Household Water Treatment Uptake during a Public Health Response to a Large Typhoid Fever Outbreak in Harare, Zimbabwe

Abstract

Abstract. Locally manufactured sodium hypochlorite (chlorine) solution has been sold in Zimbabwe since 2010. During October 1, 2011-April 30, 2012, 4,181 suspected and 52 confirmed cases of typhoid fever were identified in Harare. In response to this outbreak, chlorine tablets were distributed. To evaluate household water treatment uptake, we conducted a survey and water quality testing in 458 randomly selected households in two suburbs most affected by the outbreak. Although 75% of households were aware of chlorine solution and 85% received chlorine tablets, only 18% had reportedly treated stored water and had the recommended protective level of free chlorine residuals. Water treatment was more common among households that reported water treatment before the outbreak, and those that received free tablets during the outbreak (P 0.01), but was not associated with chlorine solution awareness or use before the outbreak (P 0.05). Outbreak response did not build on pre-existing prevention programs.

Economic evaluation of typhoid vaccination in a prolonged typhoid outbreak setting: The case of Kasese district in Uganda

“…Until recently, most infections were thought to occur in Asia [2]; however, new reports suggest that parts of sub-Saharan Africa are also highly affected [1]. High rates of endemic typhoid were documented in an urban population in Kenya during 2007-2009 [3]; since 2008, severe typhoid fever outbreaks have been reported in rural areas in Malawi [4], Uganda [5], and in urban areas in Zimbabwe and Zambia [6,7].…”

Short-term WASH interventions in emergency response: a systematic review

“…The taste and smell of chlorine tablets was reported as a barrier to use in nearly half of the contexts (5/11) from three countries (ACF 2009, Imanishi et al 2014, Ruiz-Roman 2009, Johnston 2008. Part of the reason for the taste and smell objections may have been confusion between the appropriate tablet dose and water storage container size, as some respondents did not have the appropriate water storage container and this may have led to high doses and unfavorable taste (Imanishi et al 2014, ACF 2009, Johnston 2008, Varampath 2008.…”

“…Part of the reason for the taste and smell objections may have been confusion between the appropriate tablet dose and water storage container size, as some respondents did not have the appropriate water storage container and this may have led to high doses and unfavorable taste (Imanishi et al 2014, ACF 2009, Johnston 2008, Varampath 2008. Knowing a HWT method before the emergency was an indicator of use in Zimbabwe (Imanishi et al 2014) and Nepal ; in both contexts, familiarity of the products and ease-of-use was described by the beneficiaries.…”

“…Differences in kits (Ruiz-Roman 2009), including different types of doses of HWT products (e.g. several different Aquatabs doses), caused confusion (Varampath 2008, Imanishi et al 2014. Standard sized kits may not address the needs of larger families or those with different preferences or needs (Gauthier 2014, Simpson, Bazezew Legesse, and Mubayiwa 2009, Ruiz-Roman 2009.…”

Salmonella enterica Serovar Typhi and Paratyphi Responsible of Typhoid and Paratyphoid Fevers Transmitted by Environment and Food

“…The incubation period is usually 8 to 14 days but can vary from 3 days to 1 month (Crump and Heyderman, 2015). Typhoid fever typically manifests as symptoms associated with prolonged fever associated with headache, abdominal pain and other gastrointestinal symptoms (Imanishi et al, 2014). Clinical expression may also be atypical or moderate or even unapparent especially in endemic countries.…”