<h2>Unmatched case-control study was conducted in Gewani district, Afar, Ethiopia from Dec 12/2021 to January 3/2022. Cases were defined according to the WHO guideline and Controls were individual who did not developed sign and symptom living in the same community with cases. Sample size was calculated using Stat calc function of EPI-info software. Recruited 50 cases and 100 controls randomly selected from community. Data were collected using structured questionnaires and additional data was collected from line list and medical record. Data were cleaned and entered by EPI-info software then exported to SPSS Software for analysis. Bivariate and Multivariable logistic regression analysis conducted to identify the association between the outcome and independent variables.</h2>