Anatomy of a cholera epidemic in rural Haiti

Purpose: To provide the anatomy of a cholera epidemic in a community and describe the importance of Community Based Primary Care (CBPC) in documenting and responding to crises.

Background: The CDC documented 171,000 cholera cases and 3651 deaths in Haiti (October 21, 2010 – January 1, 2011). November 19th was the first case in Grand Anse which has the highest death rate in Haiti (132/100,000). The Haitian Health Foundation (HHF) provides public health and clinical services in Grand Anse through 42 community health workers and 100+ community groups. A computerized census provides data on 167,000 people.

Methods: HHF began preparing for cholera with the first case in another part of Haiti. Staff was trained in treatment and referral. Cholera education was developed and incorporated in ongoing activities. HHF designed a community response for prevention, tracking and treatment. Data was entered in excel and analyzed in SPSSv.18.

Results: In the first 7 weeks HHF provided education on all aspects of cholera for 39,000 people, and tracked 1405 cases, 270 deaths (19%), 49% improved, 32% were referred. Age was associated with outcome: mean age was 46.5 for deaths and 35.2 for survivors (F=56.0; p<.001); children <5 are 8.5% of total population but 4.4% of cholera cases and deaths.

Implications: Rapid mobilization in an epidemic is facilitated by community tracking and interventions, and provides valuable population data. Most reporting about cholera is from facilities, which underestimates prevalence and treatment rates. This information will be used by MoH, WHO and NGOs.