Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Albert Ko


Introduction: Increased rainfall and temperature are well-recognized climatic factors associated with increased rates of diarrhea, yet there is limited information on the role of droughts as the cause of diarrheal outbreaks. In 2011, Funafuti, an island in the Pacific country of Tuvalu, experienced a concurrent severe drought and outbreak of diarrhea. We performed an investigation to identify factors that contributed to epidemic transmission and evaluate the role of interventions in controlling the outbreak.

Methods: We identified cases by performing a review of medical registers in Funafuti (pop. 6,216 inhabitants) during the outbreak period from 29 August 2011 – 16 October 2011. Rainfall data were collected to evaluate the temporal and climatic associations between drought and diarrhea. We performed a case-control study to examine risk factors for diarrhea, interviewed public health officials to identify control measures that were implemented, and assessed the temporal relationship between these interventions and weekly case numbers.

Results: We identified 244 cases of diarrhea during the outbreak period. The overall attack rate was 3.9%, with highest rates (17.5%) occurring in infants aged 0 - 2 years. Peak case numbers occurred during the nadir of recorded rainfall in Tuvalu. Multivariate analyses found that households whose home water tank levels dropped below 20% capacity and that reported decreased hand washing frequency had significantly higher risk (OR 2.31 95% CI [1.16-4.60] and OR 3.00 [1.48-6.08], respectively) of having a member acquire diarrhea. Although drought conditions persisted, weekly case numbers decreased from peak numbers after implementation of a hygiene promotion and soap distribution campaign.

Conclusion: A severe drought in Tuvalu precipitated a large outbreak of diarrhea due to decreased water availability and personal hygiene. Infants were the age group that was especially vulnerable to drought-associated diarrhea. Interventions that promoted personal hygiene, along with water distribution, appear to have ameliorated the health impact of the drought. These findings highlight the need for contingency planning to address the health impacts of droughts, as they become more frequent and severe occurrences in the Pacific due to climate change.


This is an Open Access Thesis.

Open Access

This Article is Open Access