9. Community focussed interventions
9.1. Overview of Chapter 9
people who will be infected with cholera That will prevent people from dying of cholera.
•
The importance of early prevention, detection and treatment
Early prevention, detection and treatment of cholera at the household and community levels will prevent and reduce the spread of cholera and limit illness and death
Community-based strategies have the following main objectives:
Prevention of new cases in the community through provision of safe
•
water, safe food, hygiene promotion messages and sanitation activities Detection, treatment and referral for treatment of cases in the
•
household and the community
Community-based surveillance for early detection and monitoring of
•
reporting of cases and deaths.
A community-based strategy must be linked to higher level health and WASH services including surveillance systems in order to record cases and deaths, ensure appropriate supervision, supply chain and referral systems.
Community-based health workers, including trained community health workers (CHWs), hygiene promoters, volunteers, etc., play a major role in delivering services to the community. CHWs need to be identified, trained and equipped to manage their role as a key actor in cholera preparedness and response plans.
They also require close supervision and support, including oversight of supplies, in order to provide adequate and continuous service to their communities.
The following table provides an overview of the actions and strategies for cholera response, including activities to prevent the spread of the disease (see Chapter 4 for additional reference) and indicates which actors are likely to be responsible for their implementation as well as the role of the community in each.
9.1 Overview of Chapter 9
This chapter should be read in conjunction with Chapter 7 on
communication, behaviour change and social mobilisation, with specific reference to Section 7.4 on mobilising for community action and to the associated Chapter 7 Annexes, which identify methodologies for behaviour change communication and motivational messaging.
Summary of Annexes
Annex 9A Water supplies and treatment
Annex 9B PoU Water Treatment and Safe Storage Annex 9C Safe excreta disposal
Annex 9D Safe care of the dead
Annex 9E Cholera response actions in institutional or public settings Annex 9F Community-based surveillance form (weekly)
Annex 9G Provision of supplies/NFIs
A comprehensive community-based strategy integrating WASH and health promotion components is critical to early prevention, detection of illness and case management.
9
Community focussed interventions1 2 3 4 5 6
10 7 8
TOC
Target outcome Household, community and institutional
practices – Actions required (may involve sustained
behaviour change) Practitioners – Actions required
People have access to and use safe water
supply for drinking Refer to Section 4 (Table 2) for details
Households, communities, institutions and food outlets practice safe food hygiene
Refer to Section 4 (Table 2) for details
Infants are exclusively breastfed and if
needed, given safe fluids and food
Refer to Section 4 (Table 2) for details
The environment is free from excreta because people dispose of it safely
Refer to Section 8 for details on case management at community level
People wash their hands with soap and water at critical times
Refer to Section 4 (Table 2) for details
Environmental hygiene is adhered to in markets
and other public places Refer to Section 4 (Table 2) for details
Table 11 Community-focussed actions for cholera response
Cont’d from
Table 2
Located on page 42
9
Community focussed interventions1 2 3 4 5 6 7 8
TOC
Target outcome Household, community and institutional
practices – Actions required (may involve sustained
behaviour change) Practitioners – Actions required (CONT’D)
(a) Children and adults who have diarrhoea with or without vomiting are effectively rehydrated (b) Households know where to get ORS and know how to prepare and use it
Children and adults who have diarrhoea with or
• without vomiting are given ORS made with safe water and zinc.
Children and adults who have diarrhoea with or
• without vomiting and who do not have access to ORS may be given another solution (such as sugar-salt solution, or rice-based ORS) or water to slow down the process of dehydration until proper care with ORS and zinc is available. See Section 8.3.3 for details.
Children and adults who are sick during a cholera
• outbreak immediately go to a health facility.
ORPs at community level are established.
•
Community case management by trained CHWs
•
Advocacy, education and mobilisation on the use of ORS (and zinc) for the
•
treatment of dehydration and for health care-seeking behaviours during a cholera outbreak
Support for the establishment of a supply chain for ORS and zinc for easy
•
access in all urban and rural areas
See Section 9.11 on community case management of cholera.
Items contaminated with infected vomit and faeces are safely disinfected
Floors, furniture, bed linen, clothes or other items
• soiled with vomit or diarrhoea are effectively disinfected with water and chlorine.
Disinfectant spraying is not cost-effective and not
• recommended. See explanation in Section 9.6.
Education through family visits and mobilisation on the appropriate procedures
• for disinfecting areas and materials soiled with faeces or vomit. Disinfectant need to be provided
Education and mobilisation on the critical importance of not washing clothes
• and bed linen in or near open or safe water sources
Households are not ashamed of getting cholera and seek help promptly
Peer-to-peer information sharing and encouragement
• that getting cholera is not shameful and on the importance of seeking help promptly.
Awareness raising is undertaken through the media and with religious and
• community leaders to alleviate the stigma associated with cholera
Precautions to prevent cholera transmission are taken at funerals and when handling dead bodies
Handwashing facilities with soap are installed and their use is promoted:
After going to the latrine
•
After touching a corpse, its clothing or bedding
•
Before food preparation
•
Before eating food or drinking.
•
Education and mobilisation on safe handling of the dead and cholera safety at
• funerals is provided, especially for religious and community leaders and health extension workers
Households and institutions practice safe hygiene and use ORS effectively
Supplies are received and used as instructed
• • Supplies available, and those critical for taking action on WASH safety
and ORS use, are identified
Most vulnerable people for the distribution of supplies are identified
•
Supplies, with training and support for use, are distributed
• Community focussed interventions
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KEy RESOURCES
US Centers for Disease Control & Prevention (CDC), Community Health Worker Training Materials for Cholera Prevention and Control, 2012.
CDC, Slideshow: ‘Cholera Prevention & Control: Introduction and Community Engagement’, 2010.
UNICEF and partners: Joint Statement: Scaling up the community based health workforce for emergencies. October 2011.