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Jaber T, Boelee E, Bleser J, Bartram JK. Outbreaks of faecal-orally transmitted diseases in displacement camps: A scoping review of pathogens, risk factors, exposure routes, and drivers of transmission. Glob Public Health 2024; 19:2380847. [PMID: 39052912 DOI: 10.1080/17441692.2024.2380847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 07/10/2024] [Indexed: 07/27/2024]
Abstract
Many forcibly displaced people reside in camps characterised by precarious living conditions, exposing them to numerous health risks. This scoping review elucidated the risk factors and exposure routes implicated in outbreaks of faecal-oral pathogens in camps, as well as the context-specific drivers of transmission that shape these outbreaks. Journal articles were identified from PubMed, Embase, Scopus, and Web of Science. Portals for grey literature were also searched. A total of 48 records, published between 1937 and 2022, were included in the analysis. Cholera outbreaks were the most frequently reported. Risk factors included drinking water from shallow wells and rivers, consuming ice and leftover food, and inconsistent handwashing. These indicate exposure through vehicles of transmission in both public and domestic domains, emphasising the importance of a multipronged approach to outbreak prevention and control. Outbreaks were often exacerbated by extreme weather events and acute population influxes that damage or overwhelm water and sanitation facilities. Such shocks warrant explicit recommendations in preparedness and response guidelines. Development projects and outbreak response measures in surrounding areas may reduce the risk of importing pathogens into camps. Future research could further investigate faecal-oral pathogens other than Vibrio cholerae and analyse the co-occurrence of the identified transmission drivers.
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Affiliation(s)
- Tarek Jaber
- School of Business and Economics, Maastricht University, Maastricht, the Netherlands
- UNU-MERIT, Maastricht, the Netherlands
- Department of Freshwater Ecology and Water Quality, Deltares, Utrecht, the Netherlands
| | - Eline Boelee
- Department of Freshwater Ecology and Water Quality, Deltares, Utrecht, the Netherlands
| | - Julia Bleser
- Department of Freshwater Ecology and Water Quality, Deltares, Utrecht, the Netherlands
| | - Jamie K Bartram
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Civil Engineering, University of Leeds, Leeds, UK
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2
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Als D, Meteke S, Stefopulos M, Gaffey MF, Kamali M, Munyuzangabo M, Shah S, Jain RP, Radhakrishnan A, Siddiqui FJ, Ataullahjan A, Bhutta ZA. Delivering water, sanitation and hygiene interventions to women and children in conflict settings: a systematic review. BMJ Glob Health 2021; 5:bmjgh-2019-002064. [PMID: 32641288 PMCID: PMC7348465 DOI: 10.1136/bmjgh-2019-002064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/31/2020] [Accepted: 05/09/2020] [Indexed: 11/24/2022] Open
Abstract
Background Access to safe water and sanitation facilities and the adoption of effective hygiene practices are fundamental to reducing maternal and child morbidity and mortality globally. In armed conflict settings, inadequate water, sanitation and hygiene (WASH) infrastructure poses major health risks for women and children. This review aimed to synthesise the existing information on WASH interventions being delivered to women and children in conflict settings in low-income and middle-income countries (LMICs) and to identify the personnel, sites and platforms being used to deliver such interventions. Methods We conducted a systematic search for publications indexed in four databases, and grey literature was searched through the websites of humanitarian agencies and organisations. Eligible publications reported WASH interventions delivered to conflict-affected women or children. We extracted and synthesised information on intervention delivery characteristics, as well as barriers and facilitators. Results We identified 58 eligible publications reporting on the delivery of WASH interventions, mostly in Sub-Saharan Africa. Non-Governmental Organization (NGO)/United Nations (UN) agency staff were reported to be involved in delivering interventions in 62% of publications, with the most commonly reported delivery site being community spaces (50%). Only one publication reported quantitative data on intervention effectiveness among women or children. Discussion This review revealed gaps in the current evidence on WASH intervention delivery in conflict settings. Little information is available on the delivery of water treatment or environmental hygiene interventions, or about the sites and personnel used to deliver WASH interventions. Limited quantitative data on WASH intervention coverage or effectiveness with respect to women or children are important gaps, as multiple factors can affect how WASH services are accessed differently by women and men, and the hygiene needs of adolescent girls and boys differ; these factors must be taken into account when delivering interventions in conflict settings. PROSPERO registration number CRD42019125221
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Affiliation(s)
- Daina Als
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Meteke
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marianne Stefopulos
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle F Gaffey
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mahdis Kamali
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mariella Munyuzangabo
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shailja Shah
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Reena P Jain
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amruta Radhakrishnan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fahad J Siddiqui
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
| | - Anushka Ataullahjan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada .,Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
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Cooper B, Behnke NL, Cronk R, Anthonj C, Shackelford BB, Tu R, Bartram J. Environmental health conditions in the transitional stage of forcible displacement: A systematic scoping review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 762:143136. [PMID: 33153751 DOI: 10.1016/j.scitotenv.2020.143136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 10/10/2020] [Accepted: 10/11/2020] [Indexed: 06/11/2023]
Abstract
In 2019, 30,000 people were forced to leave their homes due to conflict, persecution, and natural disaster each day. Eighty-five percent of refugees live in developing countries, and they often face underfunded and inadequate environmental health services. Many displaced persons live in camps and other temporary settlements long after the displacement event occurs. However, there is little evidence on environmental health conditions in the transitional phase-defined by the United Nations High Commissioner for Refugees as six months to two years after displacement. To address this gap in research, we conducted a systematic scoping review of environmental health conditions, exposures, and outcomes in transitional displacement settings, as well as reported obstacles and recommendations for improvement. Eighty-eight publications met the inclusion criteria. Water supply was the most frequently discussed environmental health topic. Overcrowding was the most common risk factor reported, Vibrio cholerae was the most common pathogen reported, and diarrhea was the most commonly reported health outcome. Obstacles and recommendations were categorized as institutional, political or implementation-based. Identified knowledge gaps included minimal information on setting logistics and on topics such as menstrual hygiene, oral hygiene and fomite contamination. In order to improve environmental health conditions in transitional displacement settings, all levels of government and non-governmental organizations should increase collaboration to improve resource provision. This study is the first to report on environmental health conditions in this important time of transition between the emergency and protracted stages of displacement.
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Affiliation(s)
- Brittany Cooper
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States
| | - Nikki L Behnke
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States
| | - Ryan Cronk
- ICF, 2635 Meridian Pkwy Suite 200, Durham, NC 27713.
| | - Carmen Anthonj
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States; Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands
| | - Brandie Banner Shackelford
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States
| | - Raymond Tu
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States
| | - Jamie Bartram
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States; School of Civil Engineering, University of Leeds, Woodhouse Ln, Woodhouse, Leeds LS2 9DY, United Kingdom
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Bwire G, Orach CG, Aceng FL, Arianitwe SE, Matseketse D, Tumusherure E, Makumbi I, Muruta A, Merrill RD, Debes A, Ali M, Sack DA. Refugee Settlements and Cholera Risks in Uganda, 2016-2019. Am J Trop Med Hyg 2021; 104:1225-1231. [PMID: 33556038 PMCID: PMC8045616 DOI: 10.4269/ajtmh.20-0741] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/28/2020] [Indexed: 11/07/2022] Open
Abstract
During 2016 to 2019, cholera outbreaks were reported commonly to the Ministry of Health from refugee settlements. To further understand the risks cholera posed to refugees, a review of surveillance data on cholera in Uganda for the period 2016-2019 was carried out. During this 4-year period, there were seven such outbreaks with 1,495 cases and 30 deaths in five refugee settlements and one refugee reception center. Most deaths occurred early in the outbreak, often in the settlements or before arrival at a treatment center rather than after arrival at a treatment center. During the different years, these outbreaks occurred during different times of the year but simultaneously in settlements that were geographically separated and affected all ages and genders. Some outbreaks spread to the local populations within Uganda. Cholera control prevention measures are currently being implemented; however, additional measures are needed to reduce the risk of cholera among refugees including oral cholera vaccination and a water, sanitation and hygiene package during the refugee registration process. A standardized protocol is needed to quickly conduct case-control studies to generate information to guide future cholera outbreak prevention in refugees and the host population.
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Affiliation(s)
- Godfrey Bwire
- Department of Integrated Epidemiology, Surveillance and Public Health Emergencies, Ministry of Health, Kampala Uganda
| | | | - Freda Loy Aceng
- Department of Integrated Epidemiology, Surveillance and Public Health Emergencies, Ministry of Health, Kampala Uganda
| | | | | | - Edson Tumusherure
- Department of Health, Isingiro District Local Government, Isingiro, Uganda
| | - Issa Makumbi
- Emergency Operational Centre, Ministry of Health, Kampala, Uganda
| | - Allan Muruta
- Department of Integrated Epidemiology, Surveillance and Public Health Emergencies, Ministry of Health, Kampala Uganda
| | - Rebecca D. Merrill
- Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amanda Debes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mohammad Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David A. Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Torondel B, Khan R, Larsen TH, White S. Evaluating the Efficacy of the Supertowel™ as a Handwashing Product: A Simulation of Real-World Use Conditions. Am J Trop Med Hyg 2021; 104:1554-1561. [PMID: 33534745 PMCID: PMC8045667 DOI: 10.4269/ajtmh.20-1284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022] Open
Abstract
The Supertowel is a fabric treated with a permanent antimicrobial bonding and has been designed as a soap alternative in emergency situations. The Supertowel has been shown to be as efficacious as handwashing with soap and water when tested under controlled laboratory conditions. It has also been shown to be a practical, acceptable, and desirable product among crisis-affected populations. The aim of this study was to test whether the Supertowel remains as efficacious when used under conditions which mimic real-world hand cleaning in challenging settings. Two rounds of laboratory tests, with 16 volunteers in each, were conducted to test the efficacy of the Supertowel when used for a shorter duration, when less wet, when used with contaminated water, when visibly dirty, and when dry. Volunteers pre-contaminated their hands with nonpathogenic Escherichia coli. Comparisons were made between hand cleaning with the Supertowel and the reference condition (normally handwashing with soap), using a crossover design. The Supertowel was marginally less efficacious than handwashing with soap when used for 15 seconds (P = 0.04) but as efficacious at 30 and 60 seconds durations. All the other Supertowel conditions were as efficient as their reference comparisons meaning that the Supertowel can effectively remove pathogens from hands when it is wet, damp, or completely dry, when it is used with contaminated water, when visibly dirty with mud and/or oil.
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Affiliation(s)
- Belen Torondel
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rummana Khan
- Department of Microbiology, KET’s Scientific Research Centre, Mumbai, India
| | | | - Sian White
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Richterman A, Sainvilien DR, Eberly L, Ivers LC. Individual and Household Risk Factors for Symptomatic Cholera Infection: A Systematic Review and Meta-analysis. J Infect Dis 2018; 218:S154-S164. [PMID: 30137536 PMCID: PMC6188541 DOI: 10.1093/infdis/jiy444] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Cholera has caused 7 global pandemics, including the current one which has been ongoing since 1961. A systematic review of risk factors for symptomatic cholera infection has not been previously published. Methods In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we performed a systematic review and meta-analysis of individual and household risk factors for symptomatic cholera infection. Results We identified 110 studies eligible for inclusion in qualitative synthesis. Factors associated with symptomatic cholera that were eligible for meta-analysis included education less than secondary level (summary odds ratio [SOR], 2.64; 95% confidence interval [CI], 1.41-4.92; I2 = 8%), unimproved water source (SOR, 3.48; 95% CI, 2.18-5.54; I2 = 77%), open container water storage (SOR, 2.03; 95% CI, 1.09-3.76; I2 = 62%), consumption of food outside the home (SOR, 2.76; 95% CI, 1.62-4.69; I2 = 64%), household contact with cholera (SOR, 2.91; 95% CI, 1.62-5.25; I2 = 89%), water treatment (SOR, 0.37; 95% CI, .21-.63; I2 = 74%), and handwashing (SOR, 0.29; 95% CI, .20-.43; I2 = 37%). Other notable associations with symptomatic infection included income/wealth, blood group, gastric acidity, infant breastfeeding status, and human immunodeficiency virus infection. Conclusions We identified potential risk factors for symptomatic cholera infection including environmental characteristics, socioeconomic factors, and intrinsic patient factors. Ultimately, a combination of interventional approaches targeting various groups with risk-adapted intensities may prove to be the optimal strategy for cholera control.
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Affiliation(s)
- Aaron Richterman
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Lauren Eberly
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Louise C Ivers
- Center for Global Health, Massachusetts General Hospital
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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7
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Wolfe M, Kaur M, Yates T, Woodin M, Lantagne D. A Systematic Review and Meta-Analysis of the Association between Water, Sanitation, and Hygiene Exposures and Cholera in Case-Control Studies. Am J Trop Med Hyg 2018; 99:534-545. [PMID: 29968551 PMCID: PMC6090371 DOI: 10.4269/ajtmh.17-0897] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Case-control studies are conducted to identify cholera transmission routes. Water, sanitation, and hygiene (WASH) exposures can facilitate cholera transmission (risk factors) or interrupt transmission (protective factors). To our knowledge, the association between WASH exposures and cholera from case-control studies has not been systematically analyzed. A systematic review was completed to close this gap, including describing the theory of risk and protection, developing inclusion criteria, searching and selecting studies, assessing quality of evidence, and summarizing associations between cholera and seven predicted WASH protective factors and eight predicted WASH risk factors using meta-analysis and sensitivity analysis. Overall, 47 articles describing 51 individual studies from 30 countries met the inclusion criteria. All eight predicted risk factors were associated with higher odds of cholera (odds ratio [OR] = 1.9-5.6), with heterogeneity (I2) of 0-92%. Of the predicted protective factors, five of seven were associated with lower odds of cholera (OR = 0.35-1.4), with heterogeneity of 57-91%; exceptions were insignificant associations for improved water source (OR = 1.1, heterogeneity 91%) and improved sanitation (OR = 1.4, heterogeneity 68%). Results were robust; 3/70 (5%) associations changed directionality or significance in sensitivity analysis. Meta-analysis results highlight that predicted risk factors are associated with cholera; however, predicted protective factors are not as consistently protective. This variable protection is attributed to 1) cholera transmission via multiple routes and 2) WASH intervention implementation quality variation. Water, sanitation, and hygiene interventions should address multiple transmission routes and be well implemented, according to international guidance, to ensure that field effectiveness matches theoretical efficacy. In addition, future case-control studies should detail WASH characteristics to contextualize results.
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Affiliation(s)
- Marlene Wolfe
- Tufts University Civil and Environmental Engineering Department, Medford, Massachusetts
| | - Mehar Kaur
- Tufts University Civil and Environmental Engineering Department, Medford, Massachusetts
| | - Travis Yates
- Tufts University Civil and Environmental Engineering Department, Medford, Massachusetts
| | - Mark Woodin
- Tufts University Civil and Environmental Engineering Department, Medford, Massachusetts
| | - Daniele Lantagne
- Tufts University Civil and Environmental Engineering Department, Medford, Massachusetts
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8
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Cohen A, Colford JM. Effects of Boiling Drinking Water on Diarrhea and Pathogen-Specific Infections in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2017; 97:1362-1377. [PMID: 29016318 PMCID: PMC5817760 DOI: 10.4269/ajtmh.17-0190] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/05/2017] [Indexed: 12/21/2022] Open
Abstract
Globally, approximately 2 billion people lack microbiologically safe drinking water. Boiling is the most prevalent household water treatment method, yet evidence of its health impact is limited. To conduct this systematic review, we searched four online databases with no limitations on language or publication date. Studies were eligible if health outcomes were measured for participants who reported consuming boiled and untreated water. We used reported and calculated odds ratios (ORs) and random-effects meta-analysis to estimate pathogen-specific and pooled effects by organism group and nonspecific diarrhea. Heterogeneity and publication bias were assessed using I2, meta-regression, and funnel plots; study quality was also assessed. Of the 1,998 records identified, 27 met inclusion criteria and reported extractable data. We found evidence of a significant protective effect of boiling for Vibrio cholerae infections (OR = 0.31, 95% confidence interval [CI] = 0.13-0.79, N = 4 studies), Blastocystis (OR = 0.35, 95% CI = 0.17-0.69, N = 3), protozoal infections overall (pooled OR = 0.61, 95% CI = 0.43-0.86, N = 11), viral infections overall (pooled OR = 0.83, 95% CI = 0.7-0.98, N = 4), and nonspecific diarrheal outcomes (OR = 0.58, 95% CI = 0.45-0.77, N = 7). We found no evidence of a protective effect for helminthic infections. Although our study was limited by the use of self-reported boiling and non-experimental designs, the evidence suggests that boiling provides measureable health benefits for pathogens whose transmission routes are primarily water based. Consequently, we believe a randomized controlled trial of boiling adherence and health outcomes is needed.
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Affiliation(s)
- Alasdair Cohen
- Division of Epidemiology, School of Public Health, University of California at Berkeley, Berkeley, California
- Department of Environmental Science, Policy and Management, University of California at Berkeley, Berkeley, California
| | - John M. Colford
- Division of Epidemiology, School of Public Health, University of California at Berkeley, Berkeley, California
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9
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De Buck E, Borra V, De Weerdt E, Vande Veegaete A, Vandekerckhove P. A systematic review of the amount of water per person per day needed to prevent morbidity and mortality in (post-)disaster settings. PLoS One 2015; 10:e0126395. [PMID: 25961720 PMCID: PMC4427459 DOI: 10.1371/journal.pone.0126395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 04/01/2015] [Indexed: 11/19/2022] Open
Abstract
Background In order to improve the effectiveness and efficiency of humanitarian efforts, minimum standards for humanitarian assistance and key indicators, showing whether a standard has been attained, have been developed. However, many of these standards and indicators are based on a consensus on best practices and experiences in humanitarian response, because relevant evidence on the impact of humanitarian interventions is often lacking. Objectives One important example of a standard in humanitarian aid in a disaster setting is “water quantity.” The accompanying indicator states how many litres of water are needed per person per day in a disaster setting. It was our objective to determine the evidence base behind this indicator, in order to improve health outcomes such as morbidity (e.g., diarrhoea) and mortality. Methods A systematic review was performed searching The Cochrane Library, Medline and Embase. We included studies performed during disasters and in refugee camps that reported a specific water amount and health-related outcomes related to water shortages, including diarrhoea, cholera, and mortality. We used GRADE to determine the quality of evidence. Results Out of 3,630 articles, 111 references relevant to our question were selected. Based on our selection criteria, we finally retained 6 observational studies, including 1 study that was performed during the disaster and 5 studies in a post-disaster phase. From two studies there is conclusive evidence on the relationship between the amount of water received and diarrhoea or mortality rates in refugee camps. However, overall, these studies do not contain enough data with relevance to a specific amount of water, and the level of evidence is very low. Conclusions More primary research on water amounts in a disaster setting is necessary, so that the humanitarian sector can further professionalise its water-related standards, indicators and interventions.
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Affiliation(s)
- Emmy De Buck
- Belgian Red Cross-Flanders, Mechelen, Belgium
- * E-mail:
| | - Vere Borra
- Belgian Red Cross-Flanders, Mechelen, Belgium
| | | | | | - Philippe Vandekerckhove
- Belgian Red Cross-Flanders, Mechelen, Belgium
- Department of Public Health and Primary Care, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
- Faculty of Medicine, University of Ghent, Ghent, Belgium
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10
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Saidi SM, Chowdhury N, Awasthi SP, Asakura M, Hinenoya A, Iijima Y, Yamasaki S. Prevalence of Vibrio cholerae O1 El Tor variant in a cholera-endemic zone of Kenya. J Med Microbiol 2014; 63:415-420. [PMID: 24396087 DOI: 10.1099/jmm.0.068999-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Since 2007, Kenya has experienced an increase in cholera outbreaks characterized by a high fatality rate. In this study, we characterized 81 Vibrio cholerae isolates from diarrhoeal stool samples in Nyanza, a cholera-endemic lake region of Kenya, for virulence properties, clonality and antibiotic susceptibility. Eighty of these isolates were V. cholerae O1 El Tor variants carrying the classical ctxB gene sequence, while one isolate was V. cholerae non-O1/O139. All of the El Tor variants were of clonal origin, as revealed by PFGE, and were susceptible to ampicillin, tetracycline, ciprofloxacin, fosfomycin, kanamycin and norfloxacin. However, the isolates showed resistance to sulfamethoxazole/trimethoprim and streptomycin, and intermediate resistance to nalidixic acid, chloramphenicol and imipenem. The non-O1/O139 isolate carried the cholix toxin II gene (chxA II) and was susceptible to all antimicrobials tested except ampicillin. We propose that an El Tor variant clone caused the Nyanza cholera outbreak of 2007-2008.
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Affiliation(s)
- Suleiman M Saidi
- Medical Sciences Department, Technical University of Mombasa, Mombasa, Kenya.,International Prevention of Epidemics, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Osaka, Japan
| | - Nityananda Chowdhury
- International Prevention of Epidemics, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Osaka, Japan
| | - Sharda P Awasthi
- International Prevention of Epidemics, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Osaka, Japan
| | - Masahiro Asakura
- International Prevention of Epidemics, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Osaka, Japan
| | - Atsushi Hinenoya
- International Prevention of Epidemics, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Osaka, Japan
| | | | - Shinji Yamasaki
- International Prevention of Epidemics, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Osaka, Japan
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11
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Real-time modelling used for outbreak management during a cholera epidemic, Haiti, 2010-2011. Epidemiol Infect 2012; 141:1276-85. [PMID: 22935487 DOI: 10.1017/s0950268812001793] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The emergence of epidemic cholera in post-earthquake Haiti portended a public health disaster of uncertain magnitude. In order to coordinate relief efforts in an environment with limited healthcare infrastructure and stretched resources, timely and realistic projections of the extent of the cholera outbreak were crucial. Projections were shared with Government and partner organizations beginning 5 days after the first reported case and were updated using progressively more advanced methods as more surveillance data became available. The first projection estimated that 105 000 cholera cases would occur in the first year. Subsequent projections using different methods estimated up to 652 000 cases and 163 000-247 000 hospitalizations during the first year. Current surveillance data show these projections to have provided reasonable approximations of the observed epidemic. Providing the real-time projections allowed Haitian ministries and external aid organizations to better plan and implement response measures during the evolving epidemic.
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12
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Brown J, Cavill S, Cumming O, Jeandron A. Water, sanitation, and hygiene in emergencies: summary review and recommendations for further research. ACTA ACUST UNITED AC 2012. [DOI: 10.3362/1756-3488.2012.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Joe Brown
- London School of Hygiene and Tropical Medicine
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13
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Aagaard-Hansen J, Nombela N, Alvar J. Population movement: a key factor in the epidemiology of neglected tropical diseases. Trop Med Int Health 2010; 15:1281-8. [PMID: 20976871 DOI: 10.1111/j.1365-3156.2010.02629.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Connolly MA, Gayer M, Ryan MJ, Salama P, Spiegel P, Heymann DL. Communicable diseases in complex emergencies: impact and challenges. Lancet 2004; 364:1974-83. [PMID: 15567014 DOI: 10.1016/s0140-6736(04)17481-3] [Citation(s) in RCA: 226] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Communicable diseases, alone or in combination with malnutrition, account for most deaths in complex emergencies. Factors promoting disease transmission interact synergistically leading to high incidence rates of diarrhoea, respiratory infection, malaria, and measles. This excess morbidity and mortality is avoidable as effective interventions are available. Adequate shelter, water, food, and sanitation linked to effective case management, immunisation, health education, and disease surveillance are crucial. However, delivery mechanisms are often compromised by loss of health staff, damage to infrastructure, insecurity, and poor co-ordination. Although progress has been made in the control of specific communicable diseases in camp settings, complex emergencies affecting large geographical areas or entire countries pose a greater challenge. Available interventions need to be implemented more systematically in complex emergencies with higher levels of coordination between governments, UN agencies, and non-governmental organisations. In addition, further research is needed to adapt and simplify interventions, and to explore novel diagnostics, vaccines, and therapies.
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Affiliation(s)
- H J Koornhof
- Department of Clinical Microbiology and Infectious Diseases, South African Institute for Medical Research, Johannesburg, South Africa
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Abstract
Nongovernmental organisations (NGOs) are the main actors of vaccine delivery during complex humanitarian emergencies such as large population displacements. This paper discusses the use of vaccinations against measles, cholera and meningitis in this context. The role of NGOs in the advocacy for making new and more effective vaccines available to the most vulnerable populations is also emphasised.
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Affiliation(s)
- C Paquet
- Epicentre and Médecins Sans Frontières, 8 rue Saint Sabin, 75011, Paris, France.
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Paquet C, Hanquet G. Control of infectious diseases in refugee and displaced populations in developing countries. ACTA ACUST UNITED AC 1998. [DOI: 10.1016/s0020-2452(98)80024-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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