Evaluation of monitoring tools for WASH response in a cholera outbreak in northeast Nigeria

Ricau, Marine; Lacan, Lise; Ihemezue, Emmanuel; Lantagne, Daniele; String, Gabrielle

doi:10.2166/washdev.2021.056

Cited by 3 publications

(3 citation statements)

References 18 publications

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“…Providing services and protecting health in conflict zones is especially challenging and coordination across organisations in reporting and operations are needed to streamline resources and prevent duplication of services [63]. The traffic-light system used here helps highlight what is needed in these situations to protect health and when outbreaks may occur.…”

Section: Discussionmentioning

confidence: 99%

The impact of social and environmental extremes on cholera time varying reproduction number in Nigeria

Charnley

Yennan

Ochu

et al. 2022

Preprint

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Cholera is reported as endemic in more than 50 countries, many of which are in sub-Saharan Africa. Nigeria currently reports the second highest number of cases, with several risk factors potentially contributing to this including poverty, water, sanitation and climate. Enteric pathogens have a significant global burden, especially on children and those most vulnerable. Despite this, attention is often drawn away from these diseases, most recently to Ebola and COVID-19. To address the need for more research and focus on cholera, a covariate selection process and machine learning was used. Data for environmental (floods, droughts) and social (conflicts) extremes, along with pre-existing social vulnerabilities, were fit to time varying reproductive number in Nigeria. We analysed this both spatially and temporally and used it to create a traffic-light system for cholera transmission, highlighting potential thresholds and triggers for outbreak. Improved access to sanitation, number of monthly conflict events, Multidimensional Poverty Index and Palmers Drought Severity Index were retained in the best fit model. Varying exposure periods showed that those living in decreased poverty, with more access to sanitation were not as vulnerable to changes and offset some of the cholera risk caused by extremes. The work presented here shows the need to address these pre-existing vulnerabilities and sustainable development for disaster prevention and mitigation and improve health and quality of life.

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Section: Discussionmentioning

confidence: 99%

The impact of social and environmental extremes on cholera time varying reproduction number in Nigeria

Charnley

Yennan

Ochu

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…This was seen for bucket chlorination in Cameroon where households reported receiving the intervention, yet few households actually had the minimum free chlorine residual levels for safe drinking water [33]. However, even when activities are monitored, the scarcity and inconsistency of the reported data can make it difficult to draw conclusions about program effectiveness and to make recommendations to improve the response [34]. Future research is needed on how best to complete effective monitoring in cholera outbreaks.…”

Section: Plos Watermentioning

confidence: 99%

Developing context-specific water, sanitation and hygiene guidance for National Cholera Plans: Qualitative inputs

et al. 2023

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Globally, cholera continues to cause morbidity and mortality, and the Global Task Force on Cholera Control (GTFCC) works with countries affected by cholera to develop National Cholera Plans (NCPs). Water, sanitation, and hygiene (WASH) can prevent and/or control cholera. However, WASH program success varies, and is not necessarily replicable across contexts. Thus, guidance needs to be developed to assist countries in appropriately designing WASH programming in NCPs. The objective of this project was to develop guidelines for selecting context-specific WASH for cholera response. For that, a literature review of WASH interventions in cholera was completed, a Working Group was convened to collaboratively develop the guidelines, and we conducted key informant interviews (KII) with Working Group experts, representing international and national non-governmental organizations, donors, international organizations and health authorities. Inductive qualitative content analysis of KIIs was completed. KIIs were conducted with 18 informants, and data was coded into 26 subcategories, categorized under: 1) intervention objectives; 2) decision factors; 3) intervention circumstances; 4) influencing factors; and, 5) WASH activities. Based on these categories, we developed guidelines with the following steps: 1) define the disease objective (control, prevention, or elimination); 2) understand and define the broad context (including existing WASH infrastructure and population habits, available funding, outbreak sources and transmission pathways, stakeholder capacity, and access difficulties); and, 3) focus on monitoring of activities, multi-sectoral coordination (including WASH and health), and targeted approaches, both for implementation and future research. Overall, while building upon previous research and guidance, our results expand to include specific guidance for countries incorporating WASH into their NCPs, and highlight the necessity of a broad contextual understanding to select the most appropriate and successful WASH for cholera programming. These results have been used, with GTFCC, to develop a guidance document for including context-specific WASH in NCPs.

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“…The influence of conflict shows the need to incorporate and include conflict metrics in disease control research and policy in Nigeria and potentially in other conflict-affected countries. Providing services and protecting health in conflict zones is especially challenging and coordination across organisations in reporting and operations are needed to streamline resources and prevent duplication of services [63]. The traffic-light system used here helps highlight the need to protect basic services and reduce inequities in conflict situations to protect health and prevent outbreaks.…”

Section: Plos Global Public Healthmentioning

confidence: 99%

The impact of social and environmental extremes on cholera time varying reproduction number in Nigeria

Charnley

Yennan

Ochu

et al. 2022

PLOS Glob Public Health

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Nigeria currently reports the second highest number of cholera cases in Africa, with numerous socioeconomic and environmental risk factors. Less investigated are the role of extreme events, despite recent work showing their potential importance. To address this gap, we used a machine learning approach to understand the risks and thresholds for cholera outbreaks and extreme events, taking into consideration pre-existing vulnerabilities. We estimated time varying reproductive number (R) from cholera incidence in Nigeria and used a machine learning approach to evaluate its association with extreme events (conflict, flood, drought) and pre-existing vulnerabilities (poverty, sanitation, healthcare). We then created a traffic-light system for cholera outbreak risk, using three hypothetical traffic-light scenarios (Red, Amber and Green) and used this to predict R. The system highlighted potential extreme events and socioeconomic thresholds for outbreaks to occur. We found that reducing poverty and increasing access to sanitation lessened vulnerability to increased cholera risk caused by extreme events (monthly conflicts and the Palmers Drought Severity Index). The main limitation is the underreporting of cholera globally and the potential number of cholera cases missed in the data used here. Increasing access to sanitation and decreasing poverty reduced the impact of extreme events in terms of cholera outbreak risk. The results here therefore add further evidence of the need for sustainable development for disaster prevention and mitigation and to improve health and quality of life.

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Evaluation of monitoring tools for WASH response in a cholera outbreak in northeast Nigeria

Cited by 3 publications

References 18 publications

The impact of social and environmental extremes on cholera time varying reproduction number in Nigeria

The impact of social and environmental extremes on cholera time varying reproduction number in Nigeria

Developing context-specific water, sanitation and hygiene guidance for National Cholera Plans: Qualitative inputs

The impact of social and environmental extremes on cholera time varying reproduction number in Nigeria

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