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Ekundayo TC, Swalaha FM, Ijabadeniyi OA. Global and regional final point-of-drinking water prevalence of Vibrio pathogens: a systematic analysis with socioeconomic, global health security, and WASH indices-guided meta-regressions. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 943:173818. [PMID: 38852862 DOI: 10.1016/j.scitotenv.2024.173818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/11/2024]
Abstract
The final point-of-drinking water (FPODW) exposure to Vibrio and waterborne pathogens remains a misaim surveillance target. Therefore, the current study purposed to estimate the global and regional prevalence of Vibrio pathogens in FPODW. Vibrio-FPODW data derived from integrated databases per PRISMA protocol were fitted to a random-intercept-logistic mixed-effects and meta-regression models. The global FPODW Vibrio prevalence was 5.13% (95%CI: 2.24-11.30) with 7.76% (6.84-8.78) cross-validated value. Vibrio prevalence in different FPODW varied with the highest in unclassified (13.98%, 3.98-38.95), household stored (6.42%, 1.16-28.69), municipal (4.39%, 1.54-11.90), and bottled (1.06%, 0.00-98.57) FPODW. Regionally, FPODW Vibrio prevalence varied significantly with highest in Africa (6.31%, 0.49-47.88), then Asia (4.83%, 2.01-11.18). Similarly, it varied significantly among income classification with the highest from low-income (8.77%, 0.91-50.05), then lower-middle-income (6.16%, 2.75-13.20), upper-middle-income (0.23%, 0.00-82.04), and 0.94% (0.19-2.72) in high-income economies. Among the WHO region, it varied significantly from 1.41% (0.17-10.45) in Eastern Mediterranean, 6.31% (0.49-47.88) in Africa to 8.86% (3.85-19.06) in South-East Asia and declining among SDI-quintiles from 11.64% (3.29-33.83) in Low-SDI, 10.59% (4.58-22.61) in High-middle-SDI to 0.26% (0.01-9.09) in Middle-SDI. FPODW Vibrio prevalence was 7.31% (2.94-17.03) in the low-GHSIG, followed by 4.55% (0.00-100.00) in the upper-GHSIG, and 2.21% (0.31-14.24) in middle-GHSIG; rural (4.18%, 0.06-76.17) and urban (5.28%, 2.35-11.44) settings. Also, sample size, SDI, SDI-quintiles, and nation significantly explained 14.12%, 10.91%, 30.35%, and 87.65% variance in FPODW Vibrio prevalence, respectively as a univariate influence. Additionally, 11.90% variance in FPODW Vibrio prevalence explained mortality rate attributed to unsafe WASH services. In conclusion, the study revealed a substantial high FPODW prevalence of Vibrio calling for initiative-taking and intentional surveillances of waterborne pathogens at the neglected stage across nations in order to achieve sustainably the SDG 3.
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Affiliation(s)
- Temitope C Ekundayo
- Department of Biotechnology and Food Science, Durban University of Technology, Steve Biko Campus, 121 Steve Biko Rd, Musgrave, Berea, 4001 Durban, South Africa.
| | - Feroz M Swalaha
- Department of Biotechnology and Food Science, Durban University of Technology, Steve Biko Campus, 121 Steve Biko Rd, Musgrave, Berea, 4001 Durban, South Africa
| | - Oluwatosin A Ijabadeniyi
- Department of Biotechnology and Food Science, Durban University of Technology, Steve Biko Campus, 121 Steve Biko Rd, Musgrave, Berea, 4001 Durban, South Africa
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Mwishingo A, Endres K, Bisimwa L, Sanvura P, Banywesize BM, Bisimwa JC, Williams C, Perin J, Boroto R, Nsimire G, Rugusha F, Endeleya F, Kitumaini P, Lunyelunye C, Timsifu J, Munyerenkana B, Bengehya J, Maheshe G, Cikomola C, George CM. Effect of a Water, Sanitation, and Hygiene Program on Handwashing with a Cleansing Agent among Diarrhea Patients and Attendants in Healthcare Facilities in the Democratic Republic of the Congo: A Randomized Pilot of the PICHA7 Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:659. [PMID: 38928906 PMCID: PMC11204100 DOI: 10.3390/ijerph21060659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 06/28/2024]
Abstract
Healthcare-acquired infections are a major problem in healthcare facility settings around the world. The Democratic Republic of the Congo (DRC) has over 2 million diarrhea patients hospitalized each year. These healthcare settings become high-risk environments for spreading diarrheal illnesses such as cholera. The objective of the Preventative Intervention for Cholera for 7 Days (PICHA7) program is to develop evidence-based water, sanitation, and hygiene (WASH) interventions to reduce cholera and other severe diarrheal diseases in the DRC. The study objective was to evaluate the effectiveness of PICHA7 program delivery in increasing handwashing with a cleansing agent at stool/vomit- and food-related events in a healthcare facility setting among diarrhea patients and patient attendants. A pilot of the PICHA7 program was conducted among 284 participants in 27 healthcare facilities from March 2020 to November 2021 in urban Bukavu in the South Kivu Province of the DRC. The standard arm received the standard message provided in the DRC to diarrhea patients on the use of oral rehydration solution and a basic WASH message at healthcare facility discharge. The PICHA7 arm received the PICHA7 WASH pictorial module delivered by a health promoter focused on handwashing with a cleansing agent at the bedside of the diarrhea patient in the healthcare facility and provision of a soapy water bottle (water and detergent powder). Within 24 h of intervention delivery, a three-hour structured observation of handwashing practices at stool/vomit- and food-related events (key events) was conducted in healthcare facilities of diarrhea patients and their attendants. Compared to the standard arm, there was significantly more handwashing with a cleansing agent at key events in the PICHA7 arm (40% vs. 15%) (odds ratio: 5.04; (95% confidence interval (CI): 2.01, 12.7)). These findings demonstrate that delivery of the PICHA7 WASH pictorial module and provision of a soapy water bottle to diarrhea patients and their attendants presents a promising approach to increase handwashing with a cleansing agent among this high-risk population in healthcare facilities in the eastern DRC.
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Affiliation(s)
- Alain Mwishingo
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Kelly Endres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA (C.W.); (J.P.)
| | - Lucien Bisimwa
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Presence Sanvura
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Blessing Muderhwa Banywesize
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Jean-Claude Bisimwa
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Camille Williams
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA (C.W.); (J.P.)
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA (C.W.); (J.P.)
| | - Raissa Boroto
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Gisèle Nsimire
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Feza Rugusha
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Freddy Endeleya
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Pacifique Kitumaini
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Claude Lunyelunye
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Jessy Timsifu
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Brigitte Munyerenkana
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Justin Bengehya
- Bureau de l’Information Sanitaire, Surveillance Epidémiologique et Recherche Scientifique, Division Provinciale de la Santé Sud Kivu, Ministère de la Santé, Bukavu B.P 265, Democratic Republic of the Congo;
| | - Ghislain Maheshe
- Faculty of Medicine, Catholic University of Bukavu, Bukavu B.P 265, Democratic Republic of the Congo;
| | - Cirhuza Cikomola
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
- Faculty of Medicine, Catholic University of Bukavu, Bukavu B.P 265, Democratic Republic of the Congo;
| | - Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA (C.W.); (J.P.)
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George CM, Parvin T, Bhuyian MSI, Uddin IM, Zohura F, Masud J, Monira S, Sack DA, Perin J, Alam M, Faruque ASG. Randomized Controlled Trial of the Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7) Cholera Rapid Response Program to Reduce Diarrheal Diseases in Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12905. [PMID: 36232205 PMCID: PMC9566036 DOI: 10.3390/ijerph191912905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/09/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
(a) Objective: To build an evidence base on effective water, sanitation, and hygiene interventions to reduce diarrheal diseases in cholera hotspots, we developed the CHoBI7 Cholera Rapid Response Program. (b) Methods: Once a cholera patient (confirmed by bacterial culture) is identified at a health facility, a health promoter delivers a targeted WASH intervention to the cholera hotspot (households within 20 m of a cholera patient) through both in-person visits during the first week and bi-weekly WASH mobile messages for the 3-month program period. A randomized controlled trial of the CHoBI7 Cholera Rapid Response Program was conducted with 284 participants in 15 cholera hotspots around cholera patients in urban Dhaka, Bangladesh. This program was compared to the standard message in Bangladesh on the use of oral rehydration solution for dehydration. Five-hour structured observation of handwashing with soap and diarrhea surveillance was conducted monthly. (c) Findings: Handwashing with soap at food- and stool-related events was significantly higher in the CHoBI7 Cholera Rapid Response Program arm compared to the standard message arm at all timepoints (overall 54% in the CHoBI7 arm vs. 23% in the standard arm, p < 0.05). Furthermore, there was a significant reduction in diarrheal prevalence for all participants (adults and children) (Prevalence Ratio (PR) 0.35, 95% CI: 0.14-0.85) and for children under 5 years of age (PR: 0.27, 95% CI: 0.085-0.87) during the 3-month program. (d) Conclusions: These findings demonstrate that the CHoBI7 Cholera Rapid Response Program is effective in lowering diarrhea prevalence and increasing handwashing with soap for a population at high risk of cholera.
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Affiliation(s)
- Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2103, USA
| | - Tahmina Parvin
- Research Training and Management International, Dhaka 1216, Bangladesh
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Md. Sazzadul Islam Bhuyian
- Research Training and Management International, Dhaka 1216, Bangladesh
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Ismat Minhaj Uddin
- Research Training and Management International, Dhaka 1216, Bangladesh
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Fatema Zohura
- Research Training and Management International, Dhaka 1216, Bangladesh
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Jahed Masud
- Research Training and Management International, Dhaka 1216, Bangladesh
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Shirajum Monira
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - David A. Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2103, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2103, USA
| | - Munirul Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - A. S. G. Faruque
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
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George CM, Perin J, Parvin T, Bhuyian S, Thomas ED, Monira S, Zohura F, Hasan T, Sack D, Alam M. Effects of a Water, Sanitation and Hygiene Mobile Health Program on Respiratory Illness in Bangladesh: A Cluster-Randomized Controlled Trial of the CHoBI7 Mobile Health Program. Am J Trop Med Hyg 2022; 106:979-984. [PMID: 35008045 PMCID: PMC8922503 DOI: 10.4269/ajtmh.21-0679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/06/2021] [Indexed: 11/07/2022] Open
Abstract
Acute respiratory infections are a leading cause of morbidity and mortality among young children globally. The objective of this study was to evaluate the impact of the Cholera-Hospital-Based-Intervention-for-7-days (CHoBI7) handwashing with soap and water treatment mobile health (mHealth) program on respiratory illness among diarrhea patients and their household members in urban Dhaka, Bangladesh. A cluster-randomized controlled trial of the CHoBI7 mHealth program was conducted among diarrhea patient households in Dhaka, Bangladesh. Patients were randomized to three arms: standard recommendation on oral rehydration solution use, health facility delivery of CHoBI7 plus mHealth (weekly voice and text messages for 12 months) (no home visits), and health facility delivery of CHoBI7 plus two home visits and mHealth. Respiratory symptoms were assessed during monthly clinical surveillance over the 12-month surveillance period. Respiratory illness was defined as rapid breathing, difficulty breathing, wheezing, or coughing. Two thousand six hundred twenty-six participants in 769 households were randomly allocated to three arms: 849 participants to the standard message arm, 886 to the mHealth with no home visits arm, and 891 to the mHealth with two home visits arm. Compared with the standard message arm, participants in the mHealth with no home visits arm (Prevalence Ratio [PR]: 0.89 [95% CI: 0.80, 0.98]), and the mHealth with two home visits arm (PR: 0.89 [95% CI: 0.81, 0.99]) had significantly lower respiratory illness prevalence over the 12-month program period. Our findings demonstrate that the CHoBI7 mHealth program is effective in reducing respiratory illness among diarrhea patient households.
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Affiliation(s)
- Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;,Address correspondence to Christine Marie George, Associate Professor, Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5535, Baltimore, MD 21205-2103. E-mail:
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tahmina Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Sazzadul Bhuyian
- International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Elizabeth D. Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shirajum Monira
- International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Fatema Zohura
- International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Tasdik Hasan
- International Centre for Diarrhoeal Disease Research, Bangladesh
| | - David Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Munirul Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh
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Nasrin S, Garbern SC, Gainey M, Kanekar S, Monjory M, Ahmed D, Qu K, Chu TC, Schmid CH, Nelson EJ, Ahmed T, Alam NH, Levine AC. Clinical, Sociodemographic and Environmental Risk Factors for Acute Bacterial Diarrhea among Adults and Children over Five Years in Bangladesh. Am J Trop Med Hyg 2022; 106:457-463. [PMID: 34724626 PMCID: PMC8832925 DOI: 10.4269/ajtmh.21-0580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/12/2021] [Indexed: 02/03/2023] Open
Abstract
In 2016, diarrheal disease was the eighth leading cause of mortality globally accounting for over 1.6 million deaths with the majority of deaths in adults and children over 5 years. This study aims to investigate the clinical, sociodemographic, and environmental risk factors associated with common bacterial acute diarrhea among adults and children over 5. Data were collected from March 2019 to March 2020 in patients over 5 years presenting with acute gastroenteritis at icddr,b. Stool samples were collected from each patient for culture and polymerase chain reaction (PCR) testing. Bivariate associations between independent variables and stool-testing indicating bacterial etiology were calculated. This analysis included 2,133 diarrheal patients of whom a bacterial enteropathogen was identified in 1,537 (72%). Detection of bacteria was associated with: younger age (OR 0.92; 95% CI: 0.88-0.96), lower mean arterial pressure (OR 0.84; 95% CI: 0.79-0.89), heart rate (OR 1.06; 95% CI: 1.01-1.10), percentage dehydration (OR 1.33; 95% CI: 1.13-1.55), respiration rate (OR 1.23; 95% CI: 1.04-1.46), lower mid-upper arm circumference (OR 0.97; 95% CI: 0.94-0.99), confused/lethargic mental status (OR 1.85; 95% CI: 1.11-3.25), rice watery stool (OR 1.92; 95% CI: 1.54-2.41), and vomiting more than three times in the past 24 hours (OR 1.30; 95% CI: 1.06-1.58). Higher monthly income (OR 0.92; 95% CI: 0.86-0.98), > 8 years of education (OR 0.79; 95% CI: 0.63-1.00), and having more than five people living at home (OR 0.80; 95% CI: 0.66-0.98) were associated with lower odds of bacterial diarrhea. These findings may help guide the development of predictive tools to aid in identifying patients with bacterial diarrhea for timely and appropriate use of antibiotics.
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Affiliation(s)
- Sabiha Nasrin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;,Address correspondence to Sabiha Nasrin, Nutrition and Clinical Services Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani. Mohakhali, Dhaka 1212, Bangladesh. E-mail:
| | - Stephanie C. Garbern
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Monique Gainey
- Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island
| | | | - Mahmuda Monjory
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dilruba Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kexin Qu
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
| | - Tzu-Chun Chu
- Center for Statistical Sciences, Brown University, Providence, Rhode Island
| | - Christopher H. Schmid
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
| | - Eric J. Nelson
- Departments of Pediatrics and Environmental and Global Health, University of Florida, Gainesville, Florida
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nur H. Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Adam C. Levine
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
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Bwire G, Waniaye JB, Otim JS, Matseketse D, Kagirita A, Orach CG. Cholera risk in cities in Uganda: understanding cases and contacts centered strategy (3CS) for rapid cholera outbreak control. Pan Afr Med J 2021; 39:193. [PMID: 34603574 PMCID: PMC8464210 DOI: 10.11604/pamj.2021.39.193.27794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 06/26/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction in the recent past, cities in sub-Saharan Africa have reported serious cholera outbreaks that last for several months. Uganda is one of the African countries where cities are prone to cholera outbreaks. Studies on cholera in Bangladesh show increased risk of cholera for the immediate household members (contacts) yet the control interventions mainly target cases with little or no focus on contacts. This study aimed to describe the rapid control of cholera outbreaks in Kampala and Mbale cities, Uganda, using, “Cases and Contacts Centered Strategy (3CS)” that consisted of identification and treatment of cases, promotion of safe water, sanitation, hygiene (WaSH) and selective chemoprophylaxis for the contacts. Methods a cross-sectional study was conducted in 2015-2016 in the Kampala and Mbale cities during cholera outbreaks. Cholera cases were treated and 816 contacts from 188 households were listed and given cholera preventive packages. Data were collected, cleaned, analysed and stored in spreadsheet. Comparison of categories was done using Chi-Square test. Results a total of 58 and 41 confirmed cholera cases out of 318 and 153 suspected cases were recorded in Kampala and Mbale cities respectively. The outbreaks lasted for 41 days in both cities. Case fatality rates were high; 12.1% (5/41) for Mbale city and 1.7% (1/58) for Kampala city. Fifty-five percent (210/379) of stool samples were tested by culture to confirm V. choleraeO1. No contacts listed and given cholera preventive package developed cholera. Both sexes and all age groups were affected. In Kampala city, the males were more affected than the females in the age groups less than 14 years, p-value of 0.0097. Conclusion this study showed that by implementing 3CS, it was possible to rapidly control cholera outbreaks in Kampala and Mbale cities and no cholera cases were reported amongst the listed household contacts. The findings on 3CS and specifically, selective antibiotic chemoprophylaxis for cholera prevention, could be used in similar manner to oral cholera vaccines to complement the core cholera control interventions (disease surveillance, treatment of cases and WaSH). However, studies are needed to guide such rollout and to understand the age-sex differences in Kampala city.
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Affiliation(s)
- Godfrey Bwire
- Department of Integrated Epidemiology, Surveillance and Public Health Emergencies, Ministry of Health, Kampala, Uganda
| | | | - Julius Simon Otim
- Directorate of Public Health, Kampala Capital City Authority, Kampala, Uganda
| | | | - Atek Kagirita
- Uganda National Health Laboratory Services/Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
| | - Christopher Garimoi Orach
- Department of Community Health and Behavioral Sciences, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
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Azman AS, Lauer SA, Bhuiyan TR, Luquero FJ, Leung DT, Hegde ST, Harris JB, Paul KK, Khaton F, Ferdous J, Lessler J, Salje H, Qadri F, Gurley ES. Vibrio cholerae O1 transmission in Bangladesh: insights from a nationally representative serosurvey. THE LANCET. MICROBE 2020; 1:e336-e343. [PMID: 33345203 PMCID: PMC7738617 DOI: 10.1016/s2666-5247(20)30141-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pandemic Vibrio cholerae from cholera-endemic countries around the Bay of Bengal regularly seed epidemics globally. Without reducing cholera in these countries, including Bangladesh, global cholera control might never be achieved. Little is known about the geographical distribution and magnitude of V cholerae O1 transmission nationally. We aimed to describe infection risk across Bangladesh, making use of advances in cholera seroepidemiology, therefore overcoming many of the limitations of current clinic-based surveillance. METHODS We tested serum samples from a nationally representative serosurvey in Bangladesh with eight V cholerae-specific assays. Using these data with a machine-learning model previously validated within a cohort of confirmed cholera cases and their household contacts, we estimated the proportion of the population with evidence of infection by V cholerae O1 in the previous year (annual seroincidence) and used Bayesian geostatistical models to create high-resolution national maps of infection risk. FINDINGS Between Oct 16, 2015, and Jan 24, 2016, we obtained and tested serum samples from 2930 participants (707 households) in 70 communities across Bangladesh. We estimated national annual seroincidence of V cholerae O1 infection of 17·3% (95% CI 10·5-24·1). Our high-resolution maps showed large heterogeneity of infection risk, with community-level annual infection risk within the sampled population ranging from 4·3% to 62·9%. Across Bangladesh, we estimated that 28·1 (95% CI 17·1-39·2) million infections occurred in the year before the survey. Despite having an annual seroincidence of V cholerae O1 infection lower than much of Bangladesh, Dhaka (the capital of Bangladesh and largest city in the country) had 2·0 (95% CI 0·6-3·9) million infections during the same year, primarily because of its large population. INTERPRETATION Serosurveillance provides an avenue for identifying areas with high V cholerae O1 transmission and investigating key risk factors for infection across geographical scales. Serosurveillance could serve as an important method for countries to plan and monitor progress towards 2030 cholera elimination goals. FUNDING The Bill & Melinda Gates Foundation, National Institutes of Health, and US Centers for Disease Control and Prevention.
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Affiliation(s)
- Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephen A Lauer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Francisco J Luquero
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Epicentre, Paris, France
| | - Daniel T Leung
- Division of Infectious Diseases and Division of Microbiology and Immunology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sonia T Hegde
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jason B Harris
- Division of Infectious Diseases and Division of Global Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard School of Medicine, Boston, MA, USA
| | | | | | | | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Henrik Salje
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
| | | | - Emily S Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- icddr,b, Dhaka, Bangladesh
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George CM, Monira S, Zohura F, Thomas ED, Hasan MT, Parvin T, Hasan K, Rashid MU, Papri N, Islam A, Rahman Z, Rafique R, Islam Bhuyian S, Saxton R, Labrique A, Alland K, Barman I, Jubyda FT, Afroze F, Sultana M, Johura FT, Khan MAH, Tahmina S, Munmun F, Sack DA, Perin J, Alam M. Effects of a Water, Sanitation and Hygiene Mobile Health Program on Diarrhea and Child Growth in Bangladesh: A Cluster-Randomized Controlled Trial of the CHoBI7 Mobile Health Program. Clin Infect Dis 2020; 73:e2560-e2568. [PMID: 32761174 PMCID: PMC8563223 DOI: 10.1093/cid/ciaa754] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background The Cholera Hospital-Based Intervention for 7 Days (CHoBI7) mobile health (mHealth) program was a cluster-randomized controlled trial of diarrhea patient households conducted in Dhaka, Bangladesh. Methods Patients were block-randomized to 3 arms: standard message on oral rehydration solution use; health facility delivery of CHoBI7 plus mHealth (no home visits); and health facility delivery of CHoBI7 plus 2 home visits and mHealth. The primary outcome was reported diarrhea in the past 2 weeks collected monthly for 12 months. The secondary outcomes were stunting, underweight, and wasting at a 12-month follow-up. Analysis was intention-to-treat. Results Between 4 December 2016 and 26 April 2018, 2626 participants in 769 households were randomly allocated to 3 arms: 849 participants to the standard message arm, 886 to mHealth with no home visits arm, and 891 to the mHealth with 2 home visits. Children <5 years had significantly lower 12-month diarrhea prevalence in both the mHealth with 2 home visits arm (prevalence ratio [PR]: 0.73 [95% confidence interval {CI}, .61–.87]) and the mHealth with no home visits arm (PR: 0.82 [95% CI, .69–.97]). Children <2 years were significantly less likely to be stunted in both the mHealth with 2 home visits arm (33% vs 45%; odds ratio [OR]: 0.55 [95% CI, .31–.97]) and the mHealth with no home visits arm (32% vs 45%; OR: 0.54 [95% CI, .31–.96]) compared with children in the standard message arm. Conclusions The CHoBI7 mHealth program lowered pediatric diarrhea and stunting among diarrhea patient households. Clinical Trials Registration NCT04008134.
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Affiliation(s)
- Christine Marie George
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Shirajum Monira
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fatema Zohura
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Elizabeth D Thomas
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - M Tasdik Hasan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmina Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Khaled Hasan
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Mahamud-Ur Rashid
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nowshin Papri
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Aminul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Zillur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Raisa Rafique
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Ronald Saxton
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Alain Labrique
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Kelsey Alland
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Indrajeet Barman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fatema Tuz Jubyda
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Farzana Afroze
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Marzia Sultana
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fatema-Tuz Johura
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Sanya Tahmina
- Bangladesh Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Farzana Munmun
- Bangladesh Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - David A Sack
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Munirul Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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9
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Zohura F, Bhuyian MSI, Saxton RE, Parvin T, Monira S, Biswas SK, Masud J, Nuzhat S, Papri N, Hasan MT, Thomas ED, Sack D, Perin J, Alam M, George CM. Effect of a water, sanitation and hygiene program on handwashing with soap among household members of diarrhoea patients in healthcare facilities in Bangladesh: a cluster-randomised controlled trial of the CHoBI7 mobile health program. Trop Med Int Health 2020; 25:1008-1015. [PMID: 32406581 DOI: 10.1111/tmi.13416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The Cholera-Hospital-Based-Intervention-for-7-days (CHoBI7) is a water treatment and handwashing with soap intervention for diarrhoea patients and their household members which is initially delivered in a healthcare facility setting. This study evaluated the effectiveness of CHoBI7 program delivery in increasing handwashing with soap in a healthcare facility setting among diarrhoea patients and their household members. METHODS A randomised controlled trial of the CHoBI7 program was conducted among 404 diarrhoea patients and their accompanying household members in healthcare facilities in Dhaka, Bangladesh. The 'Standard Message' Arm received the standard message given in Bangladesh to diarrhoea patients on the use of oral rehydration solution. The 'Health Facility Visit + Soapy Water' Arm received the standard message, the CHoBI7 communication module delivered bedside to the patient; and a soapy water bottle in the healthcare facility. The 'Health Facility Visit + Handwashing Station' Arm received this same intervention plus a small plastic handwashing station. Within 24 h of intervention delivery, three-hour structured observation of handwashing practices at stool/vomit- and food-related events (key events) was conducted in healthcare facilities of diarrhoea patients and their accompanying household members. RESULTS Compared to the Standard Message Arm, there was significantly more handwashing with soap at key events in both the Health Facility Visit + Soapy Water Arm (51% vs. 25 %) (Odds Ratio: 3.02; (95% Confidence Interval (CI): 1.41, 6.45) and the Health Facility Visit + Handwashing Station Arm (58% vs. 25%) OR: 4.12; (95% CI: 1.86, 9.14). CONCLUSION These findings demonstrate that delivery of the CHoBI7 communication module and provision of a soapy water bottle to diarrhoea patients and their accompanying household members presents a promising approach to increase handwashing with soap among this high risk population in a healthcare facility setting in Bangladesh.
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Affiliation(s)
- Fatema Zohura
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Ronald E Saxton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tahmina Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shirajum Monira
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shwapon K Biswas
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jahed Masud
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sharika Nuzhat
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nowshin Papri
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M Tasdik Hasan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Elizabeth D Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Munirul Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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10
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Thomas ED, Zohura F, Hasan MT, Rana MS, Teman A, Parvin T, Masud J, Bhuyian MSI, Hossain MK, Hasan M, Tahmina S, Munmun F, Khan MAH, Monira S, Sack DA, Leontsini E, Winch PJ, Alam M, George CM. Formative research to scale up a handwashing with soap and water treatment intervention for household members of diarrhea patients in health facilities in Dhaka, Bangladesh (CHoBI7 program). BMC Public Health 2020; 20:831. [PMID: 32487209 PMCID: PMC7268342 DOI: 10.1186/s12889-020-08727-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During the time a diarrhea patient presents at a health facility, the household members of the patient are at higher risk of developing diarrheal diseases (> 100 times for cholera) than the general population. The Cholera-Hospital-based-Intervention-for-7-Days (CHoBI7) is a health facility-initiated water treatment and handwashing with soap intervention designed to reduce transmission of diarrheal diseases between patients and their household members. The present research aimed to (1) develop a scalable approach to integrate the CHoBI7 intervention program into services provided at government and private health facilities in Bangladesh; and (2) tailor the intervention program for the household members of all diarrhea patients, irrespective of the etiology of disease. METHODS We conducted 8 months of formative research, including 60 semi-structured interviews, 2 group discussions, and a pilot study. Thirty-two interviews were conducted with diarrhea patients and their family caregivers, government stakeholders, and health care providers both to explore existing WASH and diarrhea patient care practices in health facilities and to identify considerations for scaling the CHoBI7 program. Fifty-two diarrhea patient households participated in a pilot study of a modified version of the CHoBI7 intervention program for tailoring. Twenty-eight interviews and 2 group discussions were conducted with pilot households to explore experiences with and recommendations for intervention delivery. RESULTS The intervention program was modified based on formative research findings. Pilot study participants recognized the benefits of the CHoBI7 intervention program and made suggestions to improve the acceptability and feasibility of the intervention. Modifications included 1) providing additional pictorial modules, cues to action, enabling technologies, and supplies for safe drinking water and handwashing with soap behaviors in the health facility; 2) switching out technology prone to breaks and leaks as well as sourcing plastic technologies from a high-quality, local manufacturer; and 3) including instructions discouraging the non-use or misuse of technologies and supplies. Considerations for scalability include the local availability and marketing of enabling technologies and supplies, staff for program delivery in health facilities, and potential integration into existing government or health promotion programs. CONCLUSIONS Formative research identified important considerations for the content, delivery, and scalability of the CHoBI7 health facility-initiated WASH intervention program.
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Affiliation(s)
- Elizabeth D. Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Fatema Zohura
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - M. Tasdik Hasan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md. Sohel Rana
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Alana Teman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Tahmina Parvin
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jahed Masud
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md. Sazzadul Islam Bhuyian
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md. Khobair Hossain
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Maynul Hasan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sanya Tahmina
- Department of Communicable Diseases, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Farzana Munmun
- Community Based Health Care, Directorate General of Health Services, Dhaka, Bangladesh
| | - Md. Abul Hashem Khan
- Community Based Health Care, Directorate General of Health Services, Dhaka, Bangladesh
| | - Shirajum Monira
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - David A. Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Elli Leontsini
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Peter J. Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Munirul Alam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Christine Marie George
- Associate Professor, Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5535, Baltimore, MD 21205-2103 USA
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11
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Meszaros VA, Miller-Dickson MD, Baffour-Awuah F, Almagro-Moreno S, Ogbunugafor CB. Direct transmission via households informs models of disease and intervention dynamics in cholera. PLoS One 2020; 15:e0229837. [PMID: 32163436 PMCID: PMC7067450 DOI: 10.1371/journal.pone.0229837] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/14/2020] [Indexed: 02/07/2023] Open
Abstract
While several basic properties of cholera outbreaks are common to most settings-the pathophysiology of the disease, the waterborne nature of transmission, and others-recent findings suggest that transmission within households may play a larger role in cholera outbreaks than previously appreciated. Important features of cholera outbreaks have long been effectively modeled with mathematical and computational approaches, but little is known about how variation in direct transmission via households may influence epidemic dynamics. In this study, we construct a mathematical model of cholera that incorporates transmission within and between households. We observe that variation in the magnitude of household transmission changes multiple features of disease dynamics, including the severity and duration of outbreaks. Strikingly, we observe that household transmission influences the effectiveness of possible public health interventions (e.g. water treatment, antibiotics, vaccines). We find that vaccine interventions are more effective than water treatment or antibiotic administration when direct household transmission is present. Summarizing, we position these results within the landscape of existing models of cholera, and speculate on its implications for epidemiology and public health.
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Affiliation(s)
- Victor A. Meszaros
- Department of Ecology and Evolutionary Biology, Brown University, Providence, RI, United States of America
| | - Miles D. Miller-Dickson
- Department of Ecology and Evolutionary Biology, Brown University, Providence, RI, United States of America
| | - Francis Baffour-Awuah
- Department of Mathematics, Florida State University, Tallahassee, FL, United States of America
| | - Salvador Almagro-Moreno
- Burnett School of Biomedical Sciences, University of Central Florida, Orlando, FL, United States of America
- National Center for Integrated Coastal Research, University of Central Florida, Orlando, FL, United States of America
| | - C. Brandon Ogbunugafor
- Department of Ecology and Evolutionary Biology, Brown University, Providence, RI, United States of America
- * E-mail:
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12
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D’Mello-Guyett L, Gallandat K, Van den Bergh R, Taylor D, Bulit G, Legros D, Maes P, Checchi F, Cumming O. Prevention and control of cholera with household and community water, sanitation and hygiene (WASH) interventions: A scoping review of current international guidelines. PLoS One 2020; 15:e0226549. [PMID: 31914164 PMCID: PMC6948749 DOI: 10.1371/journal.pone.0226549] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 12/03/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Cholera remains a frequent cause of outbreaks globally, particularly in areas with inadequate water, sanitation and hygiene (WASH) services. Cholera is spread through faecal-oral routes, and studies demonstrate that ingestion of Vibrio cholerae occurs from consuming contaminated food and water, contact with cholera cases and transmission from contaminated environmental point sources. WASH guidelines recommending interventions for the prevention and control of cholera are numerous and vary considerably in their recommendations. To date, there has been no review of practice guidelines used in cholera prevention and control programmes. METHODS We systematically searched international agency websites to identify WASH intervention guidelines used in cholera programmes in endemic and epidemic settings. Recommendations listed in the guidelines were extracted, categorised and analysed. Analysis was based on consistency, concordance and recommendations were classified on the basis of whether the interventions targeted within-household or community-level transmission. RESULTS Eight international guidelines were included in this review: three by non-governmental organisations (NGOs), one from a non-profit organisation (NPO), three from multilateral organisations and one from a research institution. There were 95 distinct recommendations identified, and concordance among guidelines was poor to fair. All categories of WASH interventions were featured in the guidelines. The majority of recommendations targeted community-level transmission (45%), 35% targeted within-household transmission and 20% both. CONCLUSIONS Recent evidence suggests that interventions for effective cholera control and response to epidemics should focus on case-centred approaches and within-household transmission. Guidelines did consistently propose interventions targeting transmission within households. However, the majority of recommendations listed in guidelines targeted community-level transmission and tended to be more focused on preventing contamination of the environment by cases or recurrent outbreaks, and the level of service required to interrupt community-level transmission was often not specified. The guidelines in current use were varied and interpretation may be difficult when conflicting recommendations are provided. Future editions of guidelines should reflect on the inclusion of evidence-based approaches, cholera transmission models and resource-efficient strategies.
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Affiliation(s)
- Lauren D’Mello-Guyett
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Environmental Health Unit, Médecins Sans Frontières, Brussels, Belgium
| | - Karin Gallandat
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rafael Van den Bergh
- LuxOR, Luxembourg Operational Research Unit, Médecins Sans Frontières, Luxembourg
| | - Dawn Taylor
- Public Health Unit, Médecins Sans Frontières, Amsterdam, Netherlands
| | - Gregory Bulit
- Water, Sanitation and Hygiene, UNICEF, New York, New York, United States of America
| | - Dominique Legros
- Global Task Force on Cholera Control, World Health Organization, Geneva, Switzerland
| | - Peter Maes
- Environmental Health Unit, Médecins Sans Frontières, Brussels, Belgium
| | - Francesco Checchi
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oliver Cumming
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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13
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Phelps MD, Simonsen L, Jensen PKM. Individual and household exposures associated with cholera transmission in case–control studies: a systematic review. Trop Med Int Health 2019; 24:1151-1168. [DOI: 10.1111/tmi.13293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Matthew D. Phelps
- Copenhagen Center for Disaster Research, Department of Public Health, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Lone Simonsen
- Department of Science and Environment Roskilde University Roskilde Denmark
| | - Peter K. M. Jensen
- Copenhagen Center for Disaster Research, Department of Public Health, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
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Rahman Z, Rahman MA, Rashid MU, Monira S, Johura FT, Mustafiz M, Bhuyian SI, Zohura F, Parvin T, Hasan K, Saif-Ur-Rahman KM, Islam NN, Sack DA, George CM, Alam M. Vibrio cholerae Transmits Through Water Among the Household Contacts of Cholera Patients in Cholera Endemic Coastal Villages of Bangladesh, 2015-2016 (CHoBI7 Trial). Front Public Health 2018; 6:238. [PMID: 30214899 PMCID: PMC6125298 DOI: 10.3389/fpubh.2018.00238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 08/08/2018] [Indexed: 12/15/2022] Open
Abstract
Recurrent cholera causes significant morbidity and mortality in cholera endemic estuarine areas of Bangladesh. There have been limited studies to investigate the transmission patterns of V. cholerae associated with cholera in Bangladesh. In this study, we characterized V. cholerae serogroup O1 isolated from 30 cholera patients, 76 household contacts, 119 stored drinking water samples, and 119 water source samples in Bakerganj and Mathbaria, two cholera endemic coastal regions in Bangladesh. Results of phenotypic and molecular characterization of V. cholerae isolates (n = 56) confirmed them to be toxigenic belonging to serogroup O1 biotype El Tor (ET), and possessing cholera toxin of the classical biotype (altered ET). Molecular fingerprinting of the V. cholerae O1 of clinical and water origins determined by PFGE of Not-I- digested genomic DNA showed them to be closely related, as the PFGE banding patterns were highly homogenous. Phylogenetic analysis using dendrogram of cholera patients, household contacts, and household groundwater sources showed isolates within households to be clonally linked, suggesting water as an important vehicle of transmission of cholera in the coastal villages of Bangladesh. Transmission of toxigenic V. cholerae O1 through drinking water in cholera endemic rural settings underscores the urgent need for evidence based water, sanitation, and hygiene interventions promoting safe drinking water to prevent morbidity and mortality related to cholera and other enteric infections in Bangladesh.
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Affiliation(s)
- Zillur Rahman
- Infectious Diseases Division, International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Md. Anisur Rahman
- Department of Biotechnology and Genetic Engineering, Noakhali Science and Technology University, Noakhali, Bangladesh
| | - Mahamud-ur Rashid
- Infectious Diseases Division, International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Shirajum Monira
- Infectious Diseases Division, International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Fatema-Tuz Johura
- Infectious Diseases Division, International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Munshi Mustafiz
- Infectious Diseases Division, International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Sazzadul I. Bhuyian
- Infectious Diseases Division, International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Fatema Zohura
- Infectious Diseases Division, International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Tahmina Parvin
- Infectious Diseases Division, International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Khaled Hasan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health Baltimore, Baltimore, MD, United States
| | - K. M. Saif-Ur-Rahman
- Infectious Diseases Division, International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Nazneen N. Islam
- Department of Genetic Engineering and Biotechnology, University of Chittagong, Chittagong, Bangladesh
| | - David A. Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health Baltimore, Baltimore, MD, United States
| | - Christine M. George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health Baltimore, Baltimore, MD, United States
| | - Munirul Alam
- Infectious Diseases Division, International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
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