Promotion of Cholera Awareness Among Households of Cholera Patients: A Randomized Controlled Trial of the Cholera-Hospital-Based-Intervention-for-7 Days (CHoBI7) Intervention

Abstract

Previous studies have demonstrated that household contacts of cholera patients are highly susceptible to cholera infections for a 7-day period after the presentation of the index patient in the hospital. However, there is no standard of care to prevent cholera transmission in this high-risk population. Furthermore, there is limited information available on awareness of cholera transmission and prevention among cholera patients and their household contacts. To initiate a standard of care for this high-risk population, we developed the Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7), which delivers a handwashing with soap and water treatment intervention to household contacts during the time they spend with the admitted cholera patient in the hospital and reinforces these messages through home visits. To test CHoBI7, we conducted a randomized controlled trial among 302 intervention cholera patient household members and 302 control cholera patient household members in Dhaka, Bangladesh. In this study, we evaluated the effectiveness of the CHoBI7 intervention in increasing awareness of cholera transmission and prevention, and the key times for handwashing with soap. We observed a significant increase in cholera knowledge score in the intervention arm compared with the control arm at both the 1-week follow-up {score coefficient = 2.34 (95% confidence interval [CI] = 1.96, 2.71)} and 6 to 12-month follow-up period (score coefficient = 1.59 [95% CI = 1.05, 2.13]). This 1-week hospital- and home-based intervention led to a significant increase in knowledge of cholera transmission and prevention which was sustained 6 to 12 months post-intervention. These findings suggest that the CHoBI7 intervention presents a promising approach to increase cholera awareness among this high-risk population.

Diarrhoeal disease knowledge among diarrhoea patient housholds: findings from the randomised controlled trial of the Cholera‐Hospital‐Based‐Intervention‐for‐7‐days (CHoBI7) mobile health program

“…Similarly, if more than 4 correct responses for key times for handwashing with soap were given, the maximum possible score remained 4 points. This scoring system is based on the previous cholera awareness score we published in Saif‐Ur‐Rahman et al [34]. Correct responses for diarrhoeal disease transmission were as follows: (i) by faeces, (ii) after cleaning a child’s faeces (iii) by consuming rotten or spoiled food, (iv) by not completely covering food, (v) by food that has germs or faeces, (vi) by not washing hands, (vii) by water, (viii) by flies, (ix) by not washing hands with soap, (x) by not washing hands with soap before eating, cooking food, cutting vegetables and feeding children, and (xi) by not washing hands with soap after using the toilet or defecation/urination.…”

“…However, despite this high risk, there are few interventions targeting this susceptible population, and little is known about their knowledge of diarrhoeal disease transmission and prevention. Our previous study conducted in Dhaka, Bangladesh found low knowledge of cholera transmission and prevention among cholera patient households, and that cholera knowledge was a significant mediator of handwashing with soap practices [26,34]. Studies are needed that investigate diarrhoeal disease knowledge among this high‐risk population to allow for behaviour change communication programs tailored for diarrhoea patients and their household members.…”

Prevention and control of cholera with household and community water, sanitation and hygiene (WASH) interventions: A scoping review of current international guidelines

“…CATIs) or HCF-based strategies for delivery of interventions, were rarely discussed. Limited attention was given to the importance of responding rapidly [44,113], particularly due to the hyper infective nature of newly shed V. cholerae from cholera cases [114] and lower infective dose required for transmission from cases in the first days of bacterial shedding [60], or repeated delivery of interventions [115,116], which are all important considerations for effective disease reduction.…”

“…Available evidence also suggests that case-centred strategies or CATIs, which require targeting fewer people per case averted and delivery of interventions centred to cases, are more cost-effective and resource-efficient for delivery of interventions [1,44,49,67,122,123]. For example, hygiene and health promotion and the distribution of hygiene kits at the point of care have been observed as an effective delivery channel in cholera control [63,78,113], and in other disease reduction efforts [124][125][126], yet recommendations on the location of intervention delivery was either omitted or limited in all eight of the guidelines. Prepositioning of supplies for distribution has also been noted as an important consideration to allow for timely response in case-centred and mass-delivered strategies [110].…”

Risk Factors for Household Transmission of Vibrio cholerae in Dhaka, Bangladesh (CHoBI7 Trial)

“…These findings demonstrated that the 1-week CHoBI7 intervention presents an effective approach to reduce cholera infection in a high-risk population, which leads to sustained uptake of the promoted handwashing with soap and water treatment behaviors over time, and increased cholera awareness. [13][14][15] In this prospective cohort study, we investigate environmental and individual risk factors for cholera infections in urban Dhaka, Bangladesh. This study is nested within our recent randomized controlled trial of the CHoBI7 intervention, thereby providing the unique opportunity to evaluate how risk factors change within a population with the implementation of a WASH intervention in comparison to a control group.…”