Description of the targeted WASH response strategy implemented during the cholera outbreak of 2017-2018 in Kinshasa, DRC

Abstract

Background: Rapid control of cholera outbreaks is a significant challenge in overpopulated urban settings, and documented results on field interventions are scarce. During the 2017–2018 period, Kinshasa, the capital of Democratic Republic of the Congo, experienced a sharp increase in cholera cases that showed potential to quickly spread throughout the city. A novel targeted WASH (Water, Sanitation and Hygiene) strategy was implemented to quickly stem the cholera outbreak. Methods and materials: We carried out a descriptive study of the cholera outbreak in Kinshasa from 2017 to 2018. Cholera surveillance databases from the Ministry of Health were analyzed to assess the spatiotemporal dynamics of the cholera outbreak using epidemic curves and cartography. Weekly precipitation levels in Kinshasa were also assessed. We also described the targeted cluster grid WASH strategy, which was implemented to quickly target case clusters at the household and community level, carrying out interventions focused on emergency water supply, household water treatment and safe storage, home disinfection and hygiene promotion. We also examined the evolution of the outbreak following implementation of the response strategy. Results: From January 2017 to November 2018, a total of 1712 suspected cholera cases were reported in Kinshasa. During this period, the health zones most affected included Binza Météo, Limeté, Kokolo, Kintambo and Kingabwa. Following implementation of the response strategy, the weekly cholera case numbers in Binza Météo, Kintambo and Limeté decreased by an average of 57% in two weeks and 86% in four weeks. The total weekly case numbers throughout Kinshasa Province dropped by 71% at four weeks after the outbreak peak. Conclusion: During the 2017–2018 period, Kinshasa experienced a sharp increase in cholera cases that showed potential to quickly spread throughout the city. To contain the outbreak, WASH response interventions targeted case households, nearby neighbors and public areas in case clusters using a grid approach. Following implementation of the WASH response, the outbreak in Kinshasa was quickly brought under control. A similar approach may be useful to quickly interrupt cholera transmission in other urban settings.