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J Water Health. 2018 Apr;16(2):223-232. doi: 10.2166/wh.2018.258.

Learning from water treatment and hygiene interventions in response to a hepatitis E outbreak in an open setting in Chad.

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European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Granits väg 8, Solna 171 65, Sweden.
University of Southern California, Los Angeles, CA 90007, USA.
Médecins Sans Frontières, Quartier Klemat, Rue 3211, Porte 429, N'djamena, Chad.
Médecins Sans Frontières, Plantage Middenlaan 14, Amsterdam 1018 DD, The Netherlands E-mail:


In September 2016, Médecins Sans Frontières responded to a hepatitis E (HEV) outbreak in Chad by implementing water treatment and hygiene interventions. To evaluate the coverage and use of these interventions, we conducted a cross-sectional study in the community. Our results showed that 99% of households interviewed had received a hygiene kit from us, aimed at improving water handling practice and personal hygiene and almost all respondents had heard messages about preventing jaundice and handwashing. Acceptance of chlorination of drinking water was also very high, although at the time of interview, we were only able to measure a safe free residual chlorine level (free chlorine residual (FRC) ≥0.2 mg/L) in 43% of households. Households which had refilled water containers within the last 18 hours, had sourced water from private wells or had poured water into a previously empty container, were all more likely to have a safe FRC level. In this open setting, we were able to achieve high coverage for chlorination, hygiene messaging and hygiene kit ownership; however, a review of our technical practice is needed in order to maintain safe FRC levels in drinking water in households, particularly when water is collected from multiple sources, stored and mixed with older water.

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