1
|
Rajasingham A, Hardy C, Kamwaga S, Sebunya K, Massa K, Mulungu J, Martinsen A, Nyasani E, Hulland E, Russell S, Blanton C, Nygren B, Eidex R, Handzel T. Evaluation of an Emergency Bulk Chlorination Project Targeting Drinking Water Vendors in Cholera-Affected Wards of Dar es Salaam and Morogoro, Tanzania. Am J Trop Med Hyg 2020; 100:1335-1341. [PMID: 31017078 PMCID: PMC6553885 DOI: 10.4269/ajtmh.18-0734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In August 2015, an outbreak of cholera was reported in Tanzania. In cholera-affected areas of urban Dar es Salaam and Morogoro, many households obtained drinking water from vendors, who sold water from tanks ranging in volume from 1,000 to 20,000 L. Water supplied by vendors was not adequately chlorinated. The Tanzanian Ministry of Health, Community Development, Gender, Elderly and Children and the U.N. Children’s Fund, Tanzania, collaborated to enroll and train vendors to treat their water with 8.68-g sodium dichloroisocyanurate tablets (Medentech, Ireland). The Centers for Disease Control and Prevention (CDC) provided monitoring and evaluation support. Vendors were provided a 3-month supply of chlorine tablets. A baseline assessment and routine monitoring were conducted by ward environmental health officers. Approximately 3 months after chlorine tablet distribution, an evaluation of the program was conducted. The evaluation included a full enumeration of all vendors, an in-depth survey with half of the vendors enumerated, and focus group discussions. In total, 797 (88.9%) vendors were included in the full enumeration and 392 in the in-depth survey. Free residual chlorine (FRC) was detected in 12.0% of tanks at baseline and 69.6% of tanks during the evaluation; however, only 17.4% of these tanks had FRC ≥ 0.5 mg/L. The results suggest high acceptability and use of the chlorine tablets by water vendors. However, given variation in the water source used and longer storage times, dosing could be increased in future programming. Bulk chlorination using chlorine tablets offers an efficient community-level approach to treating water closer to the point of use.
Collapse
Affiliation(s)
- Anu Rajasingham
- Emergency Response and Recovery Branch, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Colleen Hardy
- Emergency Response and Recovery Branch, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Kiwe Sebunya
- United Nations Children's Fund Tanzania, Dar es Salaam, Tanzania
| | - Khalid Massa
- Tanzanian Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Jane Mulungu
- Global Immunizations Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea Martinsen
- Emergency Response and Recovery Branch, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Evalyne Nyasani
- United Nations Children's Fund Tanzania, Dar es Salaam, Tanzania
| | - Erin Hulland
- Emergency Response and Recovery Branch, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steven Russell
- Emergency Response and Recovery Branch, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Curtis Blanton
- Emergency Response and Recovery Branch, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Benjamin Nygren
- Global Immunizations Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rachel Eidex
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Thomas Handzel
- Emergency Response and Recovery Branch, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
2
|
Public Water Supply and Sanitation Authorities for Strategic Sustainable Domestic Water Management. A Case of Iringa Region In Tanzania. J 2019. [DOI: 10.3390/j2040029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Water supply is a mandatory service for the majority from respective legal public water utilities, and its sustainability reflects implementations of best management strategies at a local level. The objectives of this study were (i) to assess current approaches used in water quality and quantity management and (ii) propose a sustainable domestic water management strategy. This was achieved through secondary water data trends, on-site water quality assessments, visits of water supply and sanitation authorities, and assessment of their performances. It was observed that water supplied in rural-based authorities was quite different from that supplied in an urban setting as far as quality and quantity are concerned; urban-based supplies are more affordable to users than rural ones. A new strategy on water management is presented for sustainable water supply; it is based on controlling groundwater abstractions and preference of surface water in public water supplies. Rural water supply management must learn several practices realized in urban supplies for the betterment of services for the majority of the users.
Collapse
|
3
|
Luby SP, Davis J, Brown RR, Gorelick SM, Wong THF. Broad approaches to cholera control in Asia: Water, sanitation and handwashing. Vaccine 2019; 38 Suppl 1:A110-A117. [PMID: 31383486 DOI: 10.1016/j.vaccine.2019.07.084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/11/2019] [Accepted: 07/24/2019] [Indexed: 12/20/2022]
Abstract
Cholera has been eliminated as a public health problem in high-income countries that have implemented sanitation system separating the community's fecal waste from their drinking water and food supply. These expensive, highly-engineered systems, first developed in London over 150 years ago, have not reached low-income high-risk communities across Asia. Barriers to their implementation in communities at highest risk for cholera include the high capital and operating costs for this technological approach, limited capacity and perverse incentives of local governments, and a decreasing availability of water. Interim solutions including household level water treatment, constructing latrines and handwashing promotion have only marginally reduced the risk of cholera and other fecally transmitted diseases. Increased research to develop and policy flexibility to implement a new generation of solutions that are designed specifically to address the physical, financial and political constraints of low-income communities offers the best prospect for reducing the burden of cholera across Asia.
Collapse
Affiliation(s)
- Stephen P Luby
- Woods Institute for the Environment, Stanford University, Stanford, CA 94305, United States.
| | - Jennifer Davis
- Woods Institute for the Environment, Stanford University, Stanford, CA 94305, United States
| | - Rebekah R Brown
- Monash Sustainable Development Institute, Monash University, Clayton, Australia
| | - Steven M Gorelick
- Woods Institute for the Environment, Stanford University, Stanford, CA 94305, United States
| | - Tony H F Wong
- Cooperative Research Centre for Water Sensitive Cities, Monash University, Clayton, Australia
| |
Collapse
|
4
|
Shannon K, Hast M, Azman AS, Legros D, McKay H, Lessler J. Cholera prevention and control in refugee settings: Successes and continued challenges. PLoS Negl Trop Dis 2019; 13:e0007347. [PMID: 31220084 PMCID: PMC6586254 DOI: 10.1371/journal.pntd.0007347] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Kerry Shannon
- Johns Hopkins Medicine, Department of Emergency Medicine, Baltimore, Maryland, United States of America
| | - Marisa Hast
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, United States of America
- * E-mail:
| | - Andrew S. Azman
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, United States of America
| | | | - Heather McKay
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, United States of America
| | - Justin Lessler
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, United States of America
| |
Collapse
|
5
|
Rebaudet S, Bulit G, Gaudart J, Michel E, Gazin P, Evers C, Beaulieu S, Abedi AA, Osei L, Barrais R, Pierre K, Moore S, Boncy J, Adrien P, Duperval Guillaume F, Beigbeder E, Piarroux R. The case-area targeted rapid response strategy to control cholera in Haiti: a four-year implementation study. PLoS Negl Trop Dis 2019; 13:e0007263. [PMID: 30990822 PMCID: PMC6485755 DOI: 10.1371/journal.pntd.0007263] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 04/26/2019] [Accepted: 02/25/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In October 2010, Haiti was struck by a large-scale cholera epidemic. The Haitian government, UNICEF and other international partners launched an unprecedented nationwide alert-response strategy in July 2013. Coordinated NGOs recruited local rapid response mobile teams to conduct case-area targeted interventions (CATIs), including education sessions, household decontamination by chlorine spraying, and distribution of chlorine tablets. An innovative red-orange-green alert system was also established to monitor the epidemic at the communal scale on a weekly basis. Our study aimed to describe and evaluate the exhaustiveness, intensity and quality of the CATIs in response to cholera alerts in Haiti between July 2013 and June 2017. METHODOLOGY/PRINCIPAL FINDINGS We analyzed the response to 7,856 weekly cholera alerts using routine surveillance data and severity criteria, which was based on the details of 31,306 notified CATIs. The odds of CATI response during the same week (exhaustiveness) and the number of complete CATIs in responded alerts (intensity and quality) were estimated using multivariate generalized linear mixed models and several covariates. CATIs were carried out significantly more often in response to red alerts (adjusted odds ratio (aOR) [95%-confidence interval, 95%-CI], 2.52 [2.22-2.87]) compared with orange alerts. Significantly more complete CATIs were carried out in response to red alerts compared with orange alerts (adjusted incidence ratio (aIR), 1.85 [1.73-1.99]). Over the course of the eight-semester study, we observed a significant improvement in the exhaustiveness (aOR, 1.43 [1.38-1.48] per semester) as well as the intensity and quality (aIR, 1.23 [1.2-1.25] per semester) of CATI responses, independently of funds available for the strategy. The odds of launching a CATI response significantly decreased with increased rainfall (aOR, 0.99 [0.97-1] per each accumulated cm). Response interventions were significantly heterogeneous between NGOs, communes and departments. CONCLUSIONS/SIGNIFICANCE The implementation of a nationwide case-area targeted rapid response strategy to control cholera in Haiti was feasible albeit with certain obstacles. Such feedback from the field and ongoing impact studies will be very informative for actors and international donors involved in cholera control and elimination in Haiti and in other affected countries.
Collapse
Affiliation(s)
- Stanislas Rebaudet
- Assistance Publique–Hôpitaux de Marseille (AP-HM), Marseille, France
- Hôpital Européen Marseille, Marseille, France
- Institut Pierre-Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris, France
| | | | - Jean Gaudart
- Assistance Publique–Hôpitaux de Marseille (AP-HM), Marseille, France
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Marseille, France
| | - Edwige Michel
- Direction d’Epidémiologie de Laboratoire et de Recherche, Ministère de la Santé Publique et de la Population, Haiti
| | - Pierre Gazin
- Institut de Recherche pour le Développement (IRD), Marseille, France
| | | | | | - Aaron Aruna Abedi
- United Nations Children's Fund, Haiti
- Direction de la Lutte contre la Maladie, Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | - Lindsay Osei
- Assistance Publique–Hôpitaux de Marseille (AP-HM), Marseille, France
- United Nations Children's Fund, Haiti
| | - Robert Barrais
- Direction d’Epidémiologie de Laboratoire et de Recherche, Ministère de la Santé Publique et de la Population, Haiti
| | - Katilla Pierre
- Direction d’Epidémiologie de Laboratoire et de Recherche, Ministère de la Santé Publique et de la Population, Haiti
| | | | - Jacques Boncy
- Laboratoire National de Santé Publique, Ministère de la Santé Publique et de la Population, Haiti
| | - Paul Adrien
- Direction d’Epidémiologie de Laboratoire et de Recherche, Ministère de la Santé Publique et de la Population, Haiti
| | | | | | - Renaud Piarroux
- Sorbonne Université, INSERM, Institut Pierre-Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| |
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW This review describes the basic epidemiologic, clinical, and microbiologic aspects of cholera, highlights new developments within these areas, and presents strategies for applying currently available tools and knowledge more effectively. RECENT FINDINGS From 1990 to 2016, the reported global burden of cholera fluctuated between 74,000 and 595,000 cases per year; however, modeling estimates suggest the real burden is between 1.3 and 4.0 million cases and 95,000 deaths yearly. In 2018, the World Health Assembly endorsed a new initiative to reduce cholera deaths by 90% and eliminate local cholera transmission in 20 countries by 2030. New tools, including localized GIS mapping, climate modeling, whole genome sequencing, oral vaccines, rapid diagnostic tests, and new applications of water, sanitation, and hygiene interventions, could support this goal. Challenges include a high proportion of fragile states among cholera-endemic countries, urbanization, climate change, and the need for cholera treatment guidelines for pregnant women and malnourished children. SUMMARY Reducing cholera morbidity and mortality depends on real-time surveillance, outbreak detection and response; timely access to appropriate case management and cholera vaccines; and provision of safe water, sanitation, and hygiene.
Collapse
Affiliation(s)
- William Davis
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop H24-9, Atlanta, GA 30329, USA
| | - Rupa Narra
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop H24-9, Atlanta, GA 30329, USA
| | - Eric D. Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop H24-9, Atlanta, GA 30329, USA
| |
Collapse
|
7
|
Spina A, Beversluis D, Irwin A, Chen A, Nassariman JN, Ahamat A, Noh I, Oosterloo J, Alfani P, Sang S, Lenglet A, Taylor DL. Learning from water treatment and hygiene interventions in response to a hepatitis E outbreak in an open setting in Chad. JOURNAL OF WATER AND HEALTH 2018; 16:223-232. [PMID: 29676758 DOI: 10.2166/wh.2018.258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In September 2016, Médecins Sans Frontières responded to a hepatitis E (HEV) outbreak in Chad by implementing water treatment and hygiene interventions. To evaluate the coverage and use of these interventions, we conducted a cross-sectional study in the community. Our results showed that 99% of households interviewed had received a hygiene kit from us, aimed at improving water handling practice and personal hygiene and almost all respondents had heard messages about preventing jaundice and handwashing. Acceptance of chlorination of drinking water was also very high, although at the time of interview, we were only able to measure a safe free residual chlorine level (free chlorine residual (FRC) ≥0.2 mg/L) in 43% of households. Households which had refilled water containers within the last 18 hours, had sourced water from private wells or had poured water into a previously empty container, were all more likely to have a safe FRC level. In this open setting, we were able to achieve high coverage for chlorination, hygiene messaging and hygiene kit ownership; however, a review of our technical practice is needed in order to maintain safe FRC levels in drinking water in households, particularly when water is collected from multiple sources, stored and mixed with older water.
Collapse
Affiliation(s)
- Alexander Spina
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Granits väg 8, Solna 171 65, Sweden
| | | | - Andrea Irwin
- Médecins Sans Frontières, Quartier Klemat, Rue 3211, Porte 429, N'djamena, Chad
| | - Alexandra Chen
- Médecins Sans Frontières, Quartier Klemat, Rue 3211, Porte 429, N'djamena, Chad
| | | | - Abdelkhadir Ahamat
- Médecins Sans Frontières, Quartier Klemat, Rue 3211, Porte 429, N'djamena, Chad
| | - Idriss Noh
- Médecins Sans Frontières, Quartier Klemat, Rue 3211, Porte 429, N'djamena, Chad
| | - Jan Oosterloo
- Médecins Sans Frontières, Quartier Klemat, Rue 3211, Porte 429, N'djamena, Chad
| | - Prince Alfani
- Médecins Sans Frontières, Quartier Klemat, Rue 3211, Porte 429, N'djamena, Chad
| | - Sibylle Sang
- Médecins Sans Frontières, Plantage Middenlaan 14, Amsterdam 1018 DD, The Netherlands E-mail:
| | - Annick Lenglet
- Médecins Sans Frontières, Plantage Middenlaan 14, Amsterdam 1018 DD, The Netherlands E-mail:
| | - Dawn Louise Taylor
- Médecins Sans Frontières, Plantage Middenlaan 14, Amsterdam 1018 DD, The Netherlands E-mail:
| |
Collapse
|
8
|
Narra R, Maeda JM, Temba H, Mghamba J, Nyanga A, Greiner AL, Bakari M, Beer KD, Chae SR, Curran KG, Eidex RB, Gibson JJ, Handzel T, Kiberiti SJ, Kishimba RS, Lukupulo H, Malibiche T, Massa K, Massay AE, McCrickard LS, Mchau GJ, Mmbaga V, Mohamed AA, Mwakapeje ER, Nestory E, Newton AE, Oyugi E, Rajasingham A, Roland ME, Rusibamayila N, Sembuche S, Urio LJ, Walker TA, Wang A, Quick RE. Notes from the Field: Ongoing Cholera Epidemic - Tanzania, 2015-2016. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2017; 66:177-178. [PMID: 28207686 PMCID: PMC5657858 DOI: 10.15585/mmwr.mm6606a5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Rupa Narra
- These authors contributed equally to this report
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|