(A253) Integrated Community-Based Interventions to Overcome a Deadly Cholera Outbreak in Zimbabwe

An unprecedented cholera outbreak affected Zimbabwe from August 2008 to July 2009 with 98,592 cases and 4,288 deaths, in 54 out of 62 districts. The main strategy used to overcome the outbreak was an integrated community-based interventions package. The present work is a case study to describe the strategy and lessons learned for future humanitarian crises and preparedness. The methodology was based on the review of epidemiological reports, assessment and surveys' reports, minutes of joint Health and Water Sanitation and Hygiene (WASH) Clusters' meetings, and direct observation as Health Cluster Coordinator. Epidemiological data showed an increasing number of cases in rural areas with community deaths representing 66% of the 1,948 deaths from 61,304 cases on 31 January 2009. Risk factors identified in communities were: lack of awareness about the disease, cultural and religious behaviors, lack of potable water with weak sanitation, lack and inappropriate use of water purification tablets, and lack of soap and water containers for effective behavior change. There also was late arrival to cholera to the few treatment centers by rural populations. In addition to treatment centers, a package of interventions was implemented by multi-sectoral stakeholders. The package included: health and WASH education tools and practice sessions for healthy and hygienic behavior change and for an effective use of oral rehydration salt as first aid measure; community-based surveillance with an early warning system and response teams; and distribution of containers and water purification tablets with drilling of water points. Epidemiological data showed a significant decrease of cholera cases where the full package was implemented. This work showed that an integrated package of interventions jointly targeting risk factors can be effective on public health threats in rural communities. Community-based preparedness and response should then take into account an integrated joint intervention package to mitigate public health threat