Abstract
BackgroundHaiti's cholera epidemic has been devastating partly due to underlying weak infrastructure and limited clean water and sanitation. A comprehensive approach to cholera control is crucial, yet some have argued that oral cholera vaccination (OCV) might result in reduced hygiene practice among recipients. We evaluated the impact of an OCV campaign on knowledge and health practice in rural Haiti.Methodology/Principal FindingsWe administered baseline surveys on knowledge and practice relevant to cholera and waterborne disease to every 10th household during a census in rural Haiti in February 2012 (N = 811). An OCV campaign occurred from May–June 2012 after which we administered identical surveys to 518 households randomly chosen from the same region in September 2012. We compared responses pre- and post-OCV campaign.Post-vaccination, there was improved knowledge with significant increase in percentage of respondents with ≥3 correct responses on cholera transmission mechanisms (odds ratio[OR] 1.91; 95% confidence interval[CI] 1.52–2.40), preventive methods (OR 1.83; 95% CI 1.46–2.30), and water treatment modalities (OR 2.75; 95% CI 2.16–3.50). Relative to pre-vaccination, participants were more likely post-OCV to report always treating water (OR 1.62; 95% CI 1.28–2.05). Respondents were also more likely to report hand washing with soap and water >4 times daily post-vaccine (OR 1.30; 95% CI 1.03–1.64). Knowledge of treating water as a cholera prevention measure was associated with practice of always treating water (OR 1.47; 95% CI 1.14–1.89). Post-vaccination, knowledge was associated with frequent hand washing (OR 2.47; 95% CI 1.35–4.51).ConclusionAn OCV campaign in rural Haiti was associated with significant improvement in cholera knowledge and practices related to waterborne disease. OCV can be part of comprehensive cholera control and reinforce, not detract from, other control efforts in Haiti.
Highlights
In October 2010, a cholera outbreak began in the Artibonite and Centre Departments of Haiti [1]
An oral cholera vaccination (OCV) campaign in rural Haiti was associated with significant improvement in cholera knowledge and practices related to waterborne disease
This study aimed to evaluate the impact of a cholera vaccination campaign in rural Haiti on knowledge of cholera and health practice related to transmission and prevention of waterborne illnesses
Summary
In October 2010, a cholera outbreak began in the Artibonite and Centre Departments of Haiti [1]. Efforts to control the cholera outbreak have been hampered by weak health systems and lack of clean water and adequate sanitation in Haiti. In 2008, only 17% of Haiti’s population used improved sanitation facilities while 12% had access to piped, treated water [5]. Pockets of densely populated areas resulting from internal migration after the earthquake likely contributed to an explosive outbreak in Haiti. Haiti’s cholera epidemic has been devastating partly due to underlying weak infrastructure and limited clean water and sanitation. A comprehensive approach to cholera control is crucial, yet some have argued that oral cholera vaccination (OCV) might result in reduced hygiene practice among recipients. We evaluated the impact of an OCV campaign on knowledge and health practice in rural Haiti
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