<p><strong>Methods:</strong> Unmatched case control study was conducted at Andasa holy water, Bahir Dar Zuria district, Northwest Ethiopia,2024. Case definition adapted from Public Health Emergency Management guideline was used. The first case was notified on May 2/2024 and confirmed by culture. Active and passive surveillances were used to detect further cases. All cases (119) registered from May 02 to June 23/2024 and 238 controls selected randomly were included. Data were collected by interviewer administered questionnaire. Data were entered using Epi-Data and analyzed by STATA v-17. Binary logistic regression was fitted.</p>