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PLoS Negl Trop Dis. 2019 Apr 16;13(4):e0007263. doi: 10.1371/journal.pntd.0007263. eCollection 2019 Apr.

The case-area targeted rapid response strategy to control cholera in Haiti: a four-year implementation study.

Author information

1
Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France.
2
Hôpital Européen Marseille, Marseille, France.
3
Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris, France.
4
United Nations Children's Fund, Haiti.
5
Aix Marseille Univ, IRD, INSERM, SESSTIM, Marseille, France.
6
Direction d'Epidémiologie de Laboratoire et de Recherche, Ministère de la Santé Publique et de la Population, Haiti.
7
Institut de Recherche pour le Développement (IRD), Marseille, France.
8
Direction de la Lutte contre la Maladie, Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo.
9
Aix Marseille Univ, Marseille, France.
10
Laboratoire National de Santé Publique, Ministère de la Santé Publique et de la Population, Haiti.
11
Ministère de la Santé Publique et de la Population, former Minister, Delmas, Haiti.
12
Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.

Abstract

BACKGROUND:

In October 2010, Haiti was struck by a large-scale cholera epidemic. The Haitian government, UNICEF and other international partners launched an unprecedented nationwide alert-response strategy in July 2013. Coordinated NGOs recruited local rapid response mobile teams to conduct case-area targeted interventions (CATIs), including education sessions, household decontamination by chlorine spraying, and distribution of chlorine tablets. An innovative red-orange-green alert system was also established to monitor the epidemic at the communal scale on a weekly basis. Our study aimed to describe and evaluate the exhaustiveness, intensity and quality of the CATIs in response to cholera alerts in Haiti between July 2013 and June 2017.

METHODOLOGY/PRINCIPAL FINDINGS:

We analyzed the response to 7,856 weekly cholera alerts using routine surveillance data and severity criteria, which was based on the details of 31,306 notified CATIs. The odds of CATI response during the same week (exhaustiveness) and the number of complete CATIs in responded alerts (intensity and quality) were estimated using multivariate generalized linear mixed models and several covariates. CATIs were carried out significantly more often in response to red alerts (adjusted odds ratio (aOR) [95%-confidence interval, 95%-CI], 2.52 [2.22-2.87]) compared with orange alerts. Significantly more complete CATIs were carried out in response to red alerts compared with orange alerts (adjusted incidence ratio (aIR), 1.85 [1.73-1.99]). Over the course of the eight-semester study, we observed a significant improvement in the exhaustiveness (aOR, 1.43 [1.38-1.48] per semester) as well as the intensity and quality (aIR, 1.23 [1.2-1.25] per semester) of CATI responses, independently of funds available for the strategy. The odds of launching a CATI response significantly decreased with increased rainfall (aOR, 0.99 [0.97-1] per each accumulated cm). Response interventions were significantly heterogeneous between NGOs, communes and departments.

CONCLUSIONS/SIGNIFICANCE:

The implementation of a nationwide case-area targeted rapid response strategy to control cholera in Haiti was feasible albeit with certain obstacles. Such feedback from the field and ongoing impact studies will be very informative for actors and international donors involved in cholera control and elimination in Haiti and in other affected countries.

PMID:
30990822
PMCID:
PMC6485755
DOI:
10.1371/journal.pntd.0007263
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: For authors working for the United Nations Children's Fund, Haiti (GB, CE, SB and EB): UNICEF-Haiti helped the Haitian Ministry of Health and Population (MSPP) to implement the alert-response strategy to control cholera in Haiti. UNICEF-Haiti received funds from several governments and institutions such as ECHO, DFID and CERF. These institutions had no involvement in study design, collection analysis and interpretation of data, writing of the report, and decision to submit the paper for publication. For authors working for Assistance Publique – Hôpitaux de Marseille (SR, JG, LO and RP): APHM, a French university-hospital, was mandated by the Haitian Ministry of Health and UNICEF-Haiti and granted by UNICEF-Haiti to provide the alert-response strategy to control cholera with prospective epidemiological analysis and evaluation. This study aimed to present and assess this strategy. Some UNICEF-Haiti staff played a role in study design, data collection and analysis, decision to publish, and preparation of the manuscript. For authors working for Ministry of Public Health and Population (EM, RB, KP, JB, PA and FDG): To implement the alert-response strategy to control cholera in Haiti, MSPP received material and financial support from UNICEF-Haiti. This study aimed to present and assess this strategy. Some UNICEF-Haiti staff played a role in study design, data collection and analysis, decision to publish, and preparation of the manuscript. For authors who were temporally contracted by UNICEF-Haiti (AAA, LO and RB): In accordance with their respective institutions, these four authors were contracted during a few months by UNICEF-Haiti as external consultants to perform prospective epidemiological analysis and evaluation of the alert-response strategy to control cholera. Some UNICEF-Haiti staff played a role in study design, data collection and analysis, decision to publish, and preparation of the manuscript. These authors have with no competing interest: PG, SM

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