The Cure for Cholera - Improving Access to Safe Water and Sanitation
From the School of Public Health and Health Services, George Washington University, Washington, DC (R.J.W.)New England Journal of Medicine (Impact Factor: 55.87). 01/2013; 368(7). DOI: 10.1056/NEJMp1214179
Whenever epidemics of cholera occur, the global public health community is energized. Experts meet, guidelines for control are reviewed and reissued, and new and modified interventions are proposed and promoted. In the past two decades, these things happened after cholera appeared in Latin America in 1991, in the wake of the Rwandan genocide and the ensuing refugee crisis in Zaire (now Democratic Republic of Congo) in 1994, in Zimbabwe in 2008, and in October 2010, at the onset of the ongoing epidemic in Haiti (see article by Barzilay et al.). But even when it is not covered in the news . . .
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- "Despite substantial gains in improved drinking water facilities, notably in the last decade or so, many countries in Sub-Saharan Africa have barely achieved their Millennium Development Goal target of halving the number of people without access to improved drinking water. Over 64 % of households in the region do not have access to basic sanitation and 42 % lack safe drinking water (Waldman et al. 2013; WHO 2013). Existing water infrastructure can barely keep up with demands from spiraling populations. "
ABSTRACT: Lack of access to potable water and good sanitation is still one of the most challenging public health concerns of the twenty-first century despite steady progress over recent decades. Almost a billion people globally lack access to safe water; over two billion live without adequate sanitation facilities. The challenge is even more daunting for Sub-Saharan Africa where coverage levels for both potable water and sanitation remain critically low. The urgent need to address the issue calls for adequate understanding of the socio-economic dimensions. Using the 2008 Ghana Demographic and Health Survey, we investigated the socio-economic and demographic factors associated with access to potable water and improved sanitation facilities. Our generalized linear models reveal that income, education, household size, and region are significant predictors of improved water and sanitation access. Our discussion and conclusion sections highlight the implications of the study results for water policy formulation and implementation in Ghana, and broadly for other developing countries.
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- "How DINEPA reconciles this complex fabric of post-earthquake water-related infrastructure into a usable network for communities that currently rely on a collection of single-point sources for access to water will determine the impacts that this infrastructure has on public health outcomes in the future. Assuring access to safe water is a challenging problem particularly confounded by the complex post-earthquake context of Haiti, where cholera remains a threat.15 Challenges surrounding surveillance of this water-related infrastructure cannot be addressed until a clearer understanding of what exists on the ground develops and how this infrastructure impacts the quality of water it supplies. "
ABSTRACT: We inventoried non-surface water sources in the Leogane and Gressier region of Haiti (approximately 270 km2) in 2012 and 2013 and screened water from 345 sites for fecal coliforms and Vibrio cholerae. An international organization/non-governmental organization responsible for construction could be identified for only 56% of water points evaluated. Sixteen percent of water points were non-functional at any given time; 37% had evidence of fecal contamination, with spatial clustering of contaminated sites. Among improved water sources (76% of sites), 24.6% had fecal coliforms versus 80.9% in unimproved sources. Fecal contamination levels increased significantly from 36% to 51% immediately after the passage of Tropical Storm Sandy in October of 2012, with a return to 34% contamination in March of 2013. Long-term sustainability of potable water delivery at a regional scale requires ongoing assessment of water quality, functionality, and development of community-based management schemes supported by a national plan for the management of potable water.
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ABSTRACT: Cholera, previously unrecognized in Haiti, spread through the country in the fall of 2010. An analysis was performed to understand the epidemiological characteristics, clinical management, and risk factors for disease severity in a population seen at the GHESKIO Cholera Treatment Center in Port-au-Prince. A comprehensive review of the medical records of patients admitted during the period of October 28, 2010-July 10, 2011 was conducted. Disease severity on admission was directly correlated with older age, more prolonged length of stay, and presentation during the two epidemic waves seen in the observation period. Although there was a high seroprevalence of human immunodeficiency virus (HIV), severity of cholera was not greater with HIV infection. This study documents the correlation of cholera waves with rainfall and its reduction in settings with improved sanitary conditions and potable water when newly introduced cholera affects all ages equally so that interventions must be directed throughout the population.
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