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Haiti still prone to cholera despite increased access to improved water sources

ATLANTA — More than 7 years after a 7.0-magnitude earthquake set the stage for a cholera outbreak in Haiti, people in the resource-poor West Indies nation are still in danger of being infected, researchers said.

Results of their study, presented at the CDC’s Annual Epidemic Intelligence Service (EIS) Conference, suggest that rural residents are particularly at risk for infection.

On Jan. 12, 2010, a devastating earthquake killed more than 200,000 in Haiti. A cholera outbreak soon followed — the worst in recent history — sickening approximately 665,000 people and killing more than 8,000, according to the CDC.

Evidence suggests that U.N. peacekeepers brought the disease to the island. In 2016, then-U.N. Secretary-General Ban Ki-moon issued an apology for his organization’s role in the outbreak.  

In August 2016, the study researchers conducted a two-stage cluster survey in Artibonite department. They surveyed 416 rural and 293 urban households and evaluated residents’ knowledge of cholera, sanitation and use of household water treatment (HWT) products.

They also evaluated access to improved water sources, which WHO defines as one protected from outside contamination, and tested water sources for microbiological indicators. The researchers compared their results with those of a 2012 CDC study.

They found that 51% of rural households had access to improved water sources, an increase from 42.9% in 2012. In the most recent study, 50% of urban households had access to improved water sources.

However, 56 out 131 (42.7%) improved water sources tested positive for Escherichia coli. At the of the time of the visit, a third of rural households had disinfected their drinking water using HWT products, the researchers said. Of those, 46% tested positive free chlorine residual ( > 0.0 mg/L).

Since 2012, there was no change in use of HWT products. There was an increase in rural access to latrines (P < .0001). Significantly, open defecation dropped in rural households from 52.3% to 25.4% (P < .0001).

Those surveyed demonstrated some knowledge of cholera because 81.9% identified contaminated water as a source of cholera infection. – by Joe Green

References:

CDC. Cholera in Haiti. https://www.cdc.gov/cholera/haiti/. Accessed April 26, 2017.

Knipes A, et al. Access to safe water in Haiti: Have we made progress? Presented at: Annual Epidemic Intelligence Service Conference; April 24-27, 2017; Atlanta.

United Nations. Secretary-General Apologizes for United Nations Role in Haiti Cholera Epidemic, Urges International Funding of New Response to Disease. 2016. https://www.un.org/press/en/2016/sgsm18323.doc.htm. Accessed April 27, 2017.

Disclosure: The researchers report no relevant financial disclosures.

Editor's note: This article was updated on April 28.

ATLANTA — More than 7 years after a 7.0-magnitude earthquake set the stage for a cholera outbreak in Haiti, people in the resource-poor West Indies nation are still in danger of being infected, researchers said.

Results of their study, presented at the CDC’s Annual Epidemic Intelligence Service (EIS) Conference, suggest that rural residents are particularly at risk for infection.

On Jan. 12, 2010, a devastating earthquake killed more than 200,000 in Haiti. A cholera outbreak soon followed — the worst in recent history — sickening approximately 665,000 people and killing more than 8,000, according to the CDC.

Evidence suggests that U.N. peacekeepers brought the disease to the island. In 2016, then-U.N. Secretary-General Ban Ki-moon issued an apology for his organization’s role in the outbreak.  

In August 2016, the study researchers conducted a two-stage cluster survey in Artibonite department. They surveyed 416 rural and 293 urban households and evaluated residents’ knowledge of cholera, sanitation and use of household water treatment (HWT) products.

They also evaluated access to improved water sources, which WHO defines as one protected from outside contamination, and tested water sources for microbiological indicators. The researchers compared their results with those of a 2012 CDC study.

They found that 51% of rural households had access to improved water sources, an increase from 42.9% in 2012. In the most recent study, 50% of urban households had access to improved water sources.

However, 56 out 131 (42.7%) improved water sources tested positive for Escherichia coli. At the of the time of the visit, a third of rural households had disinfected their drinking water using HWT products, the researchers said. Of those, 46% tested positive free chlorine residual ( > 0.0 mg/L).

Since 2012, there was no change in use of HWT products. There was an increase in rural access to latrines (P < .0001). Significantly, open defecation dropped in rural households from 52.3% to 25.4% (P < .0001).

Those surveyed demonstrated some knowledge of cholera because 81.9% identified contaminated water as a source of cholera infection. – by Joe Green

References:

CDC. Cholera in Haiti. https://www.cdc.gov/cholera/haiti/. Accessed April 26, 2017.

Knipes A, et al. Access to safe water in Haiti: Have we made progress? Presented at: Annual Epidemic Intelligence Service Conference; April 24-27, 2017; Atlanta.

United Nations. Secretary-General Apologizes for United Nations Role in Haiti Cholera Epidemic, Urges International Funding of New Response to Disease. 2016. https://www.un.org/press/en/2016/sgsm18323.doc.htm. Accessed April 27, 2017.

Disclosure: The researchers report no relevant financial disclosures.

Editor's note: This article was updated on April 28.

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