Our Advisory Council
To respond to the increasin...
An alliance of prominent or...
An advocacy tool
A contagious diarrhoeal dis...
Our prevention strategy
Methodology for the elimina...
A best practice model in th...
A best practice model in the Democratic Republic of Congo
Cholera Source Areas in DRC
A multisectorial action plan
Logos & banners
full text open access
democratic republic of the congo
african great lakes region
case-area targeted interventions
republic of the congo
Broad approaches to cholera control in Asia: Water, sanitation and handwashing
Stephen P. Luby | Jennifer Davis | Rebekah R. Brown | Steven M. Gorelick | Tony H. F. Wong
Date of Publication:
Feb 29, 2020
Cholera has been eliminated as a public health problem in high-income countries that have implemented sanitation system separating the community’s fecal waste from their drinking water and food supply. These expensive, highly-engineered systems, first developed in London over 150 years ago, have not reached low-income high-risk communities across Asia. Implementation barriers in communities at highest risk for cholera include the high capital and operating costs for this technological approach, limited capacity and perverse incentives of local governments, and a decreasing availability of water. Interim solutions including household level water treatment, latrine construction and promotion of handwashing have only marginally reduced the risk of cholera and other fecally transmitted diseases. Increased research to develop and policy flexibility to implement a new generation of solutions that are designed specifically to address the physical, financial and political constraints of low-income communities offers the best prospect to reduce the burden of cholera across Asia.
Prevention and control of cholera with household and community water, sanitation and hygiene (WASH) interventions: A scoping review of current international guidelines
Lauren D’Mello-Guyett | Karin Gallandat | Rafael Van den Bergh | Dawn Taylor | Gregory Bulit | Dominique Legros | Peter Maes | Francesco Checchi | Oliver Cumming
Date of Publication:
WASH guidelines recommending interventions for the prevention and control of cholera are numerous and vary considerably in their recommendations. To date, there has been no review of practice guidelines used in cholera prevention and control programmes. We systematically searched international agency websites to identify WASH intervention guidelines used in cholera programmes in endemic and epidemic settings. Eight international guidelines were included in this review: three by non-governmental organisations (NGOs), one from a non-profit organisation (NPO), three from multilateral organisations and one from a research institution. There were 95 distinct recommendations identified, and concordance among guidelines was poor to fair. All categories of WASH interventions were featured in the guidelines. The majority of recommendations targeted community-level transmission (45%), 35% targeted within-household transmission and 20% both. Recent evidence suggests that interventions for effective cholera control and response to epidemics should focus on case-centred approaches and within-household transmission. Guidelines did consistently propose interventions targeting transmission within households. However, the majority of recommendations listed in guidelines targeted community-level transmission and tended to be more focused on preventing contamination of the environment by cases or recurrent outbreaks, and the level of service required to interrupt community-level transmission was often not specified. The guidelines in current use were varied and interpretation may be difficult when conflicting recommendations are provided. Future editions of guidelines should reflect on the inclusion of evidence-based approaches, cholera transmission models and resource-efficient strategies.
Predicting quality and quantity of water used by urban households based on tap water service
Aurelie Jeandron | Oliver Cumming | Lumami Kapepula | Simon Cousens
Date of Publication:
December 16, 2019
npj Clean Water
Despite significant progress in improving access to safe water globally, inadequate access remains a major public health concern in low- and middle-income countries. We collected data on the bacterial quality of stored drinking water and the quantity of water used domestically from 416 households in Uvira, Democratic Republic of the Congo. An indicator of tap water availability was constructed using invoices from 3,685 georeferenced piped water connections. We examined how well this indicator predicts the probability that a household’s stored drinking water is contaminated with Escherichia coli, and the total amount of water used at home daily, accounting for distance from alternative surface water sources. Probability of drinking water contamination is predicted with good discrimination overall, and very good discrimination for poorer households. More than 80% of the households are predicted to store contaminated drinking water in areas closest to the rivers and with the worst tap water service, where river water is also the most likely reported source of drinking water. A model including household composition predicts nearly two-thirds of the variability in the reported quantity of water used daily at home. Households located near surface water and with a poor tap water service indicator are more likely to use water directly at the source. Our results provide valuable information that supports an ongoing large-scale investment in water supply infrastructure in Uvira designed to reduce the high burden of cholera and other diarrhoeal diseases. This approach may be useful in other urban settings with limited water supply access.
Cholera prevention and control in refugee settings: Successes and continued challenges
Kerry Shannon | Marisa Hast | Andrew S. Azman | Dominique Legros | Heather McKay | Justin Lessler
Date of Publication:
PLoS Neglected Tropical Diseases
Cholera has long been viewed as a serious threat for refugee populations. In the 1980s and 90s, refugee camps proliferated in Africa and Asia as a result of large civil wars and environmental disasters. These camps experienced large-scale cholera outbreaks with regularity because of overcrowding, scarce clean water, and poor sanitation and hygiene practices. Death rates were often high because of preexisting malnutrition, comorbidities, and limited access to medical care. Mobilization around these issues was greatly accelerated in 1994, when a particularly massive outbreak occurred among Rwandan refugees in the Lake Kivu region of Zaire (present-day Democratic Republic of the Congo), and approximately 42,000 people died. In response to this unprecedented tragedy, the humanitarian community developed and adopted the Sphere standards for the minimum acceptable living conditions and availability of health services in refugee camps and other humanitarian responses. Although refugee camps continue to experience many vulnerabilities, the increased focus on improved camp coordination, preparedness, timely multisectoral response, and adherence to minimum standards has resulted in a notable decrease in the number and size of camp-based cholera outbreaks and associated mortality.