RESEARCH ARTICLE a c

Full list of author information is available at the end of the articleBackground Cholera continues to be a global public health threat and one of the key indicators of poor social development [1-3]. The worldwide incidence of cholera has risen in the last decade with 589,854 cases and 7,816 deaths reported in 2011, an increase of 220.0 % cases and 186.5% deaths from 2001 [1-3]. Since 2007, Kenya has experienced rainfall and flooding, and refugee settings, mainly in the context of complex emergency situations. In East Africa, refugee settings and water source contamination were most commonly identified [1-3,7]. Climatic factors such as rainfall, water and sea surface temperatures, and the El Niño Southern Oscillation events have a significant impact on the incidence of cholera [8-10]. In East Africa, cholera epidemics have been closely associated with the El Niño years [11-15], and were aggra-vated by the low socioeconomic status, inadequate health-care systems [5,14], drinking water from lakes [15,16], an