Promotion of Cholera Awareness Among Households of Cholera Patients: A Randomized Controlled Trial of the Cholera-Hospital-Based-Intervention-for-7 Days (CHoBI7) Intervention

K. M. Saif-Ur-Rahman International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Tahmina Parvin International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Sazzadul Islam Bhuyian International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Fatema Zohura International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Farzana Begum International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Mahamud-Ur Rashid International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Shwapon Kumar Biswas International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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David Sack Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.

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R. Bradley Sack Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.

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Shirajum Monira International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Munirul Alam International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Nusrat Jahan Shaly International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Christine Marie George Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.

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Abstract

Previous studies have demonstrated that household contacts of cholera patients are highly susceptible to cholera infections for a 7-day period after the presentation of the index patient in the hospital. However, there is no standard of care to prevent cholera transmission in this high-risk population. Furthermore, there is limited information available on awareness of cholera transmission and prevention among cholera patients and their household contacts. To initiate a standard of care for this high-risk population, we developed the Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7), which delivers a handwashing with soap and water treatment intervention to household contacts during the time they spend with the admitted cholera patient in the hospital and reinforces these messages through home visits. To test CHoBI7, we conducted a randomized controlled trial among 302 intervention cholera patient household members and 302 control cholera patient household members in Dhaka, Bangladesh. In this study, we evaluated the effectiveness of the CHoBI7 intervention in increasing awareness of cholera transmission and prevention, and the key times for handwashing with soap. We observed a significant increase in cholera knowledge score in the intervention arm compared with the control arm at both the 1-week follow-up {score coefficient = 2.34 (95% confidence interval [CI] = 1.96, 2.71)} and 6 to 12-month follow-up period (score coefficient = 1.59 [95% CI = 1.05, 2.13]). This 1-week hospital- and home-based intervention led to a significant increase in knowledge of cholera transmission and prevention which was sustained 6 to 12 months post-intervention. These findings suggest that the CHoBI7 intervention presents a promising approach to increase cholera awareness among this high-risk population.

Author Notes

* Address correspondence to Christine Marie George, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room E5535, Baltimore, MD 21205-2103. E-mail: cmgeorge@jhsph.edu
† These authors contributed equally to this work.

Financial support: This research was supported by the Center for Global Health at Johns Hopkins University, and the National Institute of Health NIAID-1K01AI110526/R01AI039129.

Authors' addresses: K. M. Saif-Ur-Rahman, Sazzadul Islam Bhuyian, Fatema Zohura, Farzana Begum, and Munirul Alam, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Centers for Disease Control and Prevention, Dhaka, Bangladesh, E-mails: su.rahman@icddrb.org, sazzadul.islam@icddrb.org, fzohura@icddrb.org, farzanab@icddrb.org, and munirul@icddrb.org. Tahmina Parvin, Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh, E-mail: tparvin@icddrb.org. Mahamud-Ur Rashid and Shirajum Monira, International Health, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh, E-mails: mahamudur@icddrb.org and smonira@icddrb.org. Shwapon Kumar Biswas, Center for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh, E-mail: drskbiswas2004@yahoo.com. David Sack, R. Bradley Sack, and Christine Marie George, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, E-mails: dsack@jhsph.edu, rsack1@jhu.edu, and cmgeorge@jhsph.edu. Nusrat Jahan Shaly, Hospital Unit, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh, E-mail: sdr.nusratjahan@yahoo.com.

  • 1.

    Zuckerman JN, Rombo L, Fisch A, 2007. The true burden and risk of cholera: implications for prevention and control. Lancet Infect Dis 7: 521–530.

  • 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, Chowdhury F, Khan AI, Logvinenko T, Faruque AS, Ryan ET, Qadri F, Calderwood SB, 2008. Susceptibility to Vibrio cholerae infection in a cohort of household contacts of patients with cholera in Bangladesh. PLoS Negl Trop Dis 2: e221.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Hughes JM, Boyce JM, Levine RJ, Khan M, Aziz K, Huq M, Curlin GT, 1982. Epidemiology of eltor cholera in rural Bangladesh: importance of surface water in transmission. Bull World Health Organ 60: 395.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Spira W, Khan MU, Saeed Y, Sattar M, 1980. Microbiological surveillance of intra-neighbourhood El Tor cholera transmission in rural Bangaldesh. Bull World Health Organ 58: 731.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Weil AA, Khan AI, Chowdhury F, LaRocque RC, Faruque A, Ryan ET, Calderwood SB, Qadri F, Harris JB, 2009. Clinical outcomes in household contacts of patients with cholera in Bangladesh. Clin Infect Dis 49: 1473–1479.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Mosley WH, Ahmad S, Benenson AS, Ahmed A, 1968. The relationship of vibriocidal antibody titre to susceptibility to cholera in family contacts of cholera patients. Bull World Health Organ 38: 777–785.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Glass RI, Svennerholm AM, Khan MR, Huda S, Huq MI, Holmgren J, 1985. Seroepidemiological studies of El Tor cholera in Bangladesh: association of serum antibody levels with protection. J Infect Dis 151: 236–242.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Deb BC, Sircar BK, Sengupta PG, De SP, Mondal SK, Gupta DN, Saha NC, Ghosh S, Mitra U, Pal SC, 1986. Studies on interventions to prevent El Tor cholera transmission in urban slums. Bull World Health Organ 64: 127–131.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Wahed T, Kaukab SS, Saha NC, Khan IA, Khanam F, Chowdhury F, Saha A, Khan AI, Siddik AU, Cravioto A, Qadri F, Uddin J, 2013. Knowledge of, attitudes toward, and preventive practices relating to cholera and oral cholera vaccine among urban high-risk groups: findings of a cross-sectional study in Dhaka, Bangladesh. BMC Public Health 13: 242.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Mpazi VM, Mnyika KS, 2008. Knowledge, attitudes and practices regarding cholera outbreaks in Ilala municipality of Dar es Salaam region, Tanzania. East Afr J Public Health 2: 6–11.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    George CM, Monira S, Sack DA, Rashid MU, Saif-Ur-Rahman KM, Mahmud T, Rahman Z, Mustafiz M, Bhuyian SI, Winch PJ, Leontsini E, Perin J, Begum F, Zohura F, Biswas S, Parvin T, Zhang X, Jung D, Sack RB, Alam M, 2016. Randomized controlled trial of hospital-based hygiene and water treatment intervention (CHoBI7) to reduce cholera. Emerg Infect Dis 22: 233–241.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    George CM, Jung DS, Saif-Ur-Rahman KM, Monira S, Sack DA, Rashid MU, Mahmud T, Mustafiz M, Rahman Z, Bhuyian SI, Winch PJ, Leontsini E, Perin J, Begum F, Zohura F, Biswas S, Parvin T, Sack RB, Alam M, 2016. Sustained uptake of a hospital-based handwashing with soap and water treatment intervention (cholera-hospital-based intervention for 7 Days [CHoBI7]): a randomized controlled trial. Am J Trop Med Hyg 94: 428–436.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    George CM, Rashid MU, Sack DA, Sack RB, Saif-Ur-Rahman KM, Azman AS, Monira S, Bhuyian SI, Zillur Rahman K, Toslim Mahmud M, Mustafiz M, Alam M, 2013. Evaluation of enrichment method for the detection of Vibrio cholerae O1 using a rapid dipstick test in Bangladesh. Trop Med Int Health 19: 301–307.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    World Health Organization, 2005. The Treatment Of Diarrhoea: A Manual for Physicians and Other Senior Health Workers. Geneva, Switzerland: World Health Organization.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    University of Michigan. Optimal Design Software: Building Capacity to Evaluate Group-Level Interventions. Available at: http://people.cehd.tamu.edu/∼okwok/epsy652R/OD/od-manual-20080312-v176.pdf.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Tamason CC, Tulsiani SM, Siddique AK, Hoque BA, Mackie Jensen PK, 2016. What is cholera? A preliminary study on caretakers' knowledge in Bangladesh. J Health Popul Nutr 35: 3.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Merten S, Schaetti C, Manianga C, Lapika B, Chaignat CL, Hutubessy R, Weiss MG, 2013. Local perceptions of cholera and anticipated vaccine acceptance in Katanga province, Democratic Republic of Congo. BMC Public Health 13: 60.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Schaetti C, Khatib AM, Ali SM, Hutubessy R, Chaignat CL, Weiss MG, 2010. Social and cultural features of cholera and shigellosis in peri-urban and rural communities of Zanzibar. BMC Infect Dis 10: 339.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Figueroa ME, Kincaid DL, 2007. Social, cultural and behavioral correlates of household water treatment and storage. Sobsey N, Clasen T, eds. Household Water Treatment and Safe Storage Geneva, Switzerland: World Health Organization.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Dunston C, McAfee D, Kaiser R, Rakotoarison D, Rambeloson L, Hoang AT, Quick RE, 2001. Collaboration, cholera, and cyclones: a project to improve point-of-use water quality in Madagascar. Am J Public Health 91: 1574–1576.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Quick RE, Kimura A, Thevos A, Tembo M, Shamputa I, Hutwagner L, Mintz E, 2002. Diarrhea prevention through household-level water disinfection and safe storage in Zambia. Am J Trop Med Hyg 66: 584–589.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Dreibelbis R, Winch PJ, Leontsini E, Hulland KR, Ram PK, Unicomb L, Luby SP, 2013. The integrated behavioural model for water, sanitation, and hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings. BMC Public Health 13: 1015.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Tobias R, 2009. Changing behavior by memory aids: a social psychological model of prospective memory and habit development tested with dynamic field data. Psychol Rev 116: 408–438.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Contzen N, Inauen J, 2015. Social-cognitive factors mediating intervention effects on handwashing: a longitudinal study. J Behav Med 38: 956–969.

  • 26.

    Contzen N, Mosler HJ, 2015. Identifying the psychological determinants of handwashing: results from two cross-sectional questionnaire studies in Haiti and Ethiopia. Am J Infect Control 43: 826–832.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Contzen N, Meili IH, Mosler HJ, 1982. Changing handwashing behaviour in southern Ethiopia: a longitudinal study on infrastructural and commitment interventions. Soc Sci Med 2015: 103–114.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Nizame FA, Unicomb L, Sanghvi T, Roy S, Nuruzzaman M, Ghosh PK, Winch PJ, Luby SP, 2013. Handwashing before food preparation and child feeding: a missed opportunity for hygiene promotion. Am J Trop Med Hyg 89: 1179–1185.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    George CM, Jung D, Thomas A, Rashid M, Sack DA, Sack RB, Saif-Ur-Rahman KM, Monira S, Bhuyian SI, Rahman KM, Mahmud MT, Mustafiz M, Parvin T, Winch P, Leontsini E, Perin J, Begum F, Zohura F, Biswas S, Thomas E, Zhang X, Alam M, 2016. Psychosocial factors mediating the CHoBI7 intervention's effect on handwashing with soap: a randomized controlled trial. Health Education & Behavior.

    • PubMed
    • Search Google Scholar
    • Export Citation
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