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Modeling the effect of water, sanitation, and hygiene and oral cholera vaccine implementation in Haiti.

ABSTRACT: In 2010, toxigenic Vibrio cholerae was newly introduced to Haiti. Because resources are limited, decision-makers need to understand the effect of different preventive interventions. We built a static model to estimate the potential number of cholera cases averted through improvements in coverage in water, sanitation and hygiene (WASH) (i.e., latrines, point-of-use chlorination, and piped water), oral cholera vaccine (OCV), or a combination of both. We allowed indirect effects and non-linear relationships between effect and population coverage. Because there are limited incidence data for endemic cholera in Haiti, we estimated the incidence of cholera over 20 years in Haiti by using data from Malawi. Over the next two decades, scalable WASH interventions could avert 57,949-78,567 cholera cases, OCV could avert 38,569-77,636 cases, and interventions that combined WASH and OCV could avert 71,586-88,974 cases. Rate of implementation is the most influential variable, and combined approaches maximized the effect.

SUBMITTER: Fung IC

PROVIDER: S-EPMC3795092 | biostudies-literature | 2013 Oct

REPOSITORIES: biostudies-literature

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Modeling the effect of water, sanitation, and hygiene and oral cholera vaccine implementation in Haiti.

Fung Isaac Chun-Hai IC Fitter David L DL Borse Rebekah H RH Meltzer Martin I MI Tappero Jordan W JW

The American journal of tropical medicine and hygiene 20131001 4

In 2010, toxigenic Vibrio cholerae was newly introduced to Haiti. Because resources are limited, decision-makers need to understand the effect of different preventive interventions. We built a static model to estimate the potential number of cholera cases averted through improvements in coverage in water, sanitation and hygiene (WASH) (i.e., latrines, point-of-use chlorination, and piped water), oral cholera vaccine (OCV), or a combination of both. We allowed indirect effects and non-linear rela ...[more]

PMID: 24106189

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Project description:Oral cholera vaccines (OCVs) are relatively new public health interventions, and limited data exist on the potential impact of OCV use on traditional cholera prevention and control measures-safe water, sanitation and hygiene (WaSH). To assess OCV acceptability and knowledge, attitudes, and practices (KAPs) regarding cholera and WaSH, we conducted cross-sectional surveys, 1 month before (baseline) and 3 and 12 months after (first and second follow-up) a preemptive OCV campaign in Maela, a long-standing refugee camp on the Thailand-Burma border. We randomly selected households for the surveys, and administered questionnaires to female heads of households. In total, 271 (77%), 187 (81%), and 199 (85%) households were included in the baseline, first and second follow-up surveys, respectively. Anticipated OCV acceptability was 97% at baseline, and 91% and 85% of household members were reported to have received 1 and 2 OCV doses at first follow-up. Compared with baseline, statistically significant differences (95% Wald confidence interval not overlapping zero) were noted at first and second follow-up among the proportions of respondents who correctly identified two or more means of cholera prevention (62% versus 78% and 80%), reported boiling or treating drinking water (19% versus 44% and 69%), and washing hands with soap (66% versus 77% and 85%); a significant difference was also observed in the proportion of households with soap available at handwashing areas (84% versus 90% and 95%), consistent with reported behaviors. No significant difference was noted in the proportion of households testing positive for Escherichia coli in stored household drinking water at second follow-up (39% versus 49% and 34%). Overall, we observed some positive, and no negative changes in cholera- and WaSH-related KAPs after an OCV campaign in Maela refugee camp. OCV campaigns may provide opportunities to reinforce beneficial WaSH-related KAPs for comprehensive cholera prevention and control.

Project description:Background and methodsCholera remains a significant threat to global public health with an estimated 100,000 deaths per year. Water, sanitation and hygiene (WASH) interventions are frequently employed to control outbreaks though evidence regarding their effectiveness is often missing. This paper presents a systematic literature review investigating the function, use and impact of WASH interventions implemented to control cholera.ResultsThe review yielded eighteen studies and of the five studies reporting on health impact, four reported outcomes associated with water treatment at the point of use, and one with the provision of improved water and sanitation infrastructure. Furthermore, whilst the reporting of function and use of interventions has become more common in recent publications, the quality of studies remains low. The majority of papers (>60%) described water quality interventions, with those at the water source focussing on ineffective chlorination of wells, and the remaining being applied at the point of use. Interventions such as filtration, solar disinfection and distribution of chlorine products were implemented but their limitations regarding the need for adherence and correct use were not fully considered. Hand washing and hygiene interventions address several transmission routes but only 22% of the studies attempted to evaluate them and mainly focussed on improving knowledge and uptake of messages but not necessarily translating this into safer practices. The use and maintenance of safe water storage containers was only evaluated once, under-estimating the considerable potential for contamination between collection and use. This problem was confirmed in another study evaluating methods of container disinfection. One study investigated uptake of household disinfection kits which were accepted by the target population. A single study in an endemic setting compared a combination of interventions to improve water and sanitation infrastructure, and the resulting reductions in cholera incidence.Discussion and recommendationsThis review highlights a focus on particular routes of transmission, and the limited number of interventions tested during outbreaks. There is a distinct gap in knowledge of which interventions are most appropriate for a given context and as such a clear need for more robust impact studies evaluating a wider array of WASH interventions, in order to ensure effective cholera control and the best use of limited resources.

Project description:Cholera is an issue of major public health importance. It was first reported in Kenya in 1971, with the country experiencing outbreaks through the years, most recently in 2021. Factors associated with the outbreaks in Kenya include open defecation, population growth with inadequate expansion of safe drinking water and sanitation infrastructure, population movement from neighboring countries, crowded settings such as refugee camps coupled with massive displacement of persons, mass gathering events, and changes in rainfall patterns. The Ministry of Health, together with other ministries and partners, revised the national cholera control plan to a multisectoral cholera elimination plan that is aligned with the Global Roadmap for Ending Cholera. One of the key features in the revised plan is the identification of hotspots. The hotspot identification exercise followed guidance and tools provided by the Global Task Force on Cholera Control (GTFCC). Two epidemiological indicators were used to identify the sub-counties with the highest cholera burden: incidence per population and persistence. Additionally, two indicators were used to identify sub-counties with poor WASH coverage due to low proportions of households accessing improved water sources and improved sanitation facilities. The country reported over 25,000 cholera cases between 2015 and 2019. Of 290 sub-counties, 25 (8.6%) sub-counties were identified as a high epidemiological priority; 78 (26.9%) sub-counties were identified as high WASH priority; and 30 (10.3%) sub-counties were considered high priority based on a combination of epidemiological and WASH indicators. About 10% of the Kenyan population (4.89 million) is living in these 30-combination high-priority sub-counties. The novel method used to identify cholera hotspots in Kenya provides useful information to better target interventions in smaller geographical areas given resource constraints. Kenya plans to deploy oral cholera vaccines in addition to WASH interventions to the populations living in cholera hotspots as it targets cholera elimination by 2030.

Dataset Information

Modeling the effect of water, sanitation, and hygiene and oral cholera vaccine implementation in Haiti.

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Modeling the effect of water, sanitation, and hygiene and oral cholera vaccine implementation in Haiti.

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