A joint research project

1. Cholera and Haiti:
Risk Factors and Determinants of Health
Lydia Meintel-Wade
Jenkins Macedo
Marcus Pasay
David Safari

2. Presentation Outline
1. Basic Information of Cholera
• Life Cycle of Vibro Cholerae
2. Haitian Epidemic and Scale
• Social and Environmental Determinants
• Statistics
3. Intervention Brainstorming Activity
• Stakeholders Analysis
4. Community Health Workers Training
• Trainers of Trainers
 ORS
 SODIS

3. Basic Information of Cholera
 Vibrio cholera
 Exposure through food and water
 Vibrio cholera exists naturally in coastal and freshwater
bodies
 Global attack rate 4.6%.
 Currently an estimated 3-5 million cases occur around the
world each year, resulting in over 100,000 deaths
Source: WHO

4. Life Cycle of the Disease

5. Cholera
Symptoms (5-10%)
• profuse watery diarrhea • acute renal failure
• vomiting • severe electrolyte
• rapid heart rate imbalances
• loss of skin elasticity • coma
• low blood pressure • shock and death
• muscle cramps
 Oral rehydration salts, intravenous fluids and
electrolytes => less than 1% fatality

6. Haitian Cholera Epidemic and Scale
• Outbreak was worsened by Earthquake
that left thousands homeless, Destroyed
sanitation and water infrastructure
• Number of reported cases 473,649
(October 14, 2011)
• Attack rate 7.8% in Port au Prince
• Lowest attack rate 1.1% Southeast
• Mortality rate 63.7 per 100,000 of
exposed population.
• 250,000 cases with 4,000 deaths in first 6
months.

7. Social and Environmental Determinants
• 1/2 of Port-au-Prince had access to latrines and other forms of modern sanitation (Farmer et
al, 2011).
• 1/3 of population had no access to tap water (Farmer et al, 2011)
• Geographic location
 Artibonite
 Meiller
• Lack of clean water
• Lack of proper sanitation infrastructure

8. Intervention Brainstorming Activity
Stakeholders
• Government Officials
• NGOs
• IDP Camps Managers
• Rural Poor
• Teachers
Instruction
The community health workers-in-training will divide into four groups representing distinct
interests in Haiti: government officials, NGOs, IDP camp managers, and the rural poor.
These groups will meet as caucuses to discuss the specific needs and capabilities of their
cohorts and to suggest interventions that could reduce the spread of cholera in Haiti.

9. Intervention:
Determinants-Based Approach
• Food and Water Safety
 SODIS
 Chlorination
 Boiling
 Chemical Treatment Products
 Water Storage Facilities
 Using clean water to prepare food
 Only eat hot or peelable food

10. Intervention:
Determinants-Based Approach
 Sanitation/Hygiene
 Proper solid waste disposal and management
 Hand Washing with safe water
 Cleaning food preparation areas
 Proper

11. Community Health Workers Training
Overview
• The participants will be broken into two groups of community health
workers, each taught a different cholera prevention skill. The class will form pairs
with one member from each workshop group, and the pairs will demonstrate to
one another what they have learned.
Training Sessions Instructions
• Oral Rehydration Solution (ORS).
 Have each group learn what an ORS is and how it helps those with cholera
 Make ORS solution (drink it!)
• Solar Water Disinfection (SODIS).
 Learn the benefits and limitations of SODIS in cholera prevention.
 Fill SODIS bottles and calculate the exposure time needed

12. Video

13. Reference
 Centers for Disease Control and Prevention (CDC). “General Information.” Cholera. Last Updated Feb. 24, 2011.
 URL: http://www.cdc.gov/cholera/general/
 Accessed: 10/1/2011.

 CDC. “Acute watery diarrhea and cholera: Haiti pre-decision brief for public health action.” Dec 6, 2010
 URL:http://www.bt.cdc.gov/disasters/earthquakes/haiti/waterydiarrhea_pre-decision_brief.asp. Accessed: 09/30/2011.

 Chen-Shan Chin et al. “The Origin of the Haitian Cholera Outbreak Strain.” New England Journal of Med. January 6; 364(1): 33-42.
URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3030187/?tool=pubmed
Accessed: 09/30/2011.

 Colwell, R. (2010). “The intricate connection of cholera, climate and public health.” On the Water Front:
 Selections from the 2010 World Water Week in Stockholm. Ed. Jan Lundqvist. Stockholm International Water Institute (SIWI), Stockholm: 2011.
 URL: http://www.siwi.org/documents/Resources/Best/2010/2011_OTWF_Rita_Colwell.pdf
 Accessed: 9/28/2011.

 Dowell SF, Braden CR. “Implications of the Introduction of Cholera to Haiti. Emerging Infectious Diseases.” Emerging Infectious Disease. July 2011; 17 (7): 1299-1300
 URL: http://www.ncbi.nlm.nih.gov/pubmed/21762593
 Accessed 09/29/2011

 Farmer P, Almazor CP, Bahnsen ET, Barry D, Bazile J, et al.“Meeting cholera's challenge to Haiti and the world: a joint statement on cholera prevention and care”.
PLoS Negl Trop Dis. May 2011;5(5):e1145:1-13.
 URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3104956/
 Accessed 09/27/2011

 International Medical Corps “Cholera in Haiti: Still An Emergency.”
 URL: http://internationalmedicalcorps.org/document.doc?id=204.
 Accessed: 10/05/2011.
 Reidl, J. & Klose, K. (2002). “Vibrio cholera and cholera: out of the water and into the host.” FEMS Microbiology Reviews. 26: 125-139.
 URL: http://fst.snu.ac.kr/~shchoi/Lecture/2008%20Food%20Biotech/3c.%20Vc%20in%20host.pdf
 Accessed: 10/6/2011.

World Health Organization“Cholera Country Profile: Haiti.” Global Task Force on Cholera Control. Updated May 2011.
URL:http://www.who.int/cholera/countries/HaitiCountryProfileMay2011.pdf.
 Accessed: 10/06/2011.