Cholera and Haiti: Risk Factors and Determinants of Health
Cholera and Haiti:Risk Factors and Determinants of Health Lydia Meintel-Wade Jenkins Macedo Marcus Pasay David Safari
Presentation Outline1. Basic Information of Cholera • Life Cycle of Vibro Cholerae2. Haitian Epidemic and Scale • Social and Environmental Determinants • Statistics3. Intervention Brainstorming Activity • Stakeholders Analysis4. Community Health Workers Training • Trainers of Trainers ORS SODIS
Basic Information of Cholera 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
CholeraSymptoms (5-10%) • profuse watery diarrhea • acute renal failure • vomiting • severe electrolyte • rapid heart rate imbalances • loss of skin elasticity • coma • low blood pressure • shock and death • muscle cramps Oral rehydration salts, intravenous fluids and electrolytes => less than 1% fatality
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 ActivityStakeholders • Government Officials • NGOs • IDP Camps Managers • Rural Poor • TeachersInstructionThe community health workers-in-training will divide into four groups representing distinctinterests 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 theircohorts 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 TrainingOverview • 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
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