Abstract
Abstract Monitoring water, sanitation, and hygiene programs in cholera outbreaks is critical to improve humanitarian response. The objective of this research was to evaluate, and improve, WASH in cholera monitoring tools currently used in northeast Nigeria. We collected 723 forms from 2019 from three form types, combined them into one database of 980 activities, and stratified data by form type, response, implementing organization, activity, month/day, and geographical area. We conducted seven key informant interviews (KIIs) with monitoring tool users and decision-makers. Data irregularities (including in design, collection, and entry) led to an inability to meaningfully analyze monitoring forms. In KIIs, eight themes emerged: ease of use of current tools, improvement in monitoring over time, lack of access to data, need for training, inconsistent reporting practices, need for modification of current questions, need for the addition of new questions, and connectivity issues. Although informants reported monitoring helped organizations identify gaps during the response, the scarcity and inconsistency of the reported data make it difficult to draw any conclusions about program effectiveness, accountability in humanitarian response, or to make recommendations for improving programming. To improve monitoring, we recommend refining data collection by increasing the quantity of data reported, data consistency, and data relevancy.
Highlights
Since the first cholera pandemic in 1817, there have been seven subsequent pandemics (WHO 2018), and cholera today accounts for 1.3–4.0 million cases and 21,000–143,000 yearly deaths worldwide (Ali et al 2015)
The objective of this research was to review these monitoring tools, analyze existing data collected by WASH Cluster partners using these tools, interview tool users to understand and improve WASH in cholera monitoring in northeast Nigeria, and inform WASH in cholera response monitoring globally
Seven key informant interviews (KIIs) conducted with users/decision-makers led to eight emergent themes in qualitative analysis
Summary
Since the first cholera pandemic in 1817, there have been seven subsequent pandemics (WHO 2018), and cholera today accounts for 1.3–4.0 million cases and 21,000–143,000 yearly deaths worldwide (Ali et al 2015). As cholera is transmitted through the fecal-oral route (Sphere Association 2018; WHO 2019; CDC 2020), long-term sustainable water, sanitation, and hygiene (WASH) interventions are critical to prevent and control outbreaks (Taylor et al 2015; Wolfe et al 2018; Yates et al 2018; Jones et al 2020). WASH programs aim to reduce public health risks by creating barriers along transmission pathways through the following activities: promoting good hygiene practices, providing safe drinking water, providing appropriate sanitation facilities, and reducing environmental health risks (Neseni & Guzha 2009; Sphere Association 2018; Wolfe et al 2018; Yates et al 2018).
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