Role of Household water treatment and
safe storage during CHOLERA
A cholera epidemic is often a symptom of long history of
water and sanitation insecurity
Jan Heeger, WASHCONSULT
13 March, 2012
International call for action-HWTS and Cholera Control
World Health Assembly Resolution 64/14 on Cholera: mechanism for
control and prevention
Calls attention to role of clean water, including HWTS and
sanitation Cholera prevention
Requests WHO to revitalize the Global Task Force on Cholera
control
WHO/UNICEF International Network on Household Water Treatment
and Safe Storage encourages effective use and monitoring of HWTS
in disease outbreaks
HWTS is included as part of the WHO and UNICEF 7 point strategy on
comprehensive diarrhoea control
HWTS in emergencies
consideration
HWTS or PoUWT is one strategy among others to ensure safe
water access during cholera outbreak
Access to safe water is one of the control measures during
cholera outbreaks (human to human transmission also plays
important role, Morris, 2011)
HWTS is often fast and relatively cheap to role out
HWTS should be targeted to most vulnerable
Many WASH interventions have a significant impact on
diarrhoeal disease
44%
Handwashing with soap
39%
Household water treatment
32%
Sanitation
25%
Water Supply
Source water treatment
11%
An integrated strategy were HWTS, hand washing with soap, and possibly
improved sanitation have shown together to result in the greatest health
gains (Esry, 1996; Pickering 2012) and should be considered jointly during a
Cholera outbreak .
Possible benefit HWTS during cholera
Evidence in relation to the potential role of HWTS during cholera
Two different Studies in Haiti demonstrated that treating drinking
water was strongly protective (Lt O’Connor 2010 and Epicente, 2011)
Two key practices that protected against cholera in the
contaminated urban environment of Port-au-Prince: habitual water
treatment and proper hand washing (S. Dunkle , 2011)
Chlorine treatment decreased the risk of Cholera by ½ (Zambia,
Epicentre, 2010)
Madagascar 2001 cholera epidemic study revealed that patients
were more likely than control subjects to have drunk untreated water
(ME Reller, 2001)
Kenya 2001 cholera epidemic showed significant reduces risk of
cholera in households using solar disinfection (RM Conroy, 2001)
Improving effectiveness of HWTS in cholera outbreaks
Introduce HWTS in key risk areas before emergency (Not only
chlorine based products but also other methods like ceramic pot-filter)
Ensure HWTS is included in cholera response strategy (e.g.
distribution of HWTS to vulnerable groups like family of patients)
Ensure better monitoring during the emergency (Monitoring
"availability and correct use" is often sufficient and can be
supplemented by simple water quality measurements)
Sustainability or long-term access to the products should be
considered (chronic emergencies!)
Ensure only the right concentrations of chlorine are used
Be prepared (make IEC database and translate material beforehand)
Promote studies on transmissions routes and key risk behaviors
MERCI / THANK YOU
worldwaterforum6.org
solutionsforwater.org