Randomized Controlled Trial of Hospital-Based Hygiene and Water Treatment Intervention (CHoBI7) to Reduce Cholera

George, Christine Marie; Monira, Shirajum; Sack, David A.; Rashid, Mohammad Junaebur; Saif‐Ur‐Rahman, K. M.; Mahmud, Toslim; Rahman, Zillur; Mustafiz, Munshi; Bhuyian, Sazzadul Islam; Winch, Peter J.; Leontsini, Elli; Perin, Jamie; Begum, Farzana; Zohura, Fatema; Biswas, Shwapon; Parvin, Tahmina; Zhang, Xiaolin; Jung, Danielle; Sack, R. Bradley; Alam, Munirul

doi:10.3201/eid2202.151175

Cited by 96 publications

(163 citation statements)

References 32 publications

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“…In our recent randomized controlled trial (RCT) of this intervention where CHoBI7 was compared with the standard message given in Bangladesh to diarrhea patients at discharge on ORS use, we observed a 47% reduction in the incidence of overall cholera infections (symptomatic and asymptomatic), and a significant reduction in symptomatic cholera infections among household members of cholera cases in the intervention compared with the control arm during the 1 week intervention period. 36 These findings demonstrated the effectiveness of the hospital-based CHoBI7 intervention in reducing cholera infections among highly susceptible household members of cholera cases.…”

Section: Introductionmentioning

confidence: 79%

“…[25][26][27]44 Consistent with this, during the 1-week CHoBI7 intervention period, we observed 55% handwashing with soap events at key times in the intervention arm compared with 8% in the control arm. 36 This high uptake of the promoted behaviors during the week-long CHoBI7 intervention was likely sufficient for households to become habituated with these practices and sustain them over time. Second, the study hardware likely facilitated the promoted behaviors included in the CHoBI7 intervention.…”

Section: Discussionmentioning

confidence: 99%

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Sustained Uptake of a Hospital-Based Handwashing with Soap and Water Treatment Intervention (Cholera-Hospital-Based Intervention for 7 Days [CHoBI7]): A Randomized Controlled Trial

George¹,

Jung²,

Saif‐Ur‐Rahman³

et al. 2016

The American Journal of Tropical Medicine and Hygiene

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Abstract. Diarrhea is the second leading cause of death in children under 5 years of age globally. The time patients and caregivers spend at a health facility for severe diarrhea presents the opportunity to deliver water, sanitation, and hygiene (WASH) interventions. We recently developed Cholera-Hospital-Based Intervention for 7 days (CHoBI7), a 1-week hospital-based handwashing with soap and water treatment intervention, for household members of cholera patients. To investigate if this intervention could lead to sustained WASH practices, we conducted a follow-up evaluation of 196 intervention household members and 205 control household members enrolled in a randomized controlled trial of the CHoBI7 intervention 6 to 12 months post-intervention. Compared with the control arm, the intervention arm had four times higher odds of household members' handwashing with soap at a key time during 5-hour structured observation (odds ratio [OR]: 4.71, 95% confidence interval [CI]: 2.61, 8.49) (18% versus 50%) and a 41% reduction in households in the World Health Organization very high-risk category for stored drinking water (OR: 0.38, 95% CI: 0.15, 0.96) (58% versus 34%) 6 to 12 months post-intervention. Furthemore, 71% of observed handwashing with soap events in the intervention arm involved the preparation and use of soapy water, which was promoted during the intervention, compared to 9% of control households. These findings demonstrate that the hospital-based CHoBI7 intervention can lead to significant increases in handwashing with soap practices and improved stored drinking water quality 6 to 12 months post-intervention.

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Section: Introductionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Sustained Uptake of a Hospital-Based Handwashing with Soap and Water Treatment Intervention (Cholera-Hospital-Based Intervention for 7 Days [CHoBI7]): A Randomized Controlled Trial

George¹,

Jung²,

Saif‐Ur‐Rahman³

et al. 2016

The American Journal of Tropical Medicine and Hygiene

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“…The detailed methods for this intervention and trial are published elsewhere. 19 The intervention arm received chlorine tablets (NaDCC, 33 mg) for water treatment, a Topaz container (sealed drinking water vessel with tap) for safe water storage, and a handwashing station. The control arm received no intervention hardware.…”

Section: Methodsmentioning

confidence: 99%

“…We selected three drinking water vessels: a 16-L locally made plastic bucket with lid, a 10-L aluminum kalshi with no lid (both commonly used in Bangladesh), and a 10-L Topaz ™ (Lion Star Plastic, Jakarta, Indonesia) drinking vessel, used in our Cholera-Hospital-Based Intervention for 7 days (CHoBI7) intervention study. 19 Topaz is a container made of high-quality plastic that can be sealed by a lid that screws on, and has a tap at the bottom to dispense water. This type of container reduces the chances of secondary contamination by the user and prevents evaporation of chlorine.…”

Section: Methodsmentioning

confidence: 99%

Chlorination of Household Drinking Water Among Cholera Patients' Households to Prevent Transmission of Toxigenic Vibrio cholerae in Dhaka, Bangladesh: CHoBI7 Trial

Rashid

George

Monira

et al. 2016

The American Journal of Tropical Medicine and Hygiene

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Abstract. Household members of cholera patients are at a 100 times higher risk of cholera infections than the general population because of shared contaminated drinking water sources and secondary transmission through poor household hygiene practices. In this study, we investigated the bactericidal concentration of free chlorine required to inactivate Vibrio cholerae in household drinking water in Dhaka, Bangladesh. In laboratory experiments, we found that the concentrations of free chlorine required to inactivate 10 5 colony-forming units (CFU)/mL of V. cholerae serogroups O1 and O139 were 0.1 mg/L and 0.2 mg/L, respectively. The concentration of free chlorine generated by a single chlorine tablet (sodium dichloroisocyanurate [33 mg]) after a 30-minute reaction time in a 10-L sealed vessel containing Dhaka city municipal supply water was 1.8 mg/L; and the concentration declined to 0.26 mg/L after 24 hours. In field measurements, water collected from 165 households enrolled in a randomized controlled trial (RCT) of a chlorine and handwashing with soap intervention (Cholera-Hospital-Based-Intervention-for-7-Days[CHoBI7]), we observed significantly higher free chlorine concentrations in the 82 intervention arm households (mean = 1.12 mg/L, standard deviation [SD] = 0.52, range = 0.07-2.6 mg/L) compared with the 83 control households (0.017 mg/L, SD = 0.01, range = 0-0.06 mg/L) (P < 0.001) during spot check visits. These findings suggest that point-of-use chlorine tablets present an effective approach to inactivate V. cholerae from drinking water in households of cholera patients in Dhaka city. This result is consistent with the findings from the RCT of CHoBI7 which found that this intervention led to a significant reduction in symptomatic cholera infections among household members of cholera patients and no stored drinking water samples with detectable V. cholerae. BACKGROUND

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“…Hospital-based Hygiene -Researchers found that seven consecutive days of hygiene education given to cholera patients and caretakers had significant disease reduction in an RCT in Bangladesh (George et al 2016). The intervention, Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7), was held within the hospital and included equipping families with a hygiene kit to facilitate safe drinking water and handwashing.…”

Section: Wash and Health -Outbreak Specific Responsesmentioning

confidence: 99%

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

Yates¹,

Allen²,

Joseph³

et al. 2017

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The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO promoting evidence-informed development policies and programmes. We are the global leader in funding, producing and synthesising high-quality evidence of what works, for whom, why and at what cost. We believe that better and policy-relevant evidence will help make development more effective and improve people's lives. 3ie systematic reviews 3ie systematic reviews appraise and synthesise the available high-quality evidence on the effectiveness of social and economic development interventions in low-and middleincome countries. These reviews follow scientifically recognised review methods, and are peer-reviewed and quality assured according to internationally accepted standards. 3ie is providing leadership in demonstrating rigorous and innovative review methodologies, such as using theory-based approaches suited to inform policy and programming in the dynamic contexts and challenges of low-and middle-income countries.

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Randomized Controlled Trial of Hospital-Based Hygiene and Water Treatment Intervention (CHoBI7) to Reduce Cholera

Abstract: This intervention significantly reduced symptomatic Vibrio cholerae infection.

Cited by 96 publications

References 32 publications

Sustained Uptake of a Hospital-Based Handwashing with Soap and Water Treatment Intervention (Cholera-Hospital-Based Intervention for 7 Days [CHoBI7]): A Randomized Controlled Trial

Sustained Uptake of a Hospital-Based Handwashing with Soap and Water Treatment Intervention (Cholera-Hospital-Based Intervention for 7 Days [CHoBI7]): A Randomized Controlled Trial

Chlorination of Household Drinking Water Among Cholera Patients' Households to Prevent Transmission of Toxigenic Vibrio cholerae in Dhaka, Bangladesh: CHoBI7 Trial

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

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