Objectives: To evaluate routine use of antimicrobial drugs for treatment and prevention of cholera with special regards to the evolution of the antimicrobial drug resistance patterns of V. cholerae strains. Design: Retrospective population-based descriptive study. Subjects: Four thousand nine hundred and forty one notified cholera cases, their 15,381 patients' guards and their 159,263 household members and close neighbours. Results: A total of 4,941 patients received antibiotic therapy according to the treatment protocols. Prophylactic treatment was administered to 15,381 patients' guards in hospitals and to 159,263 household members and close neighbours during home visits. Over the entire outbreak, the antimicrobial susceptibility patterns of V. cholerae strains isolated remained stable. Conclusions: The routine use of antimicrobial therapy for cholera cases associated with simultaneous and large scale chemoprophylaxis of close contacts does not seem in our experience to compromise the stability of V. cholerae susceptibility profiles to drugs when applied within a comprehensive package of rigorously monitored community interventions. The role of therapy and chemoprophylaxis in limiting the extent of a cholera epidemic is however difficult to ascertain from our experience. Field trials need to be designed to elucidate this aspect.
Formative supervision is a quality and performance tool based on evaluation and adult training techniques. The 2004 cholera outbreak in Douala (Cameroon) presented a critical problem in terms of quality of care; formative supervision emerged as the choice of instrument developed as a key response and solution. After a chronological qualitative description of how the supervision team and system were constituted, established and organized, the results are presented: strengthening infrastructure, equipment and organisation; improving the quality of care, hygiene, communication, and management. The system requires capacity building for sustainability in order to also be eventually extended to other health districts and other health sector activities, on the condition that the necessary resources can be mobilized.
To assess the quality of the response to the 2008 outbreak of cholera in Cotonou (Benin), this retrospective study focused on the health professionals managing the response, community leaders, cases of cholera found in homes and health service documents. The terms of reference used for the purposes of this assessment included the WHO recommendations and the rules set out in the national plan for the fight against epidemics. The resources and method used in this study complied with the norms specified in the plan, as did the epidemiologic follow-up. Community and family interventions concerned only a limited number of households in comparison with the total number of cases. Of the 402 cases diagnosed between July 28th and October 16th 2008, 384 cases were given treatment complying with the specified protocols, and just one death was recorded (hospital lethality 0.25%). The mean length of hospitalization was 2.43 days ± 1.16. Compliance with standard response procedures resulted in good quality care and very low lethality. The national plan of response to epidemics is therefore validated. An improved management of outbreaks requires national multi-sector coordination. Authorities in the following areas need to be involved: healthcare, environment, education, public administration and local communities.
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