Changing Water-Sanitation Determinants of Cholera over Two Decades in Bangladesh

Mohammad Habibur Rahman Sarker International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;

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Sumon Kumar Das Menzies School of Health Research, Charles Darwin University, Darwin, Australia;

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Hasnat Sujon International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;
Infectious Disease and One Health Program, Hannover Medical School, Hannover, Germany;

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Michiko Moriyama Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan;

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Md Moshiur Rahman Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan;

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Md. Nazim Uzzaman International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;
Usher Institute, University of Edinburgh, Edinburgh, United Kingdom;

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Shakila Banu International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;

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Abu SMSB Shahid International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;

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Jui Das Institute for Social Science Research, The University of Queensland, Brisbane, Australia

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Soroar Hossain Khan International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;

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Mohammod Jobayer Chisti International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;

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ASG Faruque International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;

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Tahmeed Ahmed International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;

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ABSTRACT.

Cholera is a leading global public health threat, especially in developing countries. This study aimed to determine the changing determinants of cholera related to water-sanitation practices between 1994–1998 and 2014–2018 in Dhaka, Bangladesh. Data of all cause diarrhea cases were extracted from the Diarrheal Disease Surveillance System of the International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, and analysis was performed among three groups: Vibrio cholerae detected as sole pathogen, V. cholerae detected as mixed infection, and detection of no common enteropathogen in stool specimens (reference). Using sanitary toilet, drinking tap water, drinking boiled water, family size greater than five, and slum dwelling were the main exposures. Overall, 3,380 (20.30%) and 1,290 (9.69%) patients were positive for V. cholerae during 1994–1998 and 2014–2018, respectively. In 1994–1998, use of sanitary toilet (adjusted odds ratio [aOR]: 0.86, 95% CI: 0.76–0.97) and drinking tap water (aOR: 0.81, 95% CI: 0.72–0.92) were found to be negatively associated and in 2014–2018, drinking tap water (aOR: 1.47, 95% CI: 1.21–1.78) and slum dwelling (aOR: 1.43, 95% CI: 1.10–1.86) were found to be positively associated with V. cholerae infection after adjusting for age, sex, monthly income, and seasonality. Because the determinants of cholera such as drinking tap water can change over time in developing cities, ameliorating the water, sanitation, and hygiene (WASH) situation is of paramount importance. In addition, in settings such as urban slums, where long-term WASH monitoring might be difficult to achieve, mass vaccination with oral cholera vaccine should be introduced to control cholera.

Author Notes

Address correspondence to Mohammod Jobayer Chisti, Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, 68, Shaheed Tajuddin Ahmed Sarani Mohakhali, Dhaka 1212, Bangladesh. E-mail: chisti@icddrb.org

Financial support: The authors did not receive specific funding for this study. Hospital surveillance, however, is funded by International Centre for Diarrhoeal Disease Research, Bangladesh and the Government of the People’s Republic of Bangladesh through IHP-HNPRP. International Centre for Diarrhoeal Disease Research, Bangladesh is also grateful to the Governments of Bangladesh, Canada, Sweden, and the United Kingdom for providing core/unrestricted support. The funding agency had no role in collecting, analyzing, or interpreting the results.

Disclosure: The Diarrheal Disease Surveillance System of International Center for Diarrheal Disease Research, Bangladesh (icddr,b) is a routine ongoing activity of the Dhaka Hospital that has been approved by the Research Review Committee and Ethical Review Committee of icddr,b.

Authors’ addresses: Mohammad Habibur Rahman Sarker, Shakila Banu, Abu SMSB Shahid, Soroar Hossain Khan, Mohammod Jobayer Chisti, ASG Faruque, and Tahmeed Ahmed, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, E-mails: habibur.rahman@icddrb.org, shakila@icddrb.org, sayeem@icddrb.org, soroar@icddrb.org, chisti@icddrb.org, gfaruque@icddrb.org, and tahmeed@icddrb.org. Sumon Kumar Das, Menzies School of Health Research, Charles Darwin University, Darwin, Australia, E-mail: dassumonkumar1@gmail.com. Hasnat Sujon, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, and Infectious Disease and One Health Program, Hannover Medical School, Hannover, Germany, E-mail: hasnatsujon@gmail.com. Michiko Moriyama and Md. Moshiur Rahman, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan, E-mails: morimich@hiroshima-u.ac.jp and moshiur@hiroshima-u.ac.jp. Md. Nazim Uzzaman, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, and Usher Institute, University of Edinburgh, Edinburgh, United Kingdom, E-mail: m.n.uzzaman@sms.ed.ac.uk. Jui Das, Institute for Social Science Research, The University of Queensland, Brisbane, Australia, E-mail: jui.das@uq.net.au.

  • 1.

    Kanungo S, Azman AS, Ramamurthy T, Deen J, Dutta S, 2022. Cholera. Lancet 399: 14291440.

  • 2.

    Ali M, Nelson AR, Lopez AL, Sack DA, 2015. Updated global burden of cholera in endemic countries. PLoS Negl Trop Dis 9: e0003832.

  • 3.

    Harris JB, LaRocque RC, Charles RC, Mazumder RN, Khan AI, Bardhan PK, 2010. Cholera’s western front. Lancet 376: 19611965.

  • 4.

    Federspiel F, Ali M, 2018. The cholera outbreak in Yemen: lessons learned and way forward. BMC Public Health 18: 1338.

  • 5.

    Islam MT, Clemens JD, Qadri F, 2018. Cholera control and prevention in Bangladesh: an evaluation of the situation and solutions. J Infect Dis 218: S171S172.

    • Search Google Scholar
    • Export Citation
  • 6.

    Global Task Force on Cholera Control , 2017. Ending Cholera: A Global Roadmap to 2030. Available at: https://www.gtfcc.org/wp-content/uploads/2019/10/gtfcc-ending-cholera-a-global-roadmap-to-2030.pdf. Accessed July 27, 2022.

  • 7.

    Harris JB, LaRocque RC, Qadri F, Ryan ET, Calderwood SB, 2012. Cholera. Lancet 379: 24662476.

  • 8.

    Clemens JD, Nair GB, Ahmed T, Qadri F, Holmgren J, 2017. Cholera. Lancet 390: 15391549.

  • 9.

    Dhaka AFP, 2020. Bangladesh Kicks Off Vaccination to Eliminate Cholera. Available at: https://en.prothomalo.com/bangladesh/bangladesh-in-world-media/Bangladesh-kicks-off-vaccination-to-eliminate. Accessed July 27, 2022.

  • 10.

    United Nation’s Children Fund , 2017. World’s Second Largest Oral Cholera Vaccination Campaign Kicks Off at Rohingya Camps in Bangladesh. Available at: https://www.unicef.org/press-releases/worlds-second-largest-oral-cholera-vaccination-campaign-kicks-off-rohingya-camps. Accessed July 27, 2022.

  • 11.

    Cutler D, Miller G, 2005. The role of public health improvements in health advances: the twentieth-century United States. Demography 42: 122.

    • Search Google Scholar
    • Export Citation
  • 12.

    United Nations Children’s Fund , World Health Organization , 2015. Progress on Sanitation and Drinking Water—2015 Update and MDG Assessment. Geneva, Switzerland: WHO Press. Available at: https://apps.who.int/iris/bitstream/handle/10665/177752/9789241509145_eng.pdf?sequence=1&isAllowed=y. Accessed July 27, 2022.

  • 13.

    Sarker MHR et al., 2014. Changing characteristics of rotavirus diarrhea in children younger than five years in urban Bangladesh. PLoS One 9: e105978.

    • Search Google Scholar
    • Export Citation
  • 14.

    Das SK et al., 2013. Etiological diversity of diarrhoeal disease in Bangladesh. J Infect Dev Ctries 7: 900909.

  • 15.

    World Population Review , 2022. Dhaka Population, 2022. Available at: https://worldpopulationreview.com/world-cities/dhaka-population. Accessed July 27, 2022.

  • 16.

    Abdullah A, 2016. Rural–urban migration and informal sector of Dhaka City: issues and facts. Res J Humanities Social Sci 7: 101106.

    • Search Google Scholar
    • Export Citation
  • 17.

    Dhaka WASA , 2022. Dhaka WASA. Available at: http://www.dwasa.org.bd/site/page/82b7fee1-1878-4908-91d4-0426b0ef8183/-. Accessed July 27, 2022.

  • 18.

    icddr,b , 2022. icddr,b’s Response to the Ongoing Massive Diarrhoea Outbreak in Dhaka and Matlab. Available at: https://www.icddrb.org/news-and-events/news?id=890&task=view. Accessed July 27, 2022.

  • 19.

    Moral S, 2022. Diarrhoea Outbreak: 450,000 Patients in Three Months. Available at: https://en.prothomalo.com/bangladesh/diarrhoea-outbreak-450000-patients-in-three-months. Accessed July 28, 2022.

  • 20.

    Islam Z, Sujan MA, 2022. Breaches in WASA supply lines causing cholera outbreak in Dhaka? The Daily Star. Available at: https://www.thedailystar.net/health/disease/news/cholera-breaks-out-city-2992611. Accessed July 28, 2022.

    • Search Google Scholar
    • Export Citation
  • 21.

    Haq KA, 2007. Water management in Dhaka. Int J Water Resour Dev 22: 291311.

  • 22.

    Mahbub K, Nahar A, Ahmed M, Chakraborty A, 2011. Quality analysis of Dhaka WASA drinking water: detection and biochemical characterization of the isolates. J Environ Sci Nat Resour 4: 4149.

    • Search Google Scholar
    • Export Citation
  • 23.

    Rasheed H, Altaf F, Anwar K, Ashraf M, 2021. Drinking Water Quality in Pakistan: Current Status and Challenges. Islamabad, Pakistan: Pakistan Council of Research in Water Resources. Available at: https://pcrwr.gov.pk/wp-content/uploads/2021/10/Drinking-Water-Quality-in-Pakistan-2021.pdf. Accessed July 28, 2022.

  • 24.

    Bhunia R, Ramakrishnan R, Hutin Y, Gupte MD, 2009. Cholera outbreak secondary to contaminated pipe water in an urban area, West Bengal, India, 2006. Indian J Gastroenterol 28: 6264.

    • Search Google Scholar
    • Export Citation
  • 25.

    Adedire EB, Usman AB, Abbass GA, Ajayi IO, Fawole OI, 2015. Descriptive characterization of cholera epidemic caused by break down of public pipe borne water Supply-Egbeda, Oyo State Nigeria September 2013. Int J Epidemiol 44: i153.

    • Search Google Scholar
    • Export Citation
  • 26.

    Yeazdani S, 2016. State of drinking water and its management aspects in Dhaka city. J Nepal Geol Soc 50: 5964.

  • 27.

    Luby SP, Gupta SK, Sheikh MA, Johnston RB, Ram PK, Islam MS, 2008. Tubewell water quality and predictors of contamination in three flood-prone areas in Bangladesh. J Appl Microbiol 105: 10021008.

    • Search Google Scholar
    • Export Citation
  • 28.

    Aditi FY, Rahman SS, Hossain Md M, 2017. A study on the microbiological status of mineral drinking water. Open Microbiol J 11: 3144.

  • 29.

    Islam MS, Brooks A, Kabir M, Jahid I, Islam MS, Goswami D, Nair G, Larson C, Yukiko W, Luby S, 2007. Faecal contamination of drinking water sources of Dhaka city during the 2004 flood in Bangladesh and use of disinfectants for water treatment. J Appl Microbiol 103: 8087.

    • Search Google Scholar
    • Export Citation
  • 30.

    Hasan MK, Shahriar A, Jim KU, 2019. Water pollution in Bangladesh and its impact on public health. Heliyon 5: e02145.

  • 31.

    Posny D, Wang J, Mukandavire Z, Modnak C, 2015. Analyzing transmission dynamics of cholera with public health interventions. Math Biosci 264: 3853.

    • Search Google Scholar
    • Export Citation
  • 32.

    Nygren BL, Blackstock AJ, Mintz ED, 2014. Cholera at the crossroads: the association between endemic cholera and national access to improved water sources and sanitation. Am J Trop Med Hyg 91: 10231028.

    • Search Google Scholar
    • Export Citation
  • 33.

    Bangladesh Bureau of Statistics (BBS) , 2022. Preliminary Report on Population and Housing Census 2022. Dhaka, Bangladesh: BBS. Available at: http://bbs.gov.bd/site/page/b588b454-0f88-4679-bf20-90e06dc1d10b. Accessed July 28, 2022.

  • 34.

    Sur D et al., 2006. Epidemiological, microbiological & electron microscopic study of a cholera outbreak in a Kolkata slum community. Indian J Med Res 123: 3136.

    • Search Google Scholar
    • Export Citation
  • 35.

    Kanungo S et al., 2012. Clinical, epidemiological, and spatial characteristics of Vibrio parahaemolyticus diarrhea and cholera in the urban slums of Kolkata, India. BMC Public Health 12: 830.

    • Search Google Scholar
    • Export Citation
  • 36.

    Ferdous F, Das SK, Ahmed S, Farzana FD, Malek MA, Das J, Latham JR, Faruque AS, Chisti MJ, 2014. Diarrhoea in slum children: observation from a large diarrhoeal disease hospital in Dhaka, Bangladesh. Trop Med Int Health 19: 11701176.

    • Search Google Scholar
    • Export Citation
  • 37.

    Kanungo S, Chatterjee P, Saha J, Pan T, Chakrabarty ND, Dutta S, 2021. Water, sanitation, and hygiene practices in urban slums of eastern India. J Infect Dis 224: S573S583.

    • Search Google Scholar
    • Export Citation
  • 38.

    Rashid SF, 2009. Strategies to reduce exclusion among populations living in urban slum settlements in Bangladesh. J Health Popul Nutr 27: 574586.

    • Search Google Scholar
    • Export Citation
  • 39.

    Kumar A, 2010. Urban Risk Assessment: A Facilitator’s Guideline. Slotema M, Shahi IA, Ali SS, eds. Dhaka, Bangladesh: Plan Bangladesh and Islamic Relief Worldwide, Bangladesh. Available at: https://dokumen.tips/documents/urban-risk-assessment-ura.html?page=1. Accessed July 29, 2022.

  • 40.

    Department of Economic and Social Affairs Population Division , 2012. World Urbanization Prospects: The 2011 Revision. New York, NY: United Nations Publications. Available at: https://www.un.org/en/development/desa/population/publications/pdf/urbanization/WUP2011_Report.pdf. Accessed July 29, 2022.

  • 41.

    The Ministry of Housing and Urban Poverty Alleviation of Government of India, United Nations Development Programme (UNDP) , 2009. India: Urban Poverty Report 2009. New Delhi, India: UNDP. Available at: https://www.undp.org/india/publications/india-urban-poverty-report-2009. Accessed July 29, 2022.

  • 42.

    Global Task Force on Cholera Control , 2019. Cholera Outbreak Response Field Manual. Available at: https://www.gtfcc.org/wp-content/uploads/2020/04/gtfcc-cholera-outbreak-response-field-manual.pdf. Accessed October 10, 2022.

  • 43.

    Khan IA et al., 2013. Coverage and cost of a large oral cholera vaccination program in a high-risk cholera endemic urban population in Dhaka, Bangladesh. Vaccine 31: 60586064.

    • Search Google Scholar
    • Export Citation
  • 44.

    Montgomery M, Jones MW, Kabole I, Johnston R, Gordon B, 2018. No end to cholera without basic water, sanitation and hygiene. Bull World Health Organ 96: 371371A.

    • Search Google Scholar
    • Export Citation
  • 45.

    Devi S, 2022. Cholera vaccines rationed amid global shortage. Lancet 400: 1502.

  • 46.

    World Health Organization , United Nations Children’s Fund , 2009. Water, Sanitation and Hygiene in Health Care Facilities: Practical Steps to Achieve Universal Access. Geneva: WHO. Available at: https://www.unicef.org/media/51591/file/WASH-in-health-care-facilities-practical-steps-2019%20.pdf. Accessed October 14, 2022.

  • 47.

    Weil AA, Khan AI, Chowdhury F, LaRocque RC, Faruque ASG, Ryan ET, Calderwood SB, Qadri F, Harris JB, 2009. Clinical outcomes in household contacts of patients with cholera in Bangladesh. Clin Infect Dis 49: 9.

    • Search Google Scholar
    • Export Citation
  • 48.

    George CM et al., 2016. Randomized controlled trial of hospital-based hygiene and water treatment intervention (CHoBI7) to reduce cholera. Emerg Infect Dis 22: 41.

    • Search Google Scholar
    • Export Citation
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