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Contemporary Nigerian public health problem: prevention and surveillance are key to combating cholera
Israel Oluwasegun Ayenigbara | George Omoniyi Ayenigbara | Rowland Olasunkanmi Adeleke
Date of Publication:
GMS Hygiene and Infection Control
This review characterizes a cholera outbreak in Nigeria in 2017/2018. On the basis of own experiences and the analysis of historical outbreaks, the Vibrio cholera strains, mode of transmission, signs and symptoms, and most important the prevention and control measures are identified. Untreated, the lethality of cholera is up to 70%. Therefore, a multifaceted approach including public policy, surveillance, water purification and hygiene, community sensitization, and the use of oral cholera vaccination is vital to prevent, control, and reduce the cholera mortality rate. It is recommended that the government pass legislation to implement preventive and surveillance measures, e.g., invest in drinking water systems, sanitation systems and sewage treatment, and promote public education on basic hygiene. The latter includes boiling and treating water before drinking, washing hands frequently with soap and clean water, thoroughly cooking food before consumption, avoiding open defecation, disposing of wastes properly, and immediately taking anyone with signs and symptoms of cholera such as watery diarrhea to the hospital for treatment.
Assessment of recommended approaches for containment and safe handling of human excreta in emergency settings
Diogo Trajano Gomes da Silva | Edgard Dias | James Ebdon | Huw Taylor
Date of Publication:
Ebola and cholera treatment centres (ETCs and CTCs) generate considerable quantities of excreta that can further the transmission of disease amongst patients and health workers. Therefore, approaches for the safe handling, containment and removal of excreta within such settings are needed to minimise the likelihood of disease transmission. This study compared the performance and suitability of three chlorine-based approaches (0.5% HTH, NaDCC and NaOCl (domestic bleach)) and three lime-based approaches (10%, 20% and 30% Ca(OH)2). The experiments followed recent recommendations for ETCs. Three excreta matrices containing either raw municipal wastewater, or raw municipal wastewater plus 10% or 20% (w/v) added faecal sludge, were treated in 14 litre buckets at a ratio of 1:10 (chlorine solutions or lime suspensions: excreta matrix). The effects of mixing versus non-mixing and increasing contact time (10 and 30 mins) were also investigated. Bacterial (faecal coliforms (FC) and intestinal enterococci (IE)) and viral (somatic coliphages (SOMPH), F+specific phages (F+PH) and Bacteroides fragilis phages (GB-124PH)) indicators were used to determine the efficacy of each approach. Lime-based approaches provided greater treatment efficacy than chlorine-based approaches, with lime (30% w/v) demonstrating the greatest efficacy (log reductions values, FC = 4.75, IE = 4.16, SOMPH = 2.85, F+PH = 5.13 and GB124PH = 5.41). There was no statistical difference in efficacy between any of the chlorine-based approaches, and the highest log reduction values were: FC = 2.90, IE = 2.36, SOMPH = 3.01, F+PH = 2.36 and GB124PH = 0.74. No statistical difference was observed with respect to contact time for any of the approaches, and no statistical differences were observed with respect to mixing for the chlorine-based approaches. However, statistically significant increases in the efficacy of some lime-based approaches were observed following mixing. These findings provide evidence and practical advice to inform safe handling and containment of excreta and ensure more effective health protection in future emergency settings.
Minimizing the Risk of Disease Transmission in Emergency Settings: Novel In Situ Physico-Chemical Disinfection of Pathogen-Laden Hospital Wastewaters
Emanuele Sozzi | Kerline Fabre | Jean-François Fesselet | James E. Ebdon | Huw Taylor | Jessica N. Ricaldi
Date of Publication:
PLOS Neglected Tropical Diseases
The operation of a health care facility, such as a cholera or Ebola treatment center in an emergency setting, results in the production of pathogen-laden wastewaters that may potentially lead to onward transmission of the disease. The research presented here evaluated the design and operation of a novel treatment system, successfully used by Médecins Sans Frontières in Haiti to disinfect CTC wastewaters in situ, eliminating the need for road haulage and disposal of the waste to a poorly-managed hazardous waste facility, thereby providing an effective barrier to disease transmission through a novel but simple sanitary intervention. The physico-chemical protocols eventually successfully treated over 600 m3 of wastewater, achieving coagulation/flocculation and disinfection by exposure to high pH (Protocol A) and low pH (Protocol B) environments, using thermotolerant coliforms as a disinfection efficacy index. In Protocol A, the addition of hydrated lime resulted in wastewater disinfection and coagulation/flocculation of suspended solids. In Protocol B, disinfection was achieved by the addition of hydrochloric acid, followed by pH neutralization and coagulation/flocculation of suspended solids using aluminum sulfate. Removal rates achieved were: COD >99%; suspended solids >90%; turbidity >90% and thermotolerant coliforms >99.9%. The proposed approach is the first known successful attempt to disinfect wastewater in a disease outbreak setting without resorting to the alternative, untested, approach of ‘super chlorination’ which, it has been suggested, may not consistently achieve adequate disinfection. A basic analysis of costs demonstrated a significant saving in reagent costs compared with the less reliable approach of super-chlorination. The proposed approach to in situ sanitation in cholera treatment centers and other disease outbreak settings represents a timely response to a UN call for onsite disinfection of wastewaters generated in such emergencies, and the ‘Coalition for Cholera Prevention and Control’ recently highlighted the research as meriting serious consideration and further study. Further applications of the method to other emergency settings are being actively explored by the authors through discussion with the World Health Organization with regards to the ongoing Ebola outbreak in West Africa, and with the UK-based NGO Oxfam with regards to excreta-borne disease management in the Philippines and Myanmar, as a component of post-disaster incremental improvements to local sanitation chains.
Emergency Sanitation: Faecal Sludge Treatment Field-work Summary
Jan Spit | Dennis Malambo | Maria Elliette Gonzalez | Happiness Nobela | Lobke de Pooter | Katie Anderson
Date of Publication:
Three Emergency Faecal Sludge Treatment Options have been investigated through small scale experiments using Fresh Faecal Sludge over 3 months (Jan–April 2014) in Blantyre, Malawi.
Preliminary testing has indicated that based on the small-scale field trials, Urea Treatment, Hydrated Lime Treatment and Lactic Acid Fermentation are promising low-tech faecal sludge treatment technologies and are all potentially applicable to emergency situations. The sludge used in the trials was sourced from Bangwe Market Pit Latriens and extracted using a desludging technique involving high pressure fluidization and a vaccuum pump. The characteristics of the Faecal sludge collected from the Bangwe Market Pit Latrines each week varied considerably reflecting the heterogeneous nature of faecal sludge as well as the influence of external factors such as climatic conditions. Based on the small-scale field trials all three treatment processes are able to satisfy the key safety, sanitation and robustness criteria for emergency faecal sludge treatment processes