TY - JOUR
T1 - Feasibility of a comprehensive targeted cholera intervention in the Kathmandu Valley, Nepal
AU - Roskosky, Mellisa
AU - Acharya, Bhim
AU - Shakya, Geeta
AU - Karki, Kshitij
AU - Sekine, Kazutaka
AU - Bajracharya, Deepak
AU - Von Seidlein, Lorenz
AU - Devaux, Isabelle
AU - Lopez, Anna Lena
AU - Deen, Jacqueline
AU - Sack, David A.
N1 - Funding Information:
Financial support: Financial support for data collection, analysis, and preparation of the manuscript was provided by the Delivering Oral Vaccine Effectively (DOVE) project supported by the Bill & Melinda Gates Foundation (OPP1053556 and OPP1148763) administered through the Johns Hopkins Bloomberg School of Public Health.
Publisher Copyright:
Copyright © 2019 by The American Society of Tropical Medicine and Hygiene
PY - 2019
Y1 - 2019
N2 - A comprehensive targeted intervention (CTI) was designed and deployed in the neighborhoods of cholera cases in the Kathmandu Valley with the intent of reducing rates among the neighbors of the case. This was a feasibility study to determine whether clinical centers, laboratories, and field teams were able to mount a rapid, community-based response to a case within 2 days of hospital admission. Daily line listings were requested from 15 participating hospitals during the monsoon season, and a single case initiated the CTI. A standard case definition was used: acute watery diarrhea, with or without vomiting, in a patient aged 1 year or older. Rapid diagnostic tests and bacterial culture were used for confirmation. The strategy included household investigation of cases; water testing; water, sanitation, and hygiene (WASH) intervention; and health education. A CTI coverage survey was conducted 8 months postintervention. From June to December of 2016, 169 cases of Vibrio cholerae O1 were confirmed by bacterial culture. Average time to culture result was 3 days. On average, the CTI Rapid Response Team (RRT) was able to visit households 1.7 days after the culture result was received from the hospital (3.9 days from hospital admission). Coverage of WASH and health behavior messaging campaigns were 30.2% in the target areas. Recipients of the intervention were more likely to have knowledge of cholera symptoms, treatment, and prevention than non-recipients. Although the RRT were able to investigate cases at the household within 2 days of a positive culture result, the study identified several constraints that limited a truly rapid response.
AB - A comprehensive targeted intervention (CTI) was designed and deployed in the neighborhoods of cholera cases in the Kathmandu Valley with the intent of reducing rates among the neighbors of the case. This was a feasibility study to determine whether clinical centers, laboratories, and field teams were able to mount a rapid, community-based response to a case within 2 days of hospital admission. Daily line listings were requested from 15 participating hospitals during the monsoon season, and a single case initiated the CTI. A standard case definition was used: acute watery diarrhea, with or without vomiting, in a patient aged 1 year or older. Rapid diagnostic tests and bacterial culture were used for confirmation. The strategy included household investigation of cases; water testing; water, sanitation, and hygiene (WASH) intervention; and health education. A CTI coverage survey was conducted 8 months postintervention. From June to December of 2016, 169 cases of Vibrio cholerae O1 were confirmed by bacterial culture. Average time to culture result was 3 days. On average, the CTI Rapid Response Team (RRT) was able to visit households 1.7 days after the culture result was received from the hospital (3.9 days from hospital admission). Coverage of WASH and health behavior messaging campaigns were 30.2% in the target areas. Recipients of the intervention were more likely to have knowledge of cholera symptoms, treatment, and prevention than non-recipients. Although the RRT were able to investigate cases at the household within 2 days of a positive culture result, the study identified several constraints that limited a truly rapid response.
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U2 - 10.4269/ajtmh.18-0863
DO - 10.4269/ajtmh.18-0863
M3 - Article
C2 - 30887946
AN - SCOPUS:85065508081
SN - 0002-9637
VL - 100
SP - 1088
EP - 1097
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
IS - 5
ER -