Evidence-Based Health Behavior Interventions for Cholera: Lessons from an Outbreak Investigation in India

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  • 1 Epidemiology Group, Indian Council of Medical Research (ICMR)–National Institute of Virology, Pune, Maharashtra, India;
  • | 2 XXXXX, Nashik, Maharashtra, India;
  • | 3 Enteric Viruses Group, ICMR-National Institute of Virology, Pune, Maharashtra, India;
  • | 4 ICMR–National Institute of Cancer Prevention and Research, NOIDA, Uttar Pradesh, India;
  • | 5 Integrated Disease Surveillance Programme, Nashik, Maharashtra, India;
  • | 6 Bacteriology Group, ICMR–National Institute of Virology, Pune, Maharashtra, India

In rural India, since 2014, the Swachh Bharat Abhiyan (Clean India Mission) has ensured construction of more than 100 million toilets and is now focusing on reinforcement of sanitation behaviors. We report a cholera outbreak in a remote village in western India where open defecation was implicated in causation. A water pipeline was damaged in the vicinity of a stream flowing from a site of open defecation. Despite the availability of a toilet facility in the majority of households (75%), open defecation was widely practiced (62.8%). Many reported not washing hands with soap and water before eating (78.5%) and after defecation (61.1%). The study emphasizes the need for focused health behavior studies and evidence-based interventions to reduce the occurrence of cholera outbreaks. This could be the last lap in the path toward achieving Sustainable Development Goal 6, which aims to “ensure availability and sustainable management of water and sanitation for all.”

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Author Notes

Address correspondence to Rajlakshmi Viswanathan, Bacteriology Group, ICMR–National Institute of Virology, Microbial Containment Complex, 130/1, Sus Road, Pune 411021, Maharashtra, India. E-mail: rupamicro11@gmail.com

Financial support: This work was supported by institutional intramural funding from the Indian Council of Medical Research–National Institute of Virology, Pune, Maharashtra, India.

Authors’ addresses: Avinash Deoshatwar, Epidemiology Group, Indian Council of Medical Research (ICMR)–National Institute of Virology, Pune, Maharashtra, India, E-mail: avinash.deoshatwar@gmail.com. Dawal Salve, XXXXX, Nashik, Maharashtra, India, E-mail: idspnasik@gmail.com. Varanasi Gopalkrishna and Madhuri Joshi, Enteric Viruses Group, ICMR-National Institute of Virology, Pune, Maharashtra, India, E-mails: gopalvk58@hotmail.com and jmadhuri10121968@gmail.com. Anuj Kumar, ICMR–National Institute of Cancer Prevention and Research, NOIDA, Uttar Pradesh, India, E-mail: anuj.ahar@gmail.com. Uday Barve, Integrated Disease Surveillance Programme, Nashik, Maharashtra, India, E-mail: dr14uday@gmail.com. Savita Katendra, Varsha Dhembre, Shradha Maheshwari, and Rajlakshmi Viswanathan, Bacteriology Group, ICMR–National Institute of Virology, Pune, Maharashtra, India, E-mails: sairajsavita@gmail.com, varshadhembre.95@gmail.com, shradhamaheshwari1992@gmail.com, and vishwanathan@gov.in.

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