Description of the targeted water supply and hygiene response strategy implemented during the cholera outbreak of 2017–2018 in Kinshasa, DRC

Abstract

Background: Rapid control of cholera outbreaks is a significant challenge in overpopulated urban areas. During late-2017, Kinshasa, the capital of the Democratic Republic of the Congo, experienced a cholera outbreak that showed potential to spread throughout the city. A novel targeted water and hygiene response strategy was implemented to quickly stem the outbreak. Methods: We describe the first implementation of the cluster grid response strategy carried out in the community during the cholera outbreak in Kinshasa, in which response activities targeted cholera case clusters using a grid approach. Interventions focused on emergency water supply, household water treatment and safe storage, home disinfection and hygiene promotion. We also performed a preliminary community trial study to assess the temporal pattern of the outbreak before and after response interventions were implemented. Cholera surveillance databases from the Ministry of Health were analyzed to assess the spatiotemporal dynamics of the outbreak using epidemic curves and maps. Results: From January 2017 to November 2018, a total of 1712 suspected cholera cases were reported in Kinshasa. During this period, the most affected health zones included Binza Météo, Limeté, Kokolo, Kintambo and Kingabwa. Following implementation of the response strategy, the weekly cholera case numbers in Binza Météo, Kintambo and Limeté decreased by an average of 57% after 2 weeks and 86% after 4 weeks. The total weekly case numbers throughout Kinshasa Province dropped by 71% 4 weeks after the peak of the outbreak. Conclusion: During the 2017-2018 period, Kinshasa experienced a sharp increase in cholera case numbers. To contain the outbreak, water supply and hygiene response interventions targeted case households, nearby neighbors and public areas in case clusters using a grid approach. Following implementation of the response, the outbreak in Kinshasa was quickly brought under control. A similar approach may be adapted to quickly interrupt cholera transmission in other urban settings.

Highly targeted spatiotemporal interventions against cholera epidemics, 2000–19: a scoping review

“…After reviewing reference lists and reports sent from experts, 12 studies were added (9 articles from reference lists, 2 abstracts, and one UNICEF report). In total, 53 articles met inclusion criteria for objective 1 (n=28) , objective 2 (n=10) [46][47][48][49][50][51][52][53][54][55] , and objective 3 (n=15) [56][57][58][59][60][61][62][63][64][65][66][67][68][69][70] (appendix p 6-8).…”

“…We identified CATI use during epidemics in Cameroon (Douala), Haiti (2010-1 and 2013-7), Bangladesh (Dhaka), South Sudan (Juba), Nepal (Kathmandu Valley), Yemen, and DRC (Kinshasa) (Table 3). [56][57][58][59][60][61][62][63][64][65][66][67][68][69][70] CATI was implemented to address incident case-clusters within 1-2 weeks of cholera detection in Douala, Haiti (2010), and Kathmandu and 1-4 weeks in Kinshasa. 61,63,67,69,70 In Haiti, within two weeks of detection, CATI provided early detection of cholera-related events to inform rapid response.…”

“…65,66 In Kinshasa, CATI was used to target case-households in a 500-m radius. 70 After the 2015 earthquake in Nepal, CATI was integrated into cholera preparedness planning using existing RRTs. 67 In Yemen, to direct resources 10-months into a large national epidemic, WASH and health interventions were organized by RRTs to deliver CATI.…”

“…In Douala and Kinshasa, suspect cases were exhaustively responded to. 61,63,70 CATIs in Juba, Kathmandu, and Dhaka were launched for cases testing positive by rapid diagnostic test (RDT) or culture (Nepal). 60,64,67 In Haiti and Yemen, case-clusters with above-threshold levels of suspect cases and deaths during the previous 7 days were responded to.…”

“…The most widely used strategy was comprehensive WASH including POUWT and safe storage (at the household-level), and water treatment and hygiene promotion (at the community level). [61][62][63]65,67,70 In Haiti and Yemen, CATI focused on WASH interventions to improve hygiene and access to safe water in remote and rural areas. 65,66 In Kinshasa, emphasis was also placed on increasing community-level water supply and handwashing stations.…”