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Social mobilization for cholera prevention & control in India: Building on the existing framework
Sanjukta Sen Gupta | Satish Kumar Gupta
Date of Publication:
February 29, 2020
Social mobilization is an important component of the delivery of vaccines and has to be carried out at different levels. It plays a very critical role in success of a campaign, as was shown by the Polio eradication program in India that was supported by SMNet, a platform created for the purpose. Learnings from this has been used for other vaccine deployments in India as well. In addition, there is a social mobilization effort for routine immunization. A guideline for social mobilization was created by UNICEF specifically for cholera vaccine use during Haiti epidemic in 2010. Since there is a need to develop a roadmap for cholera control in India, especially in the known hotspots, and after natural disasters, we suggest a possible strategy that could be built on the existing framework available in India.
Outbreak of Cholera Due to Cyclone Kenneth in Northern Mozambique, 2019
Edgar Cambaza | Edson Mongo | Elda Anapakala | Robina Nhambire | Jacinto Singo | Edsone Machava
Date of Publication:
International Journal of Environmental Research and Public Health
Cyclone Kenneth was the strongest in the recorded history of the African continent. It landed in the Cabo Delgado province in northern Mozambique on 25 April 2019, causing 45 deaths, destroying approximately 40,000 houses, and leaving 374,000 people in need for assistance, most at risk of acquiring waterborne diseases such as cholera. This short article aims to explain how the resulting cholera outbreak occurred and the response by the government and partner organizations. The outbreak was declared on 2 May 2019, after 14 cases were recorded in Pemba city (11 cases) and the Mecúfi district (3 cases). The disease spread to Metuge, and by the 12th of May 2019, there were 149 cases. Aware of the risk of an outbreak of cholera, the government and partners took immediate action as the cyclone ended, adapting the Cholera Response Plan for Beira, revised after the experience with cyclone Idai (4–21 March 2019). The response relevant to cholera epidemics consisted of social mobilization campaigns for prevention, establishment of treatment centers and units, coordination to improve of water, sanitation and hygiene, and surveillance. By 26 May 2019, 252,448 people were immunized in the area affected by cyclone Kenneth. The recovery process is ongoing but the number of new cases has been reducing, seemingly due to an efficient response, support of several organizations and collaboration of the civil society. Future interventions shall follow the same model of response but the government of Mozambique shall keep a contingency fund to manage disasters such as cyclone Idai and Kenneth. The unlikeliness of two cyclones (Idai and Kenneth) within two months after decades without such kind of phenomena points towards the problem of climate change, and Mozambique needs to prepare effective, proven response plans to combat outbreaks of waterborne diseases due to cyclones.
A rapid qualitative assessment of oral cholera vaccine anticipated acceptability in a context of resistance towards cholera intervention in Nampula, Mozambique
Rachel Demolis | Carlos Botão | Leonard W. Heyerdahl | Bradford D. Gessner | Philippe Cavailler | Celestino Sinai | Amílcar Magaço | Jean-Bernard Le Gargasson | Martin Mengel | Elise Guillermet
Date of Publication:
While planning an immunization campaign in settings where public health interventions are subject to politically motivated resistance, designing context-based social mobilization strategies is critical to ensure community acceptability. In preparation for an oral cholera vaccine (OCV) campaign implemented in Nampula, Mozambique, in November 2016, we assessed potential barriers and levers for vaccine acceptability. During previous well chlorination interventions, some government representatives and health agents were attacked, because they were believed to be responsible for spreading cholera instead of purifying the wells. Politically motivated resistance to cholera interventions resurfaced when an OCV campaign was considered. Respondents also reported vaccine hesitancy related to experiences of problems during school-based vaccine introduction, rumors related to vaccine safety, and negative experiences following routine childhood immunization. Despite major suspicions associated with the OCV campaign, respondents’ perceived vulnerability to cholera and its perceived severity seem to override potential anticipated OCV vaccine hesitancy. Potential hesitancy towards the OCV campaign is grounded in global insecurity, social disequilibrium, and perceived institutional negligence, which reinforces a representation of estrangement from the central government, triggering suspicions on its intentions in implementing the OCV campaign. Recommendations include a strong involvement of community leaders, which is important for successful social mobilization; representatives of different political parties should be equally involved in social mobilization efforts, before and during campaigns; and public health officials should promote other planned interventions to mitigate the lack of trust associated with perceived institutional negligence. Successful past initiatives include public intake of purified water or newly introduced medication by social mobilizers, teachers or credible leaders.
Delivery cost analysis of a reactive mass cholera vaccination campaign: a case study of Shanchol™ vaccine use in Lake Chilwa, Malawi
Patrick G. Ilboudo | Jean-Bernard Le Gargasson
Date of Publication:
BMC Infectious Diseases
This study aims to analyze Shanchol vaccine delivery costs, focusing on the vaccination campaign in response of a cholera outbreak in Lake Chilwa, Malawi. In total, 67,240 persons received two complete doses of the vaccine. Vaccine coverage was higher in the first round than in the second. The two-dose coverage measured with the immunization card was estimated at 58%. The total financial cost incurred in implementing the campaign was US$480,275, while the economic cost was US$588,637. The total financial and economic costs per fully vaccinated person were US$7.14 and US$8.75, respectively, with delivery costs amounting to US$1.94 and US$3.55, respectively. Vaccine procurement and shipment accounted respectively for 73% and 59% of total financial and economic costs of the total vaccination campaign costs, while the incurred personnel cost accounted for 13% and 29% of total financial and economic costs. Cost for delivering a single dose of Shanchol was estimated at US$0.97. In conclusion, this study provides new evidence on economic and financial costs of a reactive campaign implemented by international partners in collaboration with MoH. It shows that involvement of international partner personnel may represent a substantial share of campaign costs, affecting unit and vaccine delivery costs.
Report of the first meeting of the Global Task Force on Cholera Control (GTFCC), 26-27 June 2014
World Health Organization
Date of Publication:
The Global Task Force for Cholera Control (GTFCC) was revitalized through a process begun in December 2012 and completed in early 2014. The first meeting of the revitalized GTFCC was held in June 2014 to finalize membership and priorities. The meeting was chaired by Professor David Sack. It was noted during the opening of the meeting that cholera is a complex public health problem requiring cross-sectoral solutions and broad stakeholder collaboration. WHO convened the first meeting of the GTFCC to identify those solutions, bring together partners also committed to cholera control and set a research agenda to better coordinate stakeholder efforts.