Cholera and Haiti:

Risk Factors and Determinants of Health

Lydia Meintel-Wade

Jenkins Macedo

Marcus Pasay

David Safari

Presentation Outline

1. Basic Information of Cholera• Life Cycle of Vibro Cholerae

2. Haitian Epidemic and Scale• Social and Environmental Determinants• Statistics

3. Intervention Brainstorming Activity• Stakeholders Analysis

4. Community Health Workers Training• Trainers of Trainers

ORS SODIS

Vibrio cholera

Exposure through food and water

Vibrio cholera exists naturally in coastal and freshwater bodies Global attack rate 4.6%.

Currently an estimated 3-5 million cases occur around the world each year, resulting in over 100,000 deaths

Source: WHO

Basic Information of Cholera

Life Cycle of the Disease

Cholera

Oral rehydration salts, intravenous fluids and electrolytes => less than 1% fatality

Symptoms (5-10%)

• profuse watery diarrhea• vomiting• rapid heart rate• loss of skin elasticity• low blood pressure• muscle cramps

• acute renal failure• severe electrolyte

imbalances • coma• shock and death

Haitian Cholera Epidemic and Scale

• Outbreak was worsened by Earthquake that left thousands homeless, Destroyed sanitation and water infrastructure

• Number of reported cases 473,649 (October 14, 2011)

• Attack rate 7.8% in Port au Prince

• Lowest attack rate 1.1% Southeast

• Mortality rate 63.7 per 100,000 of exposed population.

• 250,000 cases with 4,000 deaths in first 6 months.

Social and Environmental Determinants

• 1/2 of Port-au-Prince had access to latrines and other forms of modern sanitation (Farmer et al, 2011).

• 1/3 of population had no access to tap water (Farmer et al, 2011)

• Geographic location Artibonite Meiller

• Lack of clean water

• Lack of proper sanitation infrastructure

Intervention Brainstorming Activity

Stakeholders• Government Officials• NGOs• IDP Camps Managers• Rural Poor• Teachers

Instruction

The community health workers-in-training will divide into four groups representing distinct interests in Haiti: government officials, NGOs, IDP camp managers, and the rural poor. These groups will meet as caucuses to discuss the specific needs and capabilities of their cohorts and to suggest interventions that could reduce the spread of cholera in Haiti.

Intervention: Determinants-Based Approach

• Food and Water Safety

SODIS Chlorination Boiling Chemical Treatment Products Water Storage Facilities Using clean water to prepare food Only eat hot or peelable food

Intervention: Determinants-Based Approach

Sanitation/Hygiene Proper solid waste disposal and management Hand Washing with safe water Cleaning food preparation areas Proper

Community Health Workers Training

Overview• The participants will be broken into two groups of community

health workers, each taught a different cholera prevention skill. The class will form pairs with one member from each workshop group, and the pairs will demonstrate to one another what they have learned.

Training Sessions Instructions

• Oral Rehydration Solution (ORS). Have each group learn what an ORS is and how it helps

those with cholera Make ORS solution (drink it!)

• Solar Water Disinfection (SODIS). Learn the benefits and limitations of SODIS in cholera

prevention. Fill SODIS bottles and calculate the exposure time needed

Video

Reference

Centers for Disease Control and Prevention (CDC). “General Information.” Cholera. Last Updated Feb. 24, 2011. URL: http://www.cdc.gov/cholera/general/ Accessed: 10/1/2011.   CDC. “Acute watery diarrhea and cholera: Haiti pre-decision brief for public health action.” Dec 6, 2010 URL:http://www.bt.cdc.gov/disasters/earthquakes/haiti/waterydiarrhea_pre-decision_brief.asp. Accessed: 09/30/2011.   Chen-Shan Chin et al. “The Origin of the Haitian Cholera Outbreak Strain.” New England Journal of Med. January 6; 364(1): 33-42.

URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3030187/?tool=pubmed Accessed: 09/30/2011.

  Colwell, R. (2010). “The intricate connection of cholera, climate and public health.” On the Water Front: Selections from the 2010 World Water Week in Stockholm. Ed. Jan Lundqvist. Stockholm International Water Institute (SIWI), Stockholm: 2011. URL: http://www.siwi.org/documents/Resources/Best/2010/2011_OTWF_Rita_Colwell.pdf Accessed: 9/28/2011.   Dowell SF, Braden CR. “Implications of the Introduction of Cholera to Haiti. Emerging Infectious Diseases.” Emerging Infectious Disease. July 2011; 17 (7): 1299-1300 URL: http://www.ncbi.nlm.nih.gov/pubmed/21762593 Accessed 09/29/2011   Farmer P, Almazor CP, Bahnsen ET, Barry D, Bazile J, et al.“Meeting cholera's challenge to Haiti and the world: a joint statement on cholera prevention and care” . PLoS Negl Trop Dis. May

2011;5(5):e1145:1-13. URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3104956/ Accessed 09/27/2011   International Medical Corps “Cholera in Haiti: Still An Emergency.” URL: http://internationalmedicalcorps.org/document.doc?id=204. Accessed: 10/05/2011.

Reidl, J. & Klose, K. (2002). “Vibrio cholera and cholera: out of the water and into the host.” FEMS Microbiology Reviews. 26: 125-139. URL: http://fst.snu.ac.kr/~shchoi/Lecture/2008%20Food%20Biotech/3c.%20Vc%20in%20host.pdf Accessed: 10/6/2011.

World Health Organization“Cholera Country Profile: Haiti.” Global Task Force on Cholera Control. Updated May 2011. URL:http://www.who.int/cholera/countries/HaitiCountryProfileMay2011.pdf. Accessed: 10/06/2011.