UNICEF launches groundbreaking cholera toolkit

To tackle the alarming resurgence of cholera, UNICEF has launched a new comprehensive Cholera Toolkit on 15 May 2013.

The toolkit launch [...] will be the culmination of a thorough review of existing guidance and global consultation with UNICEF at all levels and from all divisions in Africa, along with main partners in the fight against cholera, such as the World Health Organization as the lead agency.

There are 3-5 million cholera cases each year, killing 100,000 to 120,000 people, half of whom are children under 5 years old. Only 5-10% of cases are reported. In Western and Central Africa, there were more than 80,000 cases of cholera in 2012 resulting in nearly 1,500 deaths.

The Toolkit provides the health and WASH sectors an integrated approach to cholera prevention, preparedness and response. In addition it includes specific content linked to education, nutrition, communication for development (C4D), child protection and other relevant sectors.

UNICEF Cholera Kit, p. 41

“What the toolkit does is harvest the best and most up-to-date knowledge in the field and brings it together in one location,” said UNICEF Chief of Water, Sanitation and Hygiene Sanjay Wijesekera. “It looks at the evidence. It looks at practices that have produced results.”

Download the Toolkit at: www.unicef.org/cholera

Related websites:

• WHO – Cholera
• CDC – Cholera
• MSF Field Research – Cholera

Source: UNICEF, 15 May 2013

 

 

Oxfam publishes advice on handling a cholera outbreak – but are we right?

Source: Oxfam Policy and Practice Blog, Aug 13, 2012, by Elizabeth Lamond, HSP Public Health Engineer Coordinator

Oxfam’s Cholera Outbreak Guidelines were developed as an internal resource, but today we are sharing them externally in order to seek input from the international humanitarian community. We hope that this feedback will inform later editions in order to develop a powerful resource for anyone looking to prepare for, prevent and control a cholera outbreak. Here, one of the authors of the Guideline, Bibi Lamond, explains more. 

I have been responsible for implementing and coordinating cholera outbreak programmes since 2006. In my work I have found that, although there are numerous documents and books on medical intervention for cholera control, there are no comprehensive water, sanitation and hygiene promotion (WASH) guidelines.

Oxfam’s new publication, the Cholera Outbreak Guidelines aims to meet this need and could set standards for other emergency WASH actors.

The content of the Guidelines has evolved from firsthand field experience in Oxfam’s emergency cholera programmes in Haiti, Democratic Republic of Congo, Ethiopia and Zimbabwe. It has also drawn on information from other NGOs, such as Médecins Sans Frontières, renowned for their cholera work in the field.

WASHplus Weekly – Focus on WASH-Related Diseases

Issue 58 June 1, 2012 | Focus on WASH-Related Diseases

The World Health Organization lists more than 20 diseases that are related to water, sanitation, and hygiene (WASH) conditions. This issue focuses on three of those:

• cholera,
• diarrhea, and
• typhoid fever

Information and resources for each of the three diseases include fact sheets, videos, recent peer-review studies, and links to additional resources. Future issues will focus on additional WASH-related diseases.

• Link to Weekly

OXFAM – Hygiene promotion: determining what works

OXFAM – Hygiene promotion: determining what works, 2012. Humanitarian field studies | Cholera response in Haiti

• Download Full-text (pdf)

When a massive earthquake struck Haiti in January 2010, followed by a cholera epidemic that broke out in October of that year, Oxfam rushed assistance—clean water, sanitation, and hygiene materials and information—to hard-hit areas to protect public health.

Hygiene promotion is arguably the most important intervention in a cholera epidemic: the route of cholera transmission is fecal-oral, and contaminated hands are often the principal vector. So Oxfam engages in a wide range of hygiene-promotion activities to encourage washing hands—specifically, washing hands with soap at key moments, such as before eating and after defecation.

But which of our interventions have been the most effective, and why? Is it more important to put resources into hygiene-themed theater productions or radio call-in shows? There is little hard evidence to suggest that—in Haiti or in emergencies anywhere—one hygiene-promotion activity works better than another. But lives, not to mention valuable resources, may depend on the answer, so in the spring of 2011, Oxfam engaged Eawag, the Swiss Federal Institute of Aquatic Science and Technology, to study the effectiveness of our hygiene-promotion activities in Haiti.

Haiti: lack of proper sanitation is real cause of cholera outbreak, Clinton says

Woman at Leogane camp saying the latrines behind her are full and smell foul. Photo credit: Haiti Grassroots Watch

Haiti should focus on stemming the cholera outbreak that has killed more than 7,000 people since 2010, rather than on levying blame against the source of the disease, UN special envoy to Haiti, Bill Clinton, said. While studies have suggested that the cholera came from a Nepalese soldier serving as a peacekeeper, Clinton pointed out that the country’s lack of proper sanitation was the real cause of the outbreak.

Clinton made the remarks after he toured a new public teaching hospital in Haiti’s Central Plateau that was built by the Boston-based Partners in Health.

In November 2011, the Boston-based Institute for Justice and Democracy in Haiti (IJDH) filed a demand for hundreds of millions of dollars in compensation from Haitian cholera victims.

Money to empty refugee camp toilets has run out

Clinton’s own foundation, together with UNICEF and USAID, supplied some 11,000 mobile toilets for the refugee camps that emerged after the 2010 Haiti earthquake. The NGOs that distributed the toilets and paid for them to be emptied are now pulling out one by one, leaving overflowing toilets behind, according to an IPS report.

Donor funds are being used to set up excreta treatment centres, one is now in operation in Morne-à-Cabri while a second centre is planned for Titanye, but these are not servicing the remaining refugee camps, home to nearly half a million people.

Source:

• AP, Former President Clinton urges officials to stem Haiti cholera outbreak, Washington Post, 07 Mar 2012
• Phares Jerome and Valery Daudier, Money for cleaning toilets in Haiti down the drain? – Part 1, IPS, 07 Mar 2012

Haiti: Twitter data accurately tracked cholera outbreak

Twitter messages were providing data that would have been a quicker way of detecting and tracking the 2010 cholera outbreak in Haiti than traditional methods, according to a study [1] published in the American Journal of Tropical Medicine and Hygiene.

The study found that online social media and news feeds were faster than, and broadly as accurate as, the official records at detecting the start and early progress of the epidemic, which hit Haiti after the earthquake in January 2010 and has killed more than 6,500 people.

[...]

The authors used HealthMap, an automated surveillance platform, to measure the volume of news media generated during the first 100 days of the outbreak, and they also looked at the number of ‘cholera’ posts on Twitter.

Haiti: cholera victims demand UN compensation

The United Nations has been hit with a demand for hundreds of millions of dollars in compensation from Haitian cholera victims.

The Boston, USA-based Institute for Justice and Democracy in Haiti (IJDH) filed the demand on behalf of some 5,000 victims.

IJDH is demanding US$ 50,000 in compensation for each sick person and US$ 100,000  for each death. In addition, it wants a public apology and an adequate nationwide response – including medical care and clean water and sanitation infrastructure.

The Economist – cholera and the super loo

July 30, 2011 – Solving the sanitation problem is within reach, and it could avoid many deaths

“CHOLERA most forcibly teaches us our mutual connection. Nothing shows more powerfully the duty of every man to look after the needs of others.” So said Titus Salt, a Victorian wool baron who worked to put an end to cholera in Yorkshire. It was cholera, as much as the great stink, which led London’s masters to build vast sewers, install toilets, and promote hygiene. Cholera struck fear into 19th-century cities, sweeping away the rich along with the poor. America’s President James K. Polk died of the disease after a visit to New Orleans. His successor, Zachary Taylor, may also have succumbed.

Photo from the Economist

The liquid diarrhoea and vomit jetted out by a body infected by the bacterium Vib rio choleraeis a reminder, in extreme form, of the danger lurking in the excrement which flows from every human settlement, creating a problem few want to go near. Not all human waste has the deadly bacterium; but all of it is dangerous and better disposal of faeces would go a huge way to stopping cholera and other deadly intestinal diseases.

And with the urban population in poor countries soaring, cholera is still a pressing concern. In Haiti the health ministry recently announced that 5,800 people had died of cholera since October last year. Another 250,000 had recovered, often after having lost work or schooling. Those numbers do not include Haitians believed to have died, helpless, in remote places.

Study suggests UN force brought cholera to Haiti

Evidence “strongly suggests” that a United Nations peacekeeping mission brought a cholera strain to Haiti that has killed thousands of people, a study by a team of epidemiologists and physicians says.

The study is the strongest argument yet that newly-arrived Nepalese peacekeepers at a base near the town of Mirebalais brought with them the cholera, which spread through the waterways of the Artibonite region.

The disease has killed more than 5,500 people and sickened more than 363,000 others since it was discovered in October 2010, according to the Haitian government.

“Our findings strongly suggest that contamination of the Artibonite (river) and 1 of its tributaries downstream from a military camp triggered the epidemic,” said the report in the July 2011 issue of the CDC journal Emerging Infectious Diseases.

In an email to Associate Press (AP), U.N. mission spokeswoman Sylvie Van Den Wildenberg didn’t comment on the findings of the journal article, referring only to a study released in May by a U.N.-appointed panel.

The article published in the CDC journal comes as health workers in Haiti wrestle with a spike in the number of cholera cases brought on by several weeks of rainfall. The aid group Oxfam said earlier this month that its workers were treating more than 300 new cases a day, more than three times what they saw when the disease peaked in the fall.

The CDC journal article comes as health workers in Haiti wrestle with a spike in the number of cholera cases brought on by several weeks of rainfall. Oxfam said earlier that its workers were treating more than 300 new cases a day, more than three times what they saw when the disease peaked in the fall of 2010.

The new study argues it is important for scientists to determine the origin of cholera outbreaks and how they spread in order to eliminate “accidentally imported disease.” Figuring out the source of a cholera epidemic would help health workers better treat and prevent cholera by minimizing the “distrust associated with the widespread suspicions of a cover-up of a deliberate importation of cholera.”

Read the full article
Piarroux, R. [et al.] (2011). Understanding the cholera epidemic, Haiti. Emerging infectious diseases ; vol. 17, no. 7 ; p. 1161-1167. DOI:10.3201/eid1707.110059

Source: Jonathan M. Katz, AP, 29 Jun 2011

64th World Health Assembly approves three WASH resolutions

The 64th World Health Assembly (WHA) has adopted a resolution on drinking-water, sanitation and health, and two other related resolutions on cholera and Guinea worm (dracunculiasis).

Yael Velleman at the WHA in Geneva with a copy of the WaterAid report "The sanitation problem - What can and should the health sector do". Photo: WaterAid

WaterAid had issued a call to leaders participating in the WHA in Geneva to prioritise sanitation and water in the fight against diseases including cholera and dracunculiasis. In support of their campaign, WaterAid published a new report
The sanitation problem: What can and should the health sector do?. WaterAid’s Senior Health Policy Analyst Yael Velleman wrote an opinion piece in the Guardian and posted daily updates from the WHA.