201308 Impact of a rapid cholera response program on knowledge and practices regarding water treatment and hygiene -- Kenya, 2008

Wednesday, November 11, 2009: 8:30 AM

Kashmira A. Date, MD, MPH , Enteric Diseases Epidemiology Branch, Division of Bacterial Foodborne and Mycotic Diseases, NCZVED, Centers for Disease Control and Prevention (CDC), Atlanta, GA
Benjamin Nygren, MPH , Enteric Diseases Epidemiology Branch, DBFMD, NCZVED, Centers for Disease Control and Prevention (CDC), Atlanta, GA
Bobbie Person, PhD, MPH , Centers for Disease Control and Prevention, Atlanta, GA
Alfredo Obure , Kenya Medical Research Institute, Kisumu, Kenya
Steve Kola, BA , Safe Water and AIDS Project, Kisumu, Kenya
Kathleen Wannemuehler, MS , Global Immunization Division, NCIRD, Centers for Disease Control and Prevention, Atlanta, GA
Robert E. Quick, MD, MPH , Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, GA
Background: Cholera outbreaks cause considerable morbidity and mortality in Kenya. We developed rapid cholera response teams to respond by distributing locally-available, socially-marketed water chlorination products and educating affected populations. We assessed program impact on water treatment knowledge and practices.

Methods: In November 2008, we conducted a cross-sectional survey in six cholera-affected (intervention) communities, where our cholera teams had responded, and six geographically-matched comparison communities where our teams did not respond. We confirmed water treatment by testing stored household water for residual chlorine.

Results: We surveyed 362 intervention and 361 comparison households. Over 33% of respondents in both groups were aware that a cholera outbreak had occurred; about half in each group had attended a cholera education event; 64% of intervention and 57% of comparison respondents reported receiving water treatment products at these events. Over 93% were aware of WaterGuard, the most commonly available water treatment product, but <10% from a cholera event. Water treatment on the day of interview was reported by 60% of intervention and 58% of comparison respondents. Intervention households had a greater tendency than comparison households to have detectable chlorine residuals in stored water (18% vs. 13%, matched odds ratio 1.5, 95% confidence interval 0.972.3).

Conclusions: Although cholera outbreak awareness, cholera event attendance, and water treatment knowledge were similar between the two groups, intervention households had a greater tendency than comparison households to treat stored water effectively. Efforts to improve the impact of cholera response activities, including coordination with other organizations that respond to outbreaks, are planned.

Learning Objectives:
1. Describe a rapid cholera response program in Kenya. 2. Describe the methods used to evaluate the rapid cholera response program. 3. Assess program impact on water treatment and hygiene practices, and discuss public health recommendations.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am amedical epidemiologist by background and currently serve as an Epidemic intelligence Service (EIS) officer with the CDC. I have worked in several international health settings, including India, Ghana and Kenya in monitoring and evaluation, and assessments of international health projects. I am the primary investigator on the Cholera Response project, the work that is being submitted for presentation. I was primarily responsible for the design, coordination and the implementation of this study in Kenya in 2008.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.