A community-based cholera surveillance and education program in eastern Haiti

Introduction: On October 21, 2010 a cholera outbreak was confirmed by the Haitian National Public Health Laboratory. Within one month cholera had spread to each of ten departments of Haiti. The aim of this study is to analyze whether a Haitian national health agent-led cholera surveillance program combined with basic public health messaging can provide insight into cholera outcomes.

Methods: A health agent-led team assessed villages in the primary municipality of Fond Parisien in Ouest Department from November 2010 to January 2011. Data was gathered via in-depth and key informant interviews. A purposive sampling of presumed high-risk villages throughout the region with a cross-sectional sample of households within selected villages was completed. Individual households were questioned regarding cholera symptoms and provided with simple public health education. This data was compared to clinical and demographic data at the region's primary cholera treatment center (CTC) for analysis.

Results: Continuous data collection in the form of household surveys and rapid assessment procedures monitored high-risk populations in several hard to reach villages in the region. Health agents noted multiple deaths secondary to cholera-like symptoms in communities not reported to clinical or public health authorities. A total of 2416 clinical cases of cholera presented to the CTC over the study period. The clinical fatality rate was 0.745%.

Conclusions: The use of health agents trained in disaster management and mitigation was successful and contributed to public acceptance of the primary CTC and control of cholera deaths within the region.