsvol 13 no 2 pp 97ndash109 2012

[13] K C Clarke S L McLafferty and B J Tempalski ldquoOn epi-demiology and geographic information systems a review anddiscussion of future directionsrdquo Emerging Infectious Diseasesvol 2 no 2 pp 85ndash92 1996

[14] M Palaniyandi P H Anand and R Maniyosai ldquoSpatialcognition a geospatial analysis of vector borne disease trans-mission and the environment using remote sensing and GISrdquoInternational Journal of Mosquito Research vol 1 no 3 pp 39ndash54 2014

[15] A E Olajuyigbe P Alinaitwe S A Adegboyega and E SalubildquoSpatial analysis of factors responsible for incidence of waterborne diseases in Ile-Ife Nigeriardquo Journal of Sustainable Societyvol 1 no 4 pp 96ndash113 2012

[16] O A Ajala and A M Olayiwola ldquoAn assessment of the growthof Ile-Ife Osun State Nigeria using multi-temporal imageriesrdquoJournal of Geography and Geology vol 5 no 2 pp 43ndash54 2013

[17] OA Ajala S Lekan and S A Adeyinka ldquoAccessibility to healthcare facilities a panacea for sustainable rural development inOsun state southwestern Nigeriardquo Journal of Human Ecologyvol 18 no 2 pp 121ndash128 2005

[18] WHO ldquoWorld Health Organization the global burden ofcholerardquo Bulletin of the WHO vol 90 pp 209ndash218 2012

[19] ldquoMethods for physical and chemical analysis of fresh watersrdquoin IBP Handbook H L Golterman R S Clymo and M A MOhmstad Eds vol 8 pp 211ndash213 Blackwell Scientic BostonMass USA 1978

[20] WHO Guidelines for Drinking Water Quality vol III Surveil-lance and Control of Community Supplies Geneva Switzer-land 2nd edition 1997

[21] M Chessbrough District Laboratory Practice in Tropical Coun-tries Part 2 Cambridge University Press Cambridge UK 2ndedition 2006

[22] J G Holt Ed Bergreyrsquos Manual of Determinative BacteriologyWilliams and Wilking Baltimore Md USA 9th edition 1994

[23] M Smallman-Raynor and A D Cliff ldquoThe Philippines insur-rection and the 1902ndash4 cholera epidemic part IImdashdiffusionpatterns in war and peacerdquo Journal of Historical Geography vol24 no 1-2 pp 188ndash210 1998

[24] B Trevelyan M Smallman-Raynor and A D Cliff ldquoThespatial structure of epidemic emergence geographical aspectsof poliomyelitis in north-eastern USA JulyndashOctober 1916rdquoJournal of the Royal Statistical Society Series A Statistics inSociety vol 168 no 4 pp 701ndash722 2005

[25] F Pyle Gerald ldquoStudies of disease diffusion Applied medicalgeography VH Winston and sons WDC The diffusion ofcholera in the United States in the nineteenth centuryrdquo Geo-graphic Analysis vol 1 pp 59ndash79 2010

[26] P L Doan ldquoInstitutionalizing household waste collection theurban environmental management project in Cote drsquoIvoirerdquoHabitat International vol 22 no 1 pp 27ndash39 1998

[27] United Nations Environmental Protection (UNEP) Interna-tional Source Book on Environmentally Sound Technologiesfor Municipal IETC Technical Publication 53014-001 UNEPWashington DC USA 2002

[28] N J Ashbolt ldquoMicrobial contamination of drinking water anddiseases outcomes in developing regions Toxicology in theNewCentury Opportunities and ChallengesmdashProceeding of the 5thCongress of Toxicology inDeveloping RegionsrdquoToxicology vol198 no 1 pp 229ndash238 2004

[29] E E Nkwocha and R O Egejuru ldquoProximity of munici-pal waste and rate of hospitalization for malariardquo Journal ofResearch in National development vol 6 no 2 pp 1ndash11 2008

[30] F B Osei and A A Duker ldquoSpatial dependency of V choleraprevalence on open space refuse dumps in Kumasi Ghanaa spatial statistical modellingrdquo International Journal of HealthGeographics vol 7 no 1 article 62 2008

[31] O S Levine and M M Levine ldquoHouseflies (Musca domestica)as mechanical vectors of shigellosisrdquo Reviews of InfectiousDiseases vol 13 no 4 pp 688ndash696 1991

[32] R Fotedar ldquoVector potential of houseflies (Musca domestica) inthe transmission of Vibrio cholerae in Indiardquo Acta Tropica vol78 no 1 pp 31ndash34 2001

[33] T P S Violeta ldquoInfluence of environmental factors on thepresence ofVibrio cholerae in themarine environment a climatelinkrdquo Journal of Infection in Developing Countries vol 1 no 13pp 224ndash241 2007

[34] F B Osei A A Duker E-W Augustijn and A Stein ldquoSpatialdependency of cholera prevalence on potential cholera reser-voirs in an urban area Kumasi Ghanardquo International Journalof Applied Earth Observation and Geoinformation vol 12 no 5pp 331ndash339 2010

[35] M Ali M Emch J P Donnay M Yunus and R B SackldquoIdentifying environmental risk factors for endemic cholera

4 Journal of Environmental and Public Health

4∘31

99840030

998400998400E 4∘33

9984000998400998400E 4

∘34

99840030

998400998400E

4∘31

99840030

998400998400E 4∘33

9984000998400998400E 4

∘34

99840030

998400998400E

7∘309984000998400998400N

7∘2899840030998400998400N

7∘279984000998400998400N

7∘309984000998400998400N

7∘2899840030998400998400N

7∘279984000998400998400N

N

Recent choleraHistorical choleraAbattoir Waste dumpMarket

RoadRiverShape boundaryBuildings

Figure 2 Spatial relationship of cholera incidences and the environ-mental risk factors

The 19 historical occurrences of cholera in Ife East andIfe Central LGA in the years 2010 and 2011 can be traced tothe presence of markets which contained bulk of waste dumpsites proximate to the residential areas (Figure 2) Spatialanalysis of 300-meter buffer showed the different hot spotsfor cholera incidences It was observed that 18 out of the 44waste dump sites located in this study were near the historicalcholera cases These areas are Sabo 1 Sabo 2 Sabo 3 Ojoyin3 Ojoyin 4 Ojoyin Ayegbaju Ayegbaju 2 Ilode AjamopoIle-Lami compound Ile-Lami Oke-Atan AyetoroIloroAjamopo 2 Esinmirin Otutu and Odi-Olowo Similarlyusing the same approach 7 out of the 18 markets in the studywere observed to be near the historical cholera incidences andthese areas areOja Ife Ojatutunmarket Itakogunmarket Isoobi market and Oduduwa street market Finally Sabo abat-toir and Oduduwa street abattoir were the two (2) abattoirsselected out of 36 abattoirs that were found to be proximalto the historical cholera cases (Figure 2 and Tables 2 and 3)Summarily from this studywaste dump sites andmarketwereidentified as the major factors associated with the historicalcholera cases This is because majority of the cholera caseswere found proximate to waste dump sites in the zone ofmar-ket It was also deduced from this study that there is an inter-link between cholera prevalence and proximity to waterbodies The least was the proximity to abattoir Also Vibriocholeraewere isolated in the stream at Iyana-Oja Famia roadOjoyin and Olanrewaju street

7 Environmental Risk Map for the Study Area

When the CFU count was overlaid on housing density layerin ArcGIS the CFU count was found to decrease in order of

Table 2 Proximity (300-meter buffer) from the ERFs to the choleraincidences

ERFs Total number of ERFs Hot spotsWaste dump site 42 18Market 18 7Abattoir 34 2Total 94 27

7∘309984000998400998400N

7∘2899840030998400998400N

7∘279984000998400998400N

N

Recent choleraHistorical choleraAbattoir Waste dumpMarketRoadRiver

4∘31

99840030

998400998400E 4∘33

9984000998400998400E 4

∘34

99840030

998400998400E4∘30

9984000998400998400E 4

∘36

9984000998400998400E

4∘31

99840030

998400998400E 4∘33

9984000998400998400E 4

∘34

99840030

998400998400E4∘30

9984000998400998400E 4

∘36

9984000998400998400E

7∘3199840030998400998400N

7∘309984000998400998400N

7∘2899840030998400998400N

7∘279984000998400998400N

7∘3199840030998400998400N

Kilometers0 051 2 3 4

CFU count

Shape boundary

1ndash10101ndash100gt100

House densityVery high

HighLowVery low

Figure 3 Composite map of cholera cases housing density andpredisposing factors in the study area

reducingmagnitude of housing density from high to lowThehighest CFU count was found in thewells and streams at Sabocommunity Olanrewaju dump site and Iyana-Oja dump siteHigh CFU counts were found in Oduduwa street OjoyinStreet and Famia Street This is followed by Better-Life Ola-Olu Oduduwa Slum Olonode Akaui Street Lafogido Igbo-Itapa and Ile-Lami (Figure 3)

8 Discussion

Themain socioeconomic factors (markets waste dumps andabattoirs) were generally found to be located alongwater bod-ies roads open lands and high density neighborhoods Thenature of their proximity could cause contamination alongwater courses and major roads and also constitute majorhealth challenge to the residents in their neighborhoodsespecially during flood and other forms of emergenciesWastes also constitute nuisance to the environment and formthemajor breeding site for rodents and other diseases causingorganisms These nuisances could also constitute a major

Journal of Environmental and Public Health 5

Table 3 Statistical relationship between ERFs and incidences of cholera

ERF sites Proximity to historic cholera cases No proximity to historic cholera cases Total 1205942 119901 valueWDS 18 (409) 26 (591) 44Market 7 (389) 11 (611) 18 13813 0001lowast

Abattoir 2 (56) 34 (944) 36Total 27 (276) 71 (724) 98lowast indicates significance

health challenge to the residents within the locations becauseit is likely for the disease to propagate from its origin to proxi-mal communities earlier than communities which are fartheraway References [23ndash25] corroborate these verdicts Povertyand ineffective provision of adequate waste disposal methodscan contribute greatly to the indiscriminate disposal practicesin which the indigenous people engaged Meanwhile gov-ernment policies or institutions responsible for communityhealth are usually underfunded or not motivated to controlthe situation References [26ndash28] identified that the occur-rence is rampant in many developing countries A study car-ried out in the eastern area ofNigeria on proximity ofmunici-pal waste and rate of hospitalization formalaria indicated thatproximity of waste dump to roads and residential areas hasimparted negativity on the health of the public [29]

From this study waste dump sites were identified as themajor factor associated with the historical cholera cases Thisis becausemajority of the cholera cases were found proximateto waste dump sites Therefore the cholera outbreak at theseplaces might be due to the high rate of breeding of flies whichcould serve as a carrier of V cholerae from the waste dumpsites polluted by excreta and human garbage to manrsquos foodand water Reference [30] also identified the occurrence ofthese flies in waste dump sites Research has also proven thatthe common housefly (Musca domestica) and flies generallyare mechanical vectors of many kinds of pathogens such asbacteria protozoa viruses and helminth eggs [31] Reference[32] undertook a study on vector potential houseflies (Muscadomestica) in a transmission of V cholerae in India and thisstudy ascertained the vector potential of the domestic house-fly as a carrier ofV cholerae inDelhi India where an outbreakof cholera was encountered Flooding could occur during theheavy outpour of rain thereby causing contaminated waterto flow into the water sources used for human daily activitiesAlso surface run-offs from these dumps sites serve as amajorpathway for fecal and bacterial contamination of rivers andstreamsThe run-offs also carry high organic loads leading tostagnation and increased salinity of rivers and streams thusproducing appropriate environmentally friendly sites for thecholera Vibrio This was supported in the study conductedon the influence of environmental factors on the presence ofV cholerae in the marine environment a climate link [33] Aresearch undertaken in Kumasi Ghana on the spatial depen-dency ofV cholerae on open space refuse dumpswith a spatialstatisticalmodeling suggests that cholera risk is relatively highwhen inhabitants live in close proximity to waste dumps andwhere there are numerous refuse dumps [34]

Specifically themajor outbreak of cholera in Ile-Ife whichwas found to occur at Sabo could be further associated

with the presence of abattoir in this community Ideallyabattoirs should be located few meters away from residentialareas and where there would be ample supply of water forcleansing and a means of transporting the treated remnantsHowever for Sabo community the abattoir is located insidethe community which made the wastes from this activity tobe poorly handled hence serving as a breeding place for flieswhich could predispose them to various diseases especiallycholera Also other environmental factors like markets andwaste dump sites were found near this community Thiscluster of factors could further enhance the spread once thereis an outbreak

It was also deduced from this study that there is an inter-link between cholera prevalence and proximity to water bod-ies This is because water bodies are generally being pollutedby refuses and human excreta due to the indiscriminate defe-cation practices of inhabitants inside water bodies The riskof cholera incidence is assumed to be greater for people wholive closer to them and thus will possibly tend to have highercholera prevalence than those who live farther This findingwas corroborated by the finding of Ali et al who reportedthat cholera infection is enhanced by proximity to potentiallypolluted surfacewater bodies [35]Thus this is also an indica-tion that the effects of dump sites on cholera infection requiresurface water as an intermediate pathway Therefore anyattempt to prevent defecation at dump sites will reduce fecalcontamination of rivers and streams This will in turn reducecholera infection during any outbreakAlso the epidemiolog-ical work of John Snow in London revealed the associationbetween cholera and contaminated water even before anybacteria were known to exist [36] Odi-OlowoMokuro Sem-inary Opa Mount Zion and Olubuse from the southwesternpart of the study area are areas which are positioned nearwater bodies and thus the cholera cases in these communitiesmay be attributed to proximity to water bodies

In a similar manner proximity to market was identifiedto be associated with incidences of cholera in the study areaThis is because market is associated with bulk of wastes andalso someof thesemarketswere found to be proximal towaterbodies These made dumping of wastes inside the nearbystreams very easy The markets which were found to be closeto waste dump sites were mostly located in the northeasternpart of the study area which has a very high housing density

More so market sites were found running parallel tomajor transportation routes as the sites were characterizedwith a lot of road networks which make them generally acenter of commerce Also markets are known to be close toresidential areas for easy accessibility Oja-Tutun market inthe study area is the largest market in Ile-Ife and a major

6 Journal of Environmental and Public Health

center of commerce in the town which lacked adequatesanitationmeasures especially in the deposition of waste Dueto lack of waste collection systems in this place people foundit convenient to deposit their waste inside the stream close tothemarket Cholera outbreaks could have occurred due to thefact thatmicroorganisms found their way to the variouswastedump sites around the market During wet seasons watercould percolate through the soil carrying these organismsto local surface water ground water or sea [37] Thereforeproximity to themarket also plays a significant role in choleratransmission because of the large amount ofwastes generated

The composite cholera riskmap produced from this studyserves as a prediction to the future outbreak of pathogenicdiseasesThe high level of contamination of the water sourcesis due to the presence of pathogenic bacteria and highercolony forming unit (CFU) counts present in them Thereason for the high CFU concentration in Sabo communityis because there is a cluster of abattoirs waste dump sites andmarkets around the location The combination of the threeenvironmental risk factors in the same region further aggra-vates the situation andmakes the areas to be more vulnerableto cholera infection and other bacteria diseases caused bypoor sanitation Other locations with higher CFU countswereOla-Oluwa Iyana-OduduwaOjoyinOlanrewaju Isale-Agbara Famia Better-Life Akaui Oja-Titun Iyana-OjaOlorunsogo Olonode Lafogido Igbo-Itapa and Ile-Lamicompounds with or without history of cholera incidencesThese areas could be predisposed to outbreak of diseasesbecause their CFU count exceeded the WHO permissiblelimits for drinking water [38 39] The work of Obiri-Dansoet al [40] on the spatial dependency of cholera prevalenceon potential cholera reservoirs in an urban area in KumasiGhana deduced that the spatial distribution of cholera preva-lence is dependent on higher bacterial counts found in waterThis signifies that areas with the highest CFU counts are athigher risk of outbreak of diseases It was also observed fromthe study that the new detected cases of V cholerae arespreading towards the northwestern part of the study areaThese areas are Famia road Olanrewaju street and Ojoyincommunity and the last one is at the northeastern part of thestudy area (Iyana-Oja market) in proximity to where choleraoutbreak had occurred beforeThis poses a serious risk to theinhabitants of these communities because any contact withthe water source could lead to an outbreak of cholera andother pathogenic diseases Similarly the hot spots clusters ofcholera cases were seen mainly in areas of very high to highpopulation densities These areas are Iyana-Oja AjamopoIle-Lami Oke-Atan Igbo-Itapa Sabo Iyana-Oduduwa Oja-Titun Old-Nepa Oke-Ola Ilode Ojoyin Aba-Iya Gani OpaKojumole AP and Eleyele If proper interventions are nottaken the proximity of residential buildings to disease hotspots could play an important role in transmission of thedisease to human

9 Conclusion

The spatial relationship between cholera incidences and ERFsgenerated in this study showed that areas with historicalcholera cases were close to waste dump sites near market

riversstreams and abattoirs with waste dump sites andmarkets having the highest predisposing attributes while theleast was abattoir The composite cholera risk map indicatedthe relationship between historical cholera cases and CFUcount (Sabo Ola-Oluwa Iyana-Oduduwa Ojoyin Olan-rewaju Isale-Agbara Famia Better-Life Akaui Oja-TitunIyana-Oja Olorunsogo Olonode Lafogido Igbo-Itapa andIle-Lami compounds) and medium CFU count and low CFUcount Also behaviour and socioeconomic conditions maypromote the contamination of water with cholera Sabo isusually associated with cholera contamination for other rea-sons apart from waste dump site Based on the findings fromthis study the environmental factors identified in this studyhad a significant pollution effect which could pose a severerisk to the health and wellbeing of users and this calls forurgent intervention

10 Recommendations

Communities such as Ajamopo Igbo-Itapa Ile-Lami Ayeg-baju Ojoyin Sabo Ola-Olu and Iyana-Oduduwawhich havewaste dump sites proximate to them should be given quickintervention by removing the wastes and providing refusevans to eliminate such nuisances Also communities that areproximal to markets should be properly observed becauseof the huge amount of wastes markets generate Also indis-criminate dumping of wastes should be highly prohibited andanybody that dumps wastes indiscriminately should be sanc-tioned by health authorities in the region Also governmentshould make sure that markets and abattoirs are sited at least300 meters away from residential areas

Furthermore communities such as Seminary OpaMokuro Odi-Olowo Sabo and Mount Zion that have riversand streams close to them should be properly monitoredmore importantly by creating good drainages for the free-flow of water in order to control them from overflowing toresidential buildings which could cause flooding and leadsto outbreak of diseases Also Sabo community that has anabattoir in her community should be banned from operatingby appropriate health authorities in the region

It is also recommended that water sources in communi-ties such as Sabo Ola-Oluwa Iyana-Oduduwa Ojoyin Olan-rewaju Isale-Agbara Famia Better-Life Akaui Oja-TitunIyana-Oja Olorunsogo Olonode Lafogido Igbo-Itapa andIle-Lami compounds with higher CFU counts should betreated Communities such as Ojoyin Iyana-OduduwaFamia and Olanrewaju with their water sources being con-taminated with the presence ofV cholerae should be properlymonitored to prevent outbreak of diseases Also periodicwater testing should be undertaken by health authorities inthe regions every threemonths to detect anymicroorganismsthat may be present in order to apply treatment accordingly

Conflicts of Interest

The authors declare that there are no conflicts of interestregarding the publication of this paper

Journal of Environmental and Public Health 7

References

[1] WHO ldquoVibrio choleraerdquo inGuidelines for DrinkingWater Qual-ity 2nd Edition Addendum Microbiological Agent in DrinkingWater pp 119ndash142 WHO Geneva Switzerland 2nd edition2002

[2] D A Sack R B Sack and C-L Chaignat ldquoGetting seriousabout cholerardquo The New England Journal of Medicine vol 355no 7 pp 649ndash651 2006

[3] Centers for Disease Control and prevention (CDC) Generalinformation onCholera-Vibrio Cholerae Infection CDCAtlantaGa USA 1987

[4] K J Ryan andCG Ray SherrisMedicalMicrobiologyMcGraw-Hill New York NY USA 4th edition 2004

[5] World Health Organization (WHO) ldquoCholera vaccines WHOposition paperrdquo Weekly Epidemiological Record vol 85 no 13pp 117ndash128 2010

[6] F Qadri A I Khan A S G Faruque et al ldquoEnterotoxigenicEscherichia coli andVibrio cholerae diarrhea Bangladesh 2004rdquoEmerging Infectious Diseases vol 11 no 7 pp 1104ndash1107 2005

[7] WHO ldquoCholera fact sheetrdquo 2016 httpwwwwhointmedia-centrefactsheetsfs107en

[8] T O Lawoyin N A Ogunbodede E A A Olumide andM OOnadeko ldquoOutbreak of cholera in Ibadan Nigeriardquo EuropeanJournal of Epidemiology vol 15 no 4 pp 367ndash370 1999

[9] T Igomu ldquoCholera epidemic far from being over In a rapidlyurbanizing state capital in south western Nigeriardquo Journal onSustainable Development in Africa vol 12 no 2 pp 322ndash3372011

[10] M F Goodchild ldquoSpatial turn in health researchrdquo Journal ofSpatial Information Science vol 1 no 3 2010

[11] D Richardson ldquoTransforming science and societyrdquo in Geo-graphic Information Science and Technology Body of KnowledgeD DiBiase M DeMers A Johnson et al Eds pp 7ndash10Association of American Geographers Washington DC USA2006

[12] R Feil and M F Fraga ldquoEpigenetics and the environmentemerging patterns and implicationsrdquo Nature Reviews Geneticsvol 13 no 2 pp 97ndash109 2012

[13] K C Clarke S L McLafferty and B J Tempalski ldquoOn epi-demiology and geographic information systems a review anddiscussion of future directionsrdquo Emerging Infectious Diseasesvol 2 no 2 pp 85ndash92 1996

[14] M Palaniyandi P H Anand and R Maniyosai ldquoSpatialcognition a geospatial analysis of vector borne disease trans-mission and the environment using remote sensing and GISrdquoInternational Journal of Mosquito Research vol 1 no 3 pp 39ndash54 2014

[15] A E Olajuyigbe P Alinaitwe S A Adegboyega and E SalubildquoSpatial analysis of factors responsible for incidence of waterborne diseases in Ile-Ife Nigeriardquo Journal of Sustainable Societyvol 1 no 4 pp 96ndash113 2012

[16] O A Ajala and A M Olayiwola ldquoAn assessment of the growthof Ile-Ife Osun State Nigeria using multi-temporal imageriesrdquoJournal of Geography and Geology vol 5 no 2 pp 43ndash54 2013

[17] OA Ajala S Lekan and S A Adeyinka ldquoAccessibility to healthcare facilities a panacea for sustainable rural development inOsun state southwestern Nigeriardquo Journal of Human Ecologyvol 18 no 2 pp 121ndash128 2005

[18] WHO ldquoWorld Health Organization the global burden ofcholerardquo Bulletin of the WHO vol 90 pp 209ndash218 2012

[19] ldquoMethods for physical and chemical analysis of fresh watersrdquoin IBP Handbook H L Golterman R S Clymo and M A MOhmstad Eds vol 8 pp 211ndash213 Blackwell Scientic BostonMass USA 1978

[20] WHO Guidelines for Drinking Water Quality vol III Surveil-lance and Control of Community Supplies Geneva Switzer-land 2nd edition 1997

[21] M Chessbrough District Laboratory Practice in Tropical Coun-tries Part 2 Cambridge University Press Cambridge UK 2ndedition 2006

[22] J G Holt Ed Bergreyrsquos Manual of Determinative BacteriologyWilliams and Wilking Baltimore Md USA 9th edition 1994

[23] M Smallman-Raynor and A D Cliff ldquoThe Philippines insur-rection and the 1902ndash4 cholera epidemic part IImdashdiffusionpatterns in war and peacerdquo Journal of Historical Geography vol24 no 1-2 pp 188ndash210 1998

[24] B Trevelyan M Smallman-Raynor and A D Cliff ldquoThespatial structure of epidemic emergence geographical aspectsof poliomyelitis in north-eastern USA JulyndashOctober 1916rdquoJournal of the Royal Statistical Society Series A Statistics inSociety vol 168 no 4 pp 701ndash722 2005

[25] F Pyle Gerald ldquoStudies of disease diffusion Applied medicalgeography VH Winston and sons WDC The diffusion ofcholera in the United States in the nineteenth centuryrdquo Geo-graphic Analysis vol 1 pp 59ndash79 2010

[26] P L Doan ldquoInstitutionalizing household waste collection theurban environmental management project in Cote drsquoIvoirerdquoHabitat International vol 22 no 1 pp 27ndash39 1998

[27] United Nations Environmental Protection (UNEP) Interna-tional Source Book on Environmentally Sound Technologiesfor Municipal IETC Technical Publication 53014-001 UNEPWashington DC USA 2002

[28] N J Ashbolt ldquoMicrobial contamination of drinking water anddiseases outcomes in developing regions Toxicology in theNewCentury Opportunities and ChallengesmdashProceeding of the 5thCongress of Toxicology inDeveloping RegionsrdquoToxicology vol198 no 1 pp 229ndash238 2004

[29] E E Nkwocha and R O Egejuru ldquoProximity of munici-pal waste and rate of hospitalization for malariardquo Journal ofResearch in National development vol 6 no 2 pp 1ndash11 2008

[30] F B Osei and A A Duker ldquoSpatial dependency of V choleraprevalence on open space refuse dumps in Kumasi Ghanaa spatial statistical modellingrdquo International Journal of HealthGeographics vol 7 no 1 article 62 2008

[31] O S Levine and M M Levine ldquoHouseflies (Musca domestica)as mechanical vectors of shigellosisrdquo Reviews of InfectiousDiseases vol 13 no 4 pp 688ndash696 1991

[32] R Fotedar ldquoVector potential of houseflies (Musca domestica) inthe transmission of Vibrio cholerae in Indiardquo Acta Tropica vol78 no 1 pp 31ndash34 2001

[33] T P S Violeta ldquoInfluence of environmental factors on thepresence ofVibrio cholerae in themarine environment a climatelinkrdquo Journal of Infection in Developing Countries vol 1 no 13pp 224ndash241 2007

[34] F B Osei A A Duker E-W Augustijn and A Stein ldquoSpatialdependency of cholera prevalence on potential cholera reser-voirs in an urban area Kumasi Ghanardquo International Journalof Applied Earth Observation and Geoinformation vol 12 no 5pp 331ndash339 2010

[35] M Ali M Emch J P Donnay M Yunus and R B SackldquoIdentifying environmental risk factors for endemic cholera

Journal of Environmental and Public Health 5

Table 3 Statistical relationship between ERFs and incidences of cholera

ERF sites Proximity to historic cholera cases No proximity to historic cholera cases Total 1205942 119901 valueWDS 18 (409) 26 (591) 44Market 7 (389) 11 (611) 18 13813 0001lowast

Abattoir 2 (56) 34 (944) 36Total 27 (276) 71 (724) 98lowast indicates significance

health challenge to the residents within the locations becauseit is likely for the disease to propagate from its origin to proxi-mal communities earlier than communities which are fartheraway References [23ndash25] corroborate these verdicts Povertyand ineffective provision of adequate waste disposal methodscan contribute greatly to the indiscriminate disposal practicesin which the indigenous people engaged Meanwhile gov-ernment policies or institutions responsible for communityhealth are usually underfunded or not motivated to controlthe situation References [26ndash28] identified that the occur-rence is rampant in many developing countries A study car-ried out in the eastern area ofNigeria on proximity ofmunici-pal waste and rate of hospitalization formalaria indicated thatproximity of waste dump to roads and residential areas hasimparted negativity on the health of the public [29]

From this study waste dump sites were identified as themajor factor associated with the historical cholera cases Thisis becausemajority of the cholera cases were found proximateto waste dump sites Therefore the cholera outbreak at theseplaces might be due to the high rate of breeding of flies whichcould serve as a carrier of V cholerae from the waste dumpsites polluted by excreta and human garbage to manrsquos foodand water Reference [30] also identified the occurrence ofthese flies in waste dump sites Research has also proven thatthe common housefly (Musca domestica) and flies generallyare mechanical vectors of many kinds of pathogens such asbacteria protozoa viruses and helminth eggs [31] Reference[32] undertook a study on vector potential houseflies (Muscadomestica) in a transmission of V cholerae in India and thisstudy ascertained the vector potential of the domestic house-fly as a carrier ofV cholerae inDelhi India where an outbreakof cholera was encountered Flooding could occur during theheavy outpour of rain thereby causing contaminated waterto flow into the water sources used for human daily activitiesAlso surface run-offs from these dumps sites serve as amajorpathway for fecal and bacterial contamination of rivers andstreamsThe run-offs also carry high organic loads leading tostagnation and increased salinity of rivers and streams thusproducing appropriate environmentally friendly sites for thecholera Vibrio This was supported in the study conductedon the influence of environmental factors on the presence ofV cholerae in the marine environment a climate link [33] Aresearch undertaken in Kumasi Ghana on the spatial depen-dency ofV cholerae on open space refuse dumpswith a spatialstatisticalmodeling suggests that cholera risk is relatively highwhen inhabitants live in close proximity to waste dumps andwhere there are numerous refuse dumps [34]

Specifically themajor outbreak of cholera in Ile-Ife whichwas found to occur at Sabo could be further associated

with the presence of abattoir in this community Ideallyabattoirs should be located few meters away from residentialareas and where there would be ample supply of water forcleansing and a means of transporting the treated remnantsHowever for Sabo community the abattoir is located insidethe community which made the wastes from this activity tobe poorly handled hence serving as a breeding place for flieswhich could predispose them to various diseases especiallycholera Also other environmental factors like markets andwaste dump sites were found near this community Thiscluster of factors could further enhance the spread once thereis an outbreak

It was also deduced from this study that there is an inter-link between cholera prevalence and proximity to water bod-ies This is because water bodies are generally being pollutedby refuses and human excreta due to the indiscriminate defe-cation practices of inhabitants inside water bodies The riskof cholera incidence is assumed to be greater for people wholive closer to them and thus will possibly tend to have highercholera prevalence than those who live farther This findingwas corroborated by the finding of Ali et al who reportedthat cholera infection is enhanced by proximity to potentiallypolluted surfacewater bodies [35]Thus this is also an indica-tion that the effects of dump sites on cholera infection requiresurface water as an intermediate pathway Therefore anyattempt to prevent defecation at dump sites will reduce fecalcontamination of rivers and streams This will in turn reducecholera infection during any outbreakAlso the epidemiolog-ical work of John Snow in London revealed the associationbetween cholera and contaminated water even before anybacteria were known to exist [36] Odi-OlowoMokuro Sem-inary Opa Mount Zion and Olubuse from the southwesternpart of the study area are areas which are positioned nearwater bodies and thus the cholera cases in these communitiesmay be attributed to proximity to water bodies

In a similar manner proximity to market was identifiedto be associated with incidences of cholera in the study areaThis is because market is associated with bulk of wastes andalso someof thesemarketswere found to be proximal towaterbodies These made dumping of wastes inside the nearbystreams very easy The markets which were found to be closeto waste dump sites were mostly located in the northeasternpart of the study area which has a very high housing density

More so market sites were found running parallel tomajor transportation routes as the sites were characterizedwith a lot of road networks which make them generally acenter of commerce Also markets are known to be close toresidential areas for easy accessibility Oja-Tutun market inthe study area is the largest market in Ile-Ife and a major

6 Journal of Environmental and Public Health

center of commerce in the town which lacked adequatesanitationmeasures especially in the deposition of waste Dueto lack of waste collection systems in this place people foundit convenient to deposit their waste inside the stream close tothemarket Cholera outbreaks could have occurred due to thefact thatmicroorganisms found their way to the variouswastedump sites around the market During wet seasons watercould percolate through the soil carrying these organismsto local surface water ground water or sea [37] Thereforeproximity to themarket also plays a significant role in choleratransmission because of the large amount ofwastes generated

The composite cholera riskmap produced from this studyserves as a prediction to the future outbreak of pathogenicdiseasesThe high level of contamination of the water sourcesis due to the presence of pathogenic bacteria and highercolony forming unit (CFU) counts present in them Thereason for the high CFU concentration in Sabo communityis because there is a cluster of abattoirs waste dump sites andmarkets around the location The combination of the threeenvironmental risk factors in the same region further aggra-vates the situation andmakes the areas to be more vulnerableto cholera infection and other bacteria diseases caused bypoor sanitation Other locations with higher CFU countswereOla-Oluwa Iyana-OduduwaOjoyinOlanrewaju Isale-Agbara Famia Better-Life Akaui Oja-Titun Iyana-OjaOlorunsogo Olonode Lafogido Igbo-Itapa and Ile-Lamicompounds with or without history of cholera incidencesThese areas could be predisposed to outbreak of diseasesbecause their CFU count exceeded the WHO permissiblelimits for drinking water [38 39] The work of Obiri-Dansoet al [40] on the spatial dependency of cholera prevalenceon potential cholera reservoirs in an urban area in KumasiGhana deduced that the spatial distribution of cholera preva-lence is dependent on higher bacterial counts found in waterThis signifies that areas with the highest CFU counts are athigher risk of outbreak of diseases It was also observed fromthe study that the new detected cases of V cholerae arespreading towards the northwestern part of the study areaThese areas are Famia road Olanrewaju street and Ojoyincommunity and the last one is at the northeastern part of thestudy area (Iyana-Oja market) in proximity to where choleraoutbreak had occurred beforeThis poses a serious risk to theinhabitants of these communities because any contact withthe water source could lead to an outbreak of cholera andother pathogenic diseases Similarly the hot spots clusters ofcholera cases were seen mainly in areas of very high to highpopulation densities These areas are Iyana-Oja AjamopoIle-Lami Oke-Atan Igbo-Itapa Sabo Iyana-Oduduwa Oja-Titun Old-Nepa Oke-Ola Ilode Ojoyin Aba-Iya Gani OpaKojumole AP and Eleyele If proper interventions are nottaken the proximity of residential buildings to disease hotspots could play an important role in transmission of thedisease to human

9 Conclusion

The spatial relationship between cholera incidences and ERFsgenerated in this study showed that areas with historicalcholera cases were close to waste dump sites near market

riversstreams and abattoirs with waste dump sites andmarkets having the highest predisposing attributes while theleast was abattoir The composite cholera risk map indicatedthe relationship between historical cholera cases and CFUcount (Sabo Ola-Oluwa Iyana-Oduduwa Ojoyin Olan-rewaju Isale-Agbara Famia Better-Life Akaui Oja-TitunIyana-Oja Olorunsogo Olonode Lafogido Igbo-Itapa andIle-Lami compounds) and medium CFU count and low CFUcount Also behaviour and socioeconomic conditions maypromote the contamination of water with cholera Sabo isusually associated with cholera contamination for other rea-sons apart from waste dump site Based on the findings fromthis study the environmental factors identified in this studyhad a significant pollution effect which could pose a severerisk to the health and wellbeing of users and this calls forurgent intervention

10 Recommendations

Communities such as Ajamopo Igbo-Itapa Ile-Lami Ayeg-baju Ojoyin Sabo Ola-Olu and Iyana-Oduduwawhich havewaste dump sites proximate to them should be given quickintervention by removing the wastes and providing refusevans to eliminate such nuisances Also communities that areproximal to markets should be properly observed becauseof the huge amount of wastes markets generate Also indis-criminate dumping of wastes should be highly prohibited andanybody that dumps wastes indiscriminately should be sanc-tioned by health authorities in the region Also governmentshould make sure that markets and abattoirs are sited at least300 meters away from residential areas

Furthermore communities such as Seminary OpaMokuro Odi-Olowo Sabo and Mount Zion that have riversand streams close to them should be properly monitoredmore importantly by creating good drainages for the free-flow of water in order to control them from overflowing toresidential buildings which could cause flooding and leadsto outbreak of diseases Also Sabo community that has anabattoir in her community should be banned from operatingby appropriate health authorities in the region

It is also recommended that water sources in communi-ties such as Sabo Ola-Oluwa Iyana-Oduduwa Ojoyin Olan-rewaju Isale-Agbara Famia Better-Life Akaui Oja-TitunIyana-Oja Olorunsogo Olonode Lafogido Igbo-Itapa andIle-Lami compounds with higher CFU counts should betreated Communities such as Ojoyin Iyana-OduduwaFamia and Olanrewaju with their water sources being con-taminated with the presence ofV cholerae should be properlymonitored to prevent outbreak of diseases Also periodicwater testing should be undertaken by health authorities inthe regions every threemonths to detect anymicroorganismsthat may be present in order to apply treatment accordingly

Conflicts of Interest

The authors declare that there are no conflicts of interestregarding the publication of this paper

Journal of Environmental and Public Health 7

References

[1] WHO ldquoVibrio choleraerdquo inGuidelines for DrinkingWater Qual-ity 2nd Edition Addendum Microbiological Agent in DrinkingWater pp 119ndash142 WHO Geneva Switzerland 2nd edition2002

[2] D A Sack R B Sack and C-L Chaignat ldquoGetting seriousabout cholerardquo The New England Journal of Medicine vol 355no 7 pp 649ndash651 2006

[3] Centers for Disease Control and prevention (CDC) Generalinformation onCholera-Vibrio Cholerae Infection CDCAtlantaGa USA 1987

[4] K J Ryan andCG Ray SherrisMedicalMicrobiologyMcGraw-Hill New York NY USA 4th edition 2004

[5] World Health Organization (WHO) ldquoCholera vaccines WHOposition paperrdquo Weekly Epidemiological Record vol 85 no 13pp 117ndash128 2010

[6] F Qadri A I Khan A S G Faruque et al ldquoEnterotoxigenicEscherichia coli andVibrio cholerae diarrhea Bangladesh 2004rdquoEmerging Infectious Diseases vol 11 no 7 pp 1104ndash1107 2005

[7] WHO ldquoCholera fact sheetrdquo 2016 httpwwwwhointmedia-centrefactsheetsfs107en

[8] T O Lawoyin N A Ogunbodede E A A Olumide andM OOnadeko ldquoOutbreak of cholera in Ibadan Nigeriardquo EuropeanJournal of Epidemiology vol 15 no 4 pp 367ndash370 1999

[9] T Igomu ldquoCholera epidemic far from being over In a rapidlyurbanizing state capital in south western Nigeriardquo Journal onSustainable Development in Africa vol 12 no 2 pp 322ndash3372011

[10] M F Goodchild ldquoSpatial turn in health researchrdquo Journal ofSpatial Information Science vol 1 no 3 2010

[11] D Richardson ldquoTransforming science and societyrdquo in Geo-graphic Information Science and Technology Body of KnowledgeD DiBiase M DeMers A Johnson et al Eds pp 7ndash10Association of American Geographers Washington DC USA2006

[12] R Feil and M F Fraga ldquoEpigenetics and the environmentemerging patterns and implicationsrdquo Nature Reviews Geneticsvol 13 no 2 pp 97ndash109 2012

[13] K C Clarke S L McLafferty and B J Tempalski ldquoOn epi-demiology and geographic information systems a review anddiscussion of future directionsrdquo Emerging Infectious Diseasesvol 2 no 2 pp 85ndash92 1996

[14] M Palaniyandi P H Anand and R Maniyosai ldquoSpatialcognition a geospatial analysis of vector borne disease trans-mission and the environment using remote sensing and GISrdquoInternational Journal of Mosquito Research vol 1 no 3 pp 39ndash54 2014

[15] A E Olajuyigbe P Alinaitwe S A Adegboyega and E SalubildquoSpatial analysis of factors responsible for incidence of waterborne diseases in Ile-Ife Nigeriardquo Journal of Sustainable Societyvol 1 no 4 pp 96ndash113 2012

[16] O A Ajala and A M Olayiwola ldquoAn assessment of the growthof Ile-Ife Osun State Nigeria using multi-temporal imageriesrdquoJournal of Geography and Geology vol 5 no 2 pp 43ndash54 2013

[17] OA Ajala S Lekan and S A Adeyinka ldquoAccessibility to healthcare facilities a panacea for sustainable rural development inOsun state southwestern Nigeriardquo Journal of Human Ecologyvol 18 no 2 pp 121ndash128 2005

[18] WHO ldquoWorld Health Organization the global burden ofcholerardquo Bulletin of the WHO vol 90 pp 209ndash218 2012

[19] ldquoMethods for physical and chemical analysis of fresh watersrdquoin IBP Handbook H L Golterman R S Clymo and M A MOhmstad Eds vol 8 pp 211ndash213 Blackwell Scientic BostonMass USA 1978

[20] WHO Guidelines for Drinking Water Quality vol III Surveil-lance and Control of Community Supplies Geneva Switzer-land 2nd edition 1997

[21] M Chessbrough District Laboratory Practice in Tropical Coun-tries Part 2 Cambridge University Press Cambridge UK 2ndedition 2006

[22] J G Holt Ed Bergreyrsquos Manual of Determinative BacteriologyWilliams and Wilking Baltimore Md USA 9th edition 1994

[23] M Smallman-Raynor and A D Cliff ldquoThe Philippines insur-rection and the 1902ndash4 cholera epidemic part IImdashdiffusionpatterns in war and peacerdquo Journal of Historical Geography vol24 no 1-2 pp 188ndash210 1998

[24] B Trevelyan M Smallman-Raynor and A D Cliff ldquoThespatial structure of epidemic emergence geographical aspectsof poliomyelitis in north-eastern USA JulyndashOctober 1916rdquoJournal of the Royal Statistical Society Series A Statistics inSociety vol 168 no 4 pp 701ndash722 2005

[25] F Pyle Gerald ldquoStudies of disease diffusion Applied medicalgeography VH Winston and sons WDC The diffusion ofcholera in the United States in the nineteenth centuryrdquo Geo-graphic Analysis vol 1 pp 59ndash79 2010

[26] P L Doan ldquoInstitutionalizing household waste collection theurban environmental management project in Cote drsquoIvoirerdquoHabitat International vol 22 no 1 pp 27ndash39 1998

[27] United Nations Environmental Protection (UNEP) Interna-tional Source Book on Environmentally Sound Technologiesfor Municipal IETC Technical Publication 53014-001 UNEPWashington DC USA 2002

[28] N J Ashbolt ldquoMicrobial contamination of drinking water anddiseases outcomes in developing regions Toxicology in theNewCentury Opportunities and ChallengesmdashProceeding of the 5thCongress of Toxicology inDeveloping RegionsrdquoToxicology vol198 no 1 pp 229ndash238 2004

[29] E E Nkwocha and R O Egejuru ldquoProximity of munici-pal waste and rate of hospitalization for malariardquo Journal ofResearch in National development vol 6 no 2 pp 1ndash11 2008

[30] F B Osei and A A Duker ldquoSpatial dependency of V choleraprevalence on open space refuse dumps in Kumasi Ghanaa spatial statistical modellingrdquo International Journal of HealthGeographics vol 7 no 1 article 62 2008

[31] O S Levine and M M Levine ldquoHouseflies (Musca domestica)as mechanical vectors of shigellosisrdquo Reviews of InfectiousDiseases vol 13 no 4 pp 688ndash696 1991

[32] R Fotedar ldquoVector potential of houseflies (Musca domestica) inthe transmission of Vibrio cholerae in Indiardquo Acta Tropica vol78 no 1 pp 31ndash34 2001

[33] T P S Violeta ldquoInfluence of environmental factors on thepresence ofVibrio cholerae in themarine environment a climatelinkrdquo Journal of Infection in Developing Countries vol 1 no 13pp 224ndash241 2007

[34] F B Osei A A Duker E-W Augustijn and A Stein ldquoSpatialdependency of cholera prevalence on potential cholera reser-voirs in an urban area Kumasi Ghanardquo International Journalof Applied Earth Observation and Geoinformation vol 12 no 5pp 331ndash339 2010

[35] M Ali M Emch J P Donnay M Yunus and R B SackldquoIdentifying environmental risk factors for endemic cholera

6 Journal of Environmental and Public Health

center of commerce in the town which lacked adequatesanitationmeasures especially in the deposition of waste Dueto lack of waste collection systems in this place people foundit convenient to deposit their waste inside the stream close tothemarket Cholera outbreaks could have occurred due to thefact thatmicroorganisms found their way to the variouswastedump sites around the market During wet seasons watercould percolate through the soil carrying these organismsto local surface water ground water or sea [37] Thereforeproximity to themarket also plays a significant role in choleratransmission because of the large amount ofwastes generated

The composite cholera riskmap produced from this studyserves as a prediction to the future outbreak of pathogenicdiseasesThe high level of contamination of the water sourcesis due to the presence of pathogenic bacteria and highercolony forming unit (CFU) counts present in them Thereason for the high CFU concentration in Sabo communityis because there is a cluster of abattoirs waste dump sites andmarkets around the location The combination of the threeenvironmental risk factors in the same region further aggra-vates the situation andmakes the areas to be more vulnerableto cholera infection and other bacteria diseases caused bypoor sanitation Other locations with higher CFU countswereOla-Oluwa Iyana-OduduwaOjoyinOlanrewaju Isale-Agbara Famia Better-Life Akaui Oja-Titun Iyana-OjaOlorunsogo Olonode Lafogido Igbo-Itapa and Ile-Lamicompounds with or without history of cholera incidencesThese areas could be predisposed to outbreak of diseasesbecause their CFU count exceeded the WHO permissiblelimits for drinking water [38 39] The work of Obiri-Dansoet al [40] on the spatial dependency of cholera prevalenceon potential cholera reservoirs in an urban area in KumasiGhana deduced that the spatial distribution of cholera preva-lence is dependent on higher bacterial counts found in waterThis signifies that areas with the highest CFU counts are athigher risk of outbreak of diseases It was also observed fromthe study that the new detected cases of V cholerae arespreading towards the northwestern part of the study areaThese areas are Famia road Olanrewaju street and Ojoyincommunity and the last one is at the northeastern part of thestudy area (Iyana-Oja market) in proximity to where choleraoutbreak had occurred beforeThis poses a serious risk to theinhabitants of these communities because any contact withthe water source could lead to an outbreak of cholera andother pathogenic diseases Similarly the hot spots clusters ofcholera cases were seen mainly in areas of very high to highpopulation densities These areas are Iyana-Oja AjamopoIle-Lami Oke-Atan Igbo-Itapa Sabo Iyana-Oduduwa Oja-Titun Old-Nepa Oke-Ola Ilode Ojoyin Aba-Iya Gani OpaKojumole AP and Eleyele If proper interventions are nottaken the proximity of residential buildings to disease hotspots could play an important role in transmission of thedisease to human

9 Conclusion

The spatial relationship between cholera incidences and ERFsgenerated in this study showed that areas with historicalcholera cases were close to waste dump sites near market

riversstreams and abattoirs with waste dump sites andmarkets having the highest predisposing attributes while theleast was abattoir The composite cholera risk map indicatedthe relationship between historical cholera cases and CFUcount (Sabo Ola-Oluwa Iyana-Oduduwa Ojoyin Olan-rewaju Isale-Agbara Famia Better-Life Akaui Oja-TitunIyana-Oja Olorunsogo Olonode Lafogido Igbo-Itapa andIle-Lami compounds) and medium CFU count and low CFUcount Also behaviour and socioeconomic conditions maypromote the contamination of water with cholera Sabo isusually associated with cholera contamination for other rea-sons apart from waste dump site Based on the findings fromthis study the environmental factors identified in this studyhad a significant pollution effect which could pose a severerisk to the health and wellbeing of users and this calls forurgent intervention

10 Recommendations

Communities such as Ajamopo Igbo-Itapa Ile-Lami Ayeg-baju Ojoyin Sabo Ola-Olu and Iyana-Oduduwawhich havewaste dump sites proximate to them should be given quickintervention by removing the wastes and providing refusevans to eliminate such nuisances Also communities that areproximal to markets should be properly observed becauseof the huge amount of wastes markets generate Also indis-criminate dumping of wastes should be highly prohibited andanybody that dumps wastes indiscriminately should be sanc-tioned by health authorities in the region Also governmentshould make sure that markets and abattoirs are sited at least300 meters away from residential areas

Furthermore communities such as Seminary OpaMokuro Odi-Olowo Sabo and Mount Zion that have riversand streams close to them should be properly monitoredmore importantly by creating good drainages for the free-flow of water in order to control them from overflowing toresidential buildings which could cause flooding and leadsto outbreak of diseases Also Sabo community that has anabattoir in her community should be banned from operatingby appropriate health authorities in the region

It is also recommended that water sources in communi-ties such as Sabo Ola-Oluwa Iyana-Oduduwa Ojoyin Olan-rewaju Isale-Agbara Famia Better-Life Akaui Oja-TitunIyana-Oja Olorunsogo Olonode Lafogido Igbo-Itapa andIle-Lami compounds with higher CFU counts should betreated Communities such as Ojoyin Iyana-OduduwaFamia and Olanrewaju with their water sources being con-taminated with the presence ofV cholerae should be properlymonitored to prevent outbreak of diseases Also periodicwater testing should be undertaken by health authorities inthe regions every threemonths to detect anymicroorganismsthat may be present in order to apply treatment accordingly

Conflicts of Interest

The authors declare that there are no conflicts of interestregarding the publication of this paper

Journal of Environmental and Public Health 7

References

[1] WHO ldquoVibrio choleraerdquo inGuidelines for DrinkingWater Qual-ity 2nd Edition Addendum Microbiological Agent in DrinkingWater pp 119ndash142 WHO Geneva Switzerland 2nd edition2002

[2] D A Sack R B Sack and C-L Chaignat ldquoGetting seriousabout cholerardquo The New England Journal of Medicine vol 355no 7 pp 649ndash651 2006

[3] Centers for Disease Control and prevention (CDC) Generalinformation onCholera-Vibrio Cholerae Infection CDCAtlantaGa USA 1987

[4] K J Ryan andCG Ray SherrisMedicalMicrobiologyMcGraw-Hill New York NY USA 4th edition 2004

[5] World Health Organization (WHO) ldquoCholera vaccines WHOposition paperrdquo Weekly Epidemiological Record vol 85 no 13pp 117ndash128 2010

[6] F Qadri A I Khan A S G Faruque et al ldquoEnterotoxigenicEscherichia coli andVibrio cholerae diarrhea Bangladesh 2004rdquoEmerging Infectious Diseases vol 11 no 7 pp 1104ndash1107 2005

[7] WHO ldquoCholera fact sheetrdquo 2016 httpwwwwhointmedia-centrefactsheetsfs107en

[8] T O Lawoyin N A Ogunbodede E A A Olumide andM OOnadeko ldquoOutbreak of cholera in Ibadan Nigeriardquo EuropeanJournal of Epidemiology vol 15 no 4 pp 367ndash370 1999

[9] T Igomu ldquoCholera epidemic far from being over In a rapidlyurbanizing state capital in south western Nigeriardquo Journal onSustainable Development in Africa vol 12 no 2 pp 322ndash3372011

[10] M F Goodchild ldquoSpatial turn in health researchrdquo Journal ofSpatial Information Science vol 1 no 3 2010

[11] D Richardson ldquoTransforming science and societyrdquo in Geo-graphic Information Science and Technology Body of KnowledgeD DiBiase M DeMers A Johnson et al Eds pp 7ndash10Association of American Geographers Washington DC USA2006

[12] R Feil and M F Fraga ldquoEpigenetics and the environmentemerging patterns and implicationsrdquo Nature Reviews Geneticsvol 13 no 2 pp 97ndash109 2012

[13] K C Clarke S L McLafferty and B J Tempalski ldquoOn epi-demiology and geographic information systems a review anddiscussion of future directionsrdquo Emerging Infectious Diseasesvol 2 no 2 pp 85ndash92 1996

[14] M Palaniyandi P H Anand and R Maniyosai ldquoSpatialcognition a geospatial analysis of vector borne disease trans-mission and the environment using remote sensing and GISrdquoInternational Journal of Mosquito Research vol 1 no 3 pp 39ndash54 2014

[15] A E Olajuyigbe P Alinaitwe S A Adegboyega and E SalubildquoSpatial analysis of factors responsible for incidence of waterborne diseases in Ile-Ife Nigeriardquo Journal of Sustainable Societyvol 1 no 4 pp 96ndash113 2012

[16] O A Ajala and A M Olayiwola ldquoAn assessment of the growthof Ile-Ife Osun State Nigeria using multi-temporal imageriesrdquoJournal of Geography and Geology vol 5 no 2 pp 43ndash54 2013

[17] OA Ajala S Lekan and S A Adeyinka ldquoAccessibility to healthcare facilities a panacea for sustainable rural development inOsun state southwestern Nigeriardquo Journal of Human Ecologyvol 18 no 2 pp 121ndash128 2005

[18] WHO ldquoWorld Health Organization the global burden ofcholerardquo Bulletin of the WHO vol 90 pp 209ndash218 2012

[19] ldquoMethods for physical and chemical analysis of fresh watersrdquoin IBP Handbook H L Golterman R S Clymo and M A MOhmstad Eds vol 8 pp 211ndash213 Blackwell Scientic BostonMass USA 1978

[20] WHO Guidelines for Drinking Water Quality vol III Surveil-lance and Control of Community Supplies Geneva Switzer-land 2nd edition 1997

[21] M Chessbrough District Laboratory Practice in Tropical Coun-tries Part 2 Cambridge University Press Cambridge UK 2ndedition 2006

[22] J G Holt Ed Bergreyrsquos Manual of Determinative BacteriologyWilliams and Wilking Baltimore Md USA 9th edition 1994

[23] M Smallman-Raynor and A D Cliff ldquoThe Philippines insur-rection and the 1902ndash4 cholera epidemic part IImdashdiffusionpatterns in war and peacerdquo Journal of Historical Geography vol24 no 1-2 pp 188ndash210 1998

[24] B Trevelyan M Smallman-Raynor and A D Cliff ldquoThespatial structure of epidemic emergence geographical aspectsof poliomyelitis in north-eastern USA JulyndashOctober 1916rdquoJournal of the Royal Statistical Society Series A Statistics inSociety vol 168 no 4 pp 701ndash722 2005

[25] F Pyle Gerald ldquoStudies of disease diffusion Applied medicalgeography VH Winston and sons WDC The diffusion ofcholera in the United States in the nineteenth centuryrdquo Geo-graphic Analysis vol 1 pp 59ndash79 2010

[26] P L Doan ldquoInstitutionalizing household waste collection theurban environmental management project in Cote drsquoIvoirerdquoHabitat International vol 22 no 1 pp 27ndash39 1998

[27] United Nations Environmental Protection (UNEP) Interna-tional Source Book on Environmentally Sound Technologiesfor Municipal IETC Technical Publication 53014-001 UNEPWashington DC USA 2002

[28] N J Ashbolt ldquoMicrobial contamination of drinking water anddiseases outcomes in developing regions Toxicology in theNewCentury Opportunities and ChallengesmdashProceeding of the 5thCongress of Toxicology inDeveloping RegionsrdquoToxicology vol198 no 1 pp 229ndash238 2004

[29] E E Nkwocha and R O Egejuru ldquoProximity of munici-pal waste and rate of hospitalization for malariardquo Journal ofResearch in National development vol 6 no 2 pp 1ndash11 2008

[30] F B Osei and A A Duker ldquoSpatial dependency of V choleraprevalence on open space refuse dumps in Kumasi Ghanaa spatial statistical modellingrdquo International Journal of HealthGeographics vol 7 no 1 article 62 2008

[31] O S Levine and M M Levine ldquoHouseflies (Musca domestica)as mechanical vectors of shigellosisrdquo Reviews of InfectiousDiseases vol 13 no 4 pp 688ndash696 1991

[32] R Fotedar ldquoVector potential of houseflies (Musca domestica) inthe transmission of Vibrio cholerae in Indiardquo Acta Tropica vol78 no 1 pp 31ndash34 2001

[33] T P S Violeta ldquoInfluence of environmental factors on thepresence ofVibrio cholerae in themarine environment a climatelinkrdquo Journal of Infection in Developing Countries vol 1 no 13pp 224ndash241 2007

[34] F B Osei A A Duker E-W Augustijn and A Stein ldquoSpatialdependency of cholera prevalence on potential cholera reser-voirs in an urban area Kumasi Ghanardquo International Journalof Applied Earth Observation and Geoinformation vol 12 no 5pp 331ndash339 2010

[35] M Ali M Emch J P Donnay M Yunus and R B SackldquoIdentifying environmental risk factors for endemic cholera

Journal of Environmental and Public Health 7

References

[1] WHO ldquoVibrio choleraerdquo inGuidelines for DrinkingWater Qual-ity 2nd Edition Addendum Microbiological Agent in DrinkingWater pp 119ndash142 WHO Geneva Switzerland 2nd edition2002

[2] D A Sack R B Sack and C-L Chaignat ldquoGetting seriousabout cholerardquo The New England Journal of Medicine vol 355no 7 pp 649ndash651 2006

[3] Centers for Disease Control and prevention (CDC) Generalinformation onCholera-Vibrio Cholerae Infection CDCAtlantaGa USA 1987

[4] K J Ryan andCG Ray SherrisMedicalMicrobiologyMcGraw-Hill New York NY USA 4th edition 2004

[5] World Health Organization (WHO) ldquoCholera vaccines WHOposition paperrdquo Weekly Epidemiological Record vol 85 no 13pp 117ndash128 2010

[6] F Qadri A I Khan A S G Faruque et al ldquoEnterotoxigenicEscherichia coli andVibrio cholerae diarrhea Bangladesh 2004rdquoEmerging Infectious Diseases vol 11 no 7 pp 1104ndash1107 2005

[7] WHO ldquoCholera fact sheetrdquo 2016 httpwwwwhointmedia-centrefactsheetsfs107en

[8] T O Lawoyin N A Ogunbodede E A A Olumide andM OOnadeko ldquoOutbreak of cholera in Ibadan Nigeriardquo EuropeanJournal of Epidemiology vol 15 no 4 pp 367ndash370 1999

[9] T Igomu ldquoCholera epidemic far from being over In a rapidlyurbanizing state capital in south western Nigeriardquo Journal onSustainable Development in Africa vol 12 no 2 pp 322ndash3372011

[10] M F Goodchild ldquoSpatial turn in health researchrdquo Journal ofSpatial Information Science vol 1 no 3 2010

[11] D Richardson ldquoTransforming science and societyrdquo in Geo-graphic Information Science and Technology Body of KnowledgeD DiBiase M DeMers A Johnson et al Eds pp 7ndash10Association of American Geographers Washington DC USA2006

[12] R Feil and M F Fraga ldquoEpigenetics and the environmentemerging patterns and implicationsrdquo Nature Reviews Geneticsvol 13 no 2 pp 97ndash109 2012

[13] K C Clarke S L McLafferty and B J Tempalski ldquoOn epi-demiology and geographic information systems a review anddiscussion of future directionsrdquo Emerging Infectious Diseasesvol 2 no 2 pp 85ndash92 1996

[14] M Palaniyandi P H Anand and R Maniyosai ldquoSpatialcognition a geospatial analysis of vector borne disease trans-mission and the environment using remote sensing and GISrdquoInternational Journal of Mosquito Research vol 1 no 3 pp 39ndash54 2014

[15] A E Olajuyigbe P Alinaitwe S A Adegboyega and E SalubildquoSpatial analysis of factors responsible for incidence of waterborne diseases in Ile-Ife Nigeriardquo Journal of Sustainable Societyvol 1 no 4 pp 96ndash113 2012

[16] O A Ajala and A M Olayiwola ldquoAn assessment of the growthof Ile-Ife Osun State Nigeria using multi-temporal imageriesrdquoJournal of Geography and Geology vol 5 no 2 pp 43ndash54 2013

[17] OA Ajala S Lekan and S A Adeyinka ldquoAccessibility to healthcare facilities a panacea for sustainable rural development inOsun state southwestern Nigeriardquo Journal of Human Ecologyvol 18 no 2 pp 121ndash128 2005

[18] WHO ldquoWorld Health Organization the global burden ofcholerardquo Bulletin of the WHO vol 90 pp 209ndash218 2012

[19] ldquoMethods for physical and chemical analysis of fresh watersrdquoin IBP Handbook H L Golterman R S Clymo and M A MOhmstad Eds vol 8 pp 211ndash213 Blackwell Scientic BostonMass USA 1978

[20] WHO Guidelines for Drinking Water Quality vol III Surveil-lance and Control of Community Supplies Geneva Switzer-land 2nd edition 1997

[21] M Chessbrough District Laboratory Practice in Tropical Coun-tries Part 2 Cambridge University Press Cambridge UK 2ndedition 2006

[22] J G Holt Ed Bergreyrsquos Manual of Determinative BacteriologyWilliams and Wilking Baltimore Md USA 9th edition 1994

[23] M Smallman-Raynor and A D Cliff ldquoThe Philippines insur-rection and the 1902ndash4 cholera epidemic part IImdashdiffusionpatterns in war and peacerdquo Journal of Historical Geography vol24 no 1-2 pp 188ndash210 1998

[24] B Trevelyan M Smallman-Raynor and A D Cliff ldquoThespatial structure of epidemic emergence geographical aspectsof poliomyelitis in north-eastern USA JulyndashOctober 1916rdquoJournal of the Royal Statistical Society Series A Statistics inSociety vol 168 no 4 pp 701ndash722 2005

[25] F Pyle Gerald ldquoStudies of disease diffusion Applied medicalgeography VH Winston and sons WDC The diffusion ofcholera in the United States in the nineteenth centuryrdquo Geo-graphic Analysis vol 1 pp 59ndash79 2010

[26] P L Doan ldquoInstitutionalizing household waste collection theurban environmental management project in Cote drsquoIvoirerdquoHabitat International vol 22 no 1 pp 27ndash39 1998

[27] United Nations Environmental Protection (UNEP) Interna-tional Source Book on Environmentally Sound Technologiesfor Municipal IETC Technical Publication 53014-001 UNEPWashington DC USA 2002

[28] N J Ashbolt ldquoMicrobial contamination of drinking water anddiseases outcomes in developing regions Toxicology in theNewCentury Opportunities and ChallengesmdashProceeding of the 5thCongress of Toxicology inDeveloping RegionsrdquoToxicology vol198 no 1 pp 229ndash238 2004

[29] E E Nkwocha and R O Egejuru ldquoProximity of munici-pal waste and rate of hospitalization for malariardquo Journal ofResearch in National development vol 6 no 2 pp 1ndash11 2008

[30] F B Osei and A A Duker ldquoSpatial dependency of V choleraprevalence on open space refuse dumps in Kumasi Ghanaa spatial statistical modellingrdquo International Journal of HealthGeographics vol 7 no 1 article 62 2008

[31] O S Levine and M M Levine ldquoHouseflies (Musca domestica)as mechanical vectors of shigellosisrdquo Reviews of InfectiousDiseases vol 13 no 4 pp 688ndash696 1991

[32] R Fotedar ldquoVector potential of houseflies (Musca domestica) inthe transmission of Vibrio cholerae in Indiardquo Acta Tropica vol78 no 1 pp 31ndash34 2001

[33] T P S Violeta ldquoInfluence of environmental factors on thepresence ofVibrio cholerae in themarine environment a climatelinkrdquo Journal of Infection in Developing Countries vol 1 no 13pp 224ndash241 2007

[34] F B Osei A A Duker E-W Augustijn and A Stein ldquoSpatialdependency of cholera prevalence on potential cholera reser-voirs in an urban area Kumasi Ghanardquo International Journalof Applied Earth Observation and Geoinformation vol 12 no 5pp 331ndash339 2010

[35] M Ali M Emch J P Donnay M Yunus and R B SackldquoIdentifying environmental risk factors for endemic cholera

8 Journal of Environmental and Public Health

a raster GIS approachrdquo Health and Place vol 8 no 3 pp 201ndash210 2002

[36] J Snow On the Mode of Communication of Cholera JohnChurchill London UK 2nd edition 1855

[37] I M-C Lo ldquoCharacteristics and treatment of leachates fromdomestic landfillsrdquo Environment International vol 22 no 4 pp433ndash442 1996

[38] WHO World Health Organization Bacteriological Quality ofDrinking Water 1996

[39] Environmental Protection Agency EPA National PrimaryDrinking Water Standards EPA 2002

[40] K Obiri-Danso C A A Weobong and K Jones ldquoSpatialdependency of cholera prevalence on potential cholera reser-voirs in an urban area in Kumasi Ghanardquo Journal of WaterHealth vol 9 no 3 pp 69ndash76 2005

Submit your manuscripts athttpswwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Submit your manuscripts athttpswwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom