Makeshift treatment centre during a cholera epidemic in Bangladesh

Design and psychometrics of risk assessment tool for makeshift hospitals: Focusing on pandemics

Pandemics caused a change in the health service delivery system. In disasters with massive injuries or epidemic, the capacity to admit the injured and infected patients to provide health services faces the challenges. Covid-19 virus is a respiratory disease that from its emergence until January 18, 2023, the Covid-19 virus has infected more than 672 million people worldwide. In most countries, makeshift hospital has been set up as intermediate medical centers to keep people who are likely to be carriers of the disease to control communicable diseases. Most makeshift hospitals already have alternative uses and, have changed into temporary or intermediate care centers. Based on the search of research team, any standard tools were found to assess the makeshift hospitals safety. All the safety assessment tools were related to the hospital, but since makeshift hospitals are mostly non-hospital structures, the research team has designed and validate a makeshift hospital safety assessment tool for the first time in this study. The present study is a mixed method that was conducted in 3 phases including; a document review, explaining the components affecting non-structural and functional safety of the makeshift hospital, designing makeshift hospital safety assessment tools and analyzing the results and validating it in 2022. Content validity and reliability were measured by CVR and CVI, ICC and Cronbach's alpha. In the fourth phase, with the participation of 15 specialists, managers, experts, qualitative and quantitative validity of content was done. Data were analyzed by SPSS version 21 software. The final tool contains 186 items and a 5-point Likert designed for very low safety (1), low safety (2), moderate safety (3), good safety (4), and very good safety (5). The scores of each makeshift hospital were calculated based on the items and the degree of safety. Cronbach's alpha coefficient for tool was 0.98. Retesting the questionnaire after two weeks confirmed the stability of tool (ICC = 0.98). The validity and reliability of this tool were confirmed with 186 items in 2 factors and 26 subcategories including risk of disaster, non-structural safety, safety of windows and shutters, hospital access, information and communication management, patient safety and hygiene and etc. All centers providing health services, whether temporarily or permanently, must have safety to continue their activities in disaster and maintain the safety and health of staff and inpatients. The makeshift hospital safety tool can be a suitable tool for assessing the risk and eliminating their vulnerabilities, and it can also provide important indicators for the design and set up of the makeshift hospital to policymakers and executives in the field of health.

A retrospective analysis of oral cholera vaccine use, disease severity and deaths during an outbreak in South Sudan

Objective

To determine whether pre-emptive oral cholera vaccination reduces disease severity and mortality in people who develop cholera disease during an outbreak.

Methods

The study involved a retrospective analysis of demographic and clinical data from 41 cholera treatment facilities in South Sudan on patients who developed cholera disease between 23 April and 20 July 2014 during a large outbreak, a few months after a pre-emptive oral vaccination campaign. Patients who developed severe dehydration were regarded as having a severe cholera infection. Vaccinated and unvaccinated patients were compared and multivariate logistic regression analysis was used to identify factors associated with developing severe disease or death.

Findings

In total, 4115 cholera patients were treated at the 41 facilities: 1946 (47.3%) had severe disease and 62 (1.5%) deaths occurred. Multivariate analysis showed that patients who received two doses of oral cholera vaccine were 4.5-fold less likely to develop severe disease than unvaccinated patients (adjusted odds ratio, aOR: 0.22; 95% confidence interval, CI: 0.11–0.44). Moreover, those with severe cholera were significantly more likely to die than those without (aOR: 4.76; 95% CI: 2.33–9.77).

Conclusion

Pre-emptive vaccination with two doses of oral cholera vaccine was associated with a significant reduction in the likelihood of developing severe cholera disease during an outbreak in South Sudan. Moreover, severe disease was the strongest predictor of death. Two doses of oral cholera vaccine should be used in emergencies to reduce the disease burden.

Recurrent epidemic cholera with high mortality in Cameroon: persistent challenges 40 years into the seventh pandemic

Cameroon has experienced recurrent cholera epidemics with high mortality rates. In September 2009, epidemic cholera was detected in the Far North region of Cameroon and the reported case-fatality rate was 12%. We conducted village-, healthcare facility- and community-level surveys to investigate reasons for excess cholera mortality. Results of this investigation suggest that cholera patients who died were less likely to seek care, receive rehydration therapy and antibiotics at a healthcare facility, and tended to live further from healthcare facilities. Furthermore, use of oral rehydration salts at home was very low in both decedents and survivors. Despite the many challenges inherent to delivering care in Cameroon, practical measures could be taken to reduce cholera mortality in this region, including the timely provision of treatment supplies, training of healthcare workers, establishment of rehydration centres, and promotion of household water treatment and enhanced handwashing with soap.

Why treatment centres failed to prevent cholera deaths among Rwandan refugees in Goma, Zaire

In July, 1994, in one of the worst cholera outbreaks in recent times, an estimated 12,000 Rwandan refugees died in Goma in eastern Zaire. The Vibrio cholerae strains were resistant to tetracycline and doxycycline, the commonly used drugs for cholera treatment. Despite the efforts of international organisations, which provided medical relief by establishing treatment centres in Goma, mortality from the disease was much higher than expected. In the area of Muganga camp, which had the largest concentration of refugees and where most of the medical aid organisations were active, the highest reported case-fatality ratio for a single day was 48%. The slow rate of rehydration, inadequate use of oral rehydration therapy, use of inappropriate intravenous fluids, and inadequate experience of health workers in management of severe cholera are thought to be some of the factors associated with the failure to prevent so many deaths during the epidemic. In one of the temporary treatment centres with the worst case-fatality record, our team showed that improvement of these factors could increase the odds of survival of cholera patients even in a disaster setting.