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      Cholera knowledge, socioeconomic and WaSH characteristics in Aden - Yemen, 2017: a community-based comparative survey

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          Summary

          Objectives

          To improve prevention and control response to the cholera outbreak, we sought to assess and compare the community’s cholera awareness and needs in high and low epidemic areas in Aden.

          Methods

          A community-based comparative survey was conducted in 2017. We used multi-stage cluster sampling. Eligible household heads in high and low epidemic areas were interviewed. The data collected from both areas using a pretested questionnaire.

          Results

          Cholera cases and mortality were higher in high epidemic areas compared with low epidemic areas. Socioeconomic, water, sanitation, and hygienic conditions were poorer in high epidemic areas compared with low epidemic areas. Knowledge of cholera transmission and prevention was sub-optimal in both areas. We found a mismatch between the delivered education and distributed preventive materials.

          Conclusions

          Stakeholders should tailor the design, content, and implementation of future cholera prevention and control methods to meet the needs of the community. Future educational camping should focus on the transmission prevention, including vaccination. Education and sustainable interventions should be implemented to improve the water, sanitation, and hygiene.

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          Updated Global Burden of Cholera in Endemic Countries

          Mohammad Alauddin Mohammad Ali, Allyson Nelson, Anna Lena Lopez … (2015)
          Background The global burden of cholera is largely unknown because the majority of cases are not reported. The low reporting can be attributed to limited capacity of epidemiological surveillance and laboratories, as well as social, political, and economic disincentives for reporting. We previously estimated 2.8 million cases and 91,000 deaths annually due to cholera in 51 endemic countries. A major limitation in our previous estimate was that the endemic and non-endemic countries were defined based on the countries’ reported cholera cases. We overcame the limitation with the use of a spatial modelling technique in defining endemic countries, and accordingly updated the estimates of the global burden of cholera. Methods/Principal Findings Countries were classified as cholera endemic, cholera non-endemic, or cholera-free based on whether a spatial regression model predicted an incidence rate over a certain threshold in at least three of five years (2008-2012). The at-risk populations were calculated for each country based on the percent of the country without sustainable access to improved sanitation facilities. Incidence rates from population-based published studies were used to calculate the estimated annual number of cases in endemic countries. The number of annual cholera deaths was calculated using inverse variance-weighted average case-fatality rate (CFRs) from literature-based CFR estimates. We found that approximately 1.3 billion people are at risk for cholera in endemic countries. An estimated 2.86 million cholera cases (uncertainty range: 1.3m-4.0m) occur annually in endemic countries. Among these cases, there are an estimated 95,000 deaths (uncertainty range: 21,000-143,000). Conclusion/Significance The global burden of cholera remains high. Sub-Saharan Africa accounts for the majority of this burden. Our findings can inform programmatic decision-making for cholera control.
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            Cholera

            John D Clemens, G. Nair, Tahmeed Ahmed … (2017)
            Cholera is an acute, watery diarrhoeal disease caused by Vibrio cholerae of the O1 or O139 serogroups. In the past two centuries, cholera has emerged and spread from the Ganges Delta six times and from Indonesia once to cause global pandemics. Rational approaches to the case management of cholera with oral and intravenous rehydration therapy have reduced the case fatality of cholera from more than 50% to much less than 1%. Despite improvements in water quality, sanitation, and hygiene, as well as in the clinical treatment of cholera, the disease is still estimated to cause about 100 000 deaths every year. Most deaths occur in cholera-endemic settings, and virtually all deaths occur in developing countries. Contemporary understanding of immune protection against cholera, which results from local intestinal immunity, has yielded safe and protective orally administered cholera vaccines that are now globally stockpiled for use in the control of both epidemic and endemic cholera.
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              Global Cholera Epidemiology: Opportunities to Reduce the Burden of Cholera by 2030

              Dominique Legros (2018)
              Abstract While safe drinking water and advanced sanitation systems have made the Global North cholera-free for decades, the disease still affects 47 countries across the globe resulting in an estimated 2.86 million cases and 95,000 deaths per year worldwide. Cholera impacts communities already burdened by conflict, lack of infrastructure, poor health systems, and malnutrition. In October 2017, the Global Task Force on Cholera Control (GTFCC) launched an initiative titled Ending Cholera: A Global Roadmap to 2030, with the objective to reduce cholera deaths by 90% worldwide, and eliminate cholera in at least 20 countries by 2030. The GTFCC is working to position cholera control not as a vertical programme but instead using cholera as a marker of inequity and an indicator of poverty, linking the objectives of the Roadmap to the SDGs. The roadmap consists of targeted multi-sectoral interventions, supported by a coordination mechanism, along 3 axes: (1) early detection and quick response to contain outbreaks; (2) a multisectoral approach to prevent cholera recurrence in hotspots; (3) an effective partnership mechanism of coordination for technical support, countries capacity building, research and M&E, advocacy and resource mobilization. Every case and every death from cholera is preventable with the tools we have today.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Prev Med Hyg
                Journal ID (iso-abbrev): J Prev Med Hyg
                Journal ID (publisher-id): JPMH
                Title: Journal of Preventive Medicine and Hygiene
                Publisher: Pacini Editore Srl
                ISSN (Print): 1121-2233
                ISSN (Electronic): 2421-4248
                Publication date (Electronic): 06 October 2020
                Publication date Collection: September 2020
                Volume: 61
                Issue: 3
                Pages: E392-E400
                Affiliations
                [1 ] Department of Community Medicine and Public Health, Faculty of Medicine and Health Sciences, University of Aden , Aden, Yemen
                [2 ] CRIMEDIM - Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale , Novara, Italy
                Author notes
                Correspondence: Awsan Bahattab, CRIMEDIM – Research Center in Emergency and Disaster Medicine, Università del Piemonte, vicolo Monte Ariolo 4, 28100 Novara, Italy - E-mail: awsan.bahattab@ 123456med.uniupo.it
                Article
                DOI: 10.15167/2421-4248/jpmh2020.61.3.1529
                PMC ID: 7595064
                SO-VID: 10283985-c354-4a96-b37e-7dc42b7cb22a
                Copyright © ©2020 Pacini Editore SRL, Pisa, Italy
                License:

                This is an open access article distributed in accordance with the CC-BY-NC-ND (Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International) license. The article can be used by giving appropriate credit and mentioning the license, but only for non-commercial purposes and only in the original version. For further information: https://creativecommons.org/licenses/by-nc-nd/4.0/deed.en

                History
                Date received : 14 April 2020
                Date accepted : 15 August 2020
                Page count
                Figures: 1, Tables: 6, Equations: 0, References: 25, Pages: 9
                Categories
                Subject: Original Article

                Keywords: acute watery diarrhoea,awareness,environmental sanitation,education,yemen
                Data availability:
                Keywords: acute watery diarrhoea, awareness, environmental sanitation, education, yemen

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