A Ring Water, Sanitation, and Hygiene Intervention to Reduce Cholera in Hotspots in Bangladesh

项目摘要 背景：据估计，全世界每年有290万例霍乱病例。有效的针对性水， 因此，迫切需要卫生和个人卫生（WASH）干预措施，以减少全球霍乱。我们的研究在 孟加拉国发现，居住在霍乱患者50米范围内的人患霍乱的风险要高出30倍。 发展霍乱比一般人群在第一个星期后，指数病人寻求照顾， 卫生设施。然而，很少有工作做，以制定和评估这种高风险的干预措施， 人口目的：我们的目标是制定和评估环WASH干预措施的有效性， 在霍乱传播热点地区减少霍乱感染并增加持续的讲卫生行为 例既往研究：本课题组开发了霍乱7天医院干预方案 （CHoBI7），这是一项在卫生设施中向霍乱患者及其家庭成员提供的讲卫生运动干预措施。 我们在孟加拉国进行的CHoBI7随机对照试验（RCT）表明，这种干预措施对 大大减少了霍乱，并使用肥皂洗手的人数持续增加，饮用水得到改善 霍乱患者家庭干预后12个月的水质。然而，这种干预仅仅是 重点关注霍乱患者家庭。迄今为止，还没有研究评估了 为霍乱患者附近的家庭提供环式讲卫生活动干预措施。设计与 背景：孟加拉国卫生和家庭福利部疾病控制主任希望 将CHoBI7扩展到孟加拉国，并要求我们建立可扩展方法的证据， 在霍乱患者家庭周围的一个环中递送CHoBI7。本研究将分为3个阶段。期间 形成性研究和规划阶段，我们将开发一个可扩展的，基于理论和证据的环WASH 通过深入访谈、焦点小组讨论、讲习班和试点进行干预。期间 在干预实施和评估阶段，我们将进行一项RCT，前瞻性地随访3120 参与者来自霍乱病例周围40个环的1040个家庭，以评估 干预措施：（1）减少圈内指标患者寻求护理后第一周内的霍乱感染 在卫生设施;（2）在12个月内增加用肥皂洗手和储存水的质量。 第一组将接受孟加拉国腹泻暴发期间的标准建议， 在一次访问中，提供了一份关于水化溶液使用情况和讲卫生运动做法的传单。第二只手臂将接受这个 信息和环WASH干预，其中包括两个家庭访问和移动的健康信息。整个 将对收集的水和临床霍乱弧菌菌株进行基因组测序， 霍乱弧菌在热点地区的时空传播动力学在传播和政策 在规划阶段，我们将与疾病控制局局长合作，传播研究结果， 霍乱控制政策。意义：这将是减少霍乱的环WASH计划的第一个RCT。

PROJECT SUMMARY Background: Worldwide there are estimated to be 2.9 million cholera cases annually. Effective targeted water, sanitation, and hygiene (WASH) interventions are urgently needed to reduce cholera globally. Our study in Bangladesh found that individuals living within 50 meters of a cholera patient were at 30 times higher risk of developing cholera than the general population during the first week after the index patient sought care at a health facility. However, there has been little work done to develop and evaluate interventions for this high risk population. Objective: Our objective is to develop and evaluate the effectiveness of a ring WASH intervention in reducing cholera infections and increasing sustained WASH behaviors in transmission hotspots around cholera cases. Previous studies: Our research group developed the Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7), a WASH intervention delivered to cholera patients and their household members in a health facility. Our randomized controlled trial (RCT) in Bangladesh of CHoBI7 demonstrated this intervention was effective in significantly reducing cholera, and led to sustained increases in handwashing with soap and improved drinking water quality 12 months post-intervention in cholera patient households. This intervention, however, solely focused on cholera patients households. There are no studies to date that have evaluated the impact on reducing cholera of delivering a ring WASH intervention to households living near cholera patients. Design and Setting: The Director of Disease Control at the Bangladesh Ministry of Health and Family Welfare would like to take CHoBI7 to scale across Bangladesh, and has requested we build evidence on scalable approaches for delivering CHoBI7 in a ring around cholera patient households. This study will have 3 phases. During the formative research and planning phase we will develop a scalable, theory and evidence based ring WASH intervention through in-depth interviews, focus group discussions, workshops, and a pilot. During the intervention implementation and evaluation phase we will conduct a RCT to prospectively follow 3120 participants from 1040 households living in 40 rings around cholera cases to evaluate the effectiveness of the intervention in: (1) reducing cholera infections during the first week after the index patient in the ring seeks care at a health facility; and (2) increasing handwashing with soap and stored water quality over a 12 month period. The first arm will receive the standard recommendation given in Bangladesh during diarrhea outbreaks on oral rehydration solution use and a leaflet on WASH practices during a single visit. The second arm will receive this message and the ring WASH intervention which includes two home visits and mobile health messages. Whole genome sequencing will be performed on water and clinical Vibrio cholerae strains collected to investigate spatiotemporal transmission dynamics of V. cholerae in hotspots. During the dissemination and policy planning phase, we will partner with the Director of Disease Control to disseminate study findings and inform cholera control policies. Significance: This will be the first RCT of a ring WASH program to reduce cholera.