September 7, 2008, Updated September 13, 2012

The student team who devised the cholera prevention program. L to R: Gulnoza Usmanova, Solomon Nzioka, Ana-Mari Barragan, Philip Blumenfeld, Solomon Beza, Kingsley Odiete and Ajay Phatak.A highly successful cholera prevention program developed by students at an Israeli university has been adopted by the Red Cross in Kenya for widespread use.

The program, created by students from The Hebrew University of Jerusalem, was first employed in displaced persons camps by the Red Cross, the world’s largest humanitarian organization, during the recent political crisis in Kenya. It was found to be highly effective in prevention and management of the disease.

As a result, the International Committee of the Red Cross (ICRC) and the International Federation of Red Cross and Red Crescent Movement (IFRC), have decided to implement the program beyond the camps.

Cholera, an acute diarrheal illness caused by a bacterial infection in the intestine, is a preventable disease. Though rare in the west, the disease remains common in the developing world. The World Health Organization (WHO) estimates that there were about 180,000 cholera cases in 2007, and that it accounts for 65 percent of deaths in cases of diarrheal diseases in children under five years old in developing countries.

Annual cholera outbreaks

In Kenya, there are cholera outbreaks every year, mostly as a result of torrential rains with accompanying floods that contaminate already inadequate water supplies. This, coupled with poor sanitation in many areas, heightens the risk of the disease.

The students who designed the cholera prevention program are medical and public health practitioners from Kenya, Ethiopia, Nigeria, Colombia, Uzbekistan, India and the US, who came to study in Israel on an intensive one-year masters degree in public health at the Hebrew University-Hadassah Braun School of Public Health and Community Medicine.

They discovered that the disease could be prevented and fatalities avoided if prevention efforts were integrated into routine health care, and outbreaks reported quickly in accordance with WHO requirements.

In Kenya, however, according to Kenyan student team leader, Solomon Nzioka, officials often deny initial cholera outbreaks and underestimate the number of cases in an attempt to prevent damage to the tourist industry.

“When people continue to die and the outbreak continues to spread, then officials undertake late ‘fire-fighting’ measures to combat the outbreak,” says Nzioka. “Afterwards, the officials forget what occurred and eventually wait for the next report of cholera. Due to the lack of a comprehensive control program, such a pattern repeats itself time after time.”

Part of the problem is that the Kenyan government relies heavily on international NGOs to provide health treatment, water and sanitation facilities. Since the late 1990s many of these NGOs have begun to focus solely on the problems of HIV, leaving diseases like cholera neglected.

Safe sources of drinking water

The students devised a program to increase safe drinking water sources; promote awareness in the community about cholera prevention; improve surveillance and reporting of cholera cases; build a centralized network for monitoring and immediate appropriate action; mobilize rapid response teams to areas with suspected cholera cases; improve management of patients; prevent the spread of the disease; and and conduct post-epidemic investigation and education.

A control program was first used in Kenya’s Bungoma district, and it is currently being considered by the Kenyan Ministry of Public Health and Sanitation pending funding.

If funding is secured, the students expect that in three years’ time, the program will increase access to safe drinking water from 47 to 80 percent, enhance preparedness for cholera epidemics, upgrade early-response systems, and prevent spread of cholera in the district through the strengthening of partnerships between community and government levels.

The students hope that their program, which was developed within the framework of the control of communicable diseases course, will also be adopted in other countries, such as Nigeria and Ethiopia, where cholera is rife.

Project supervisor, Prof. Mark Spigelman says the team is planning to submit their proposal to the WHO to be considered for implementation worldwide.

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Jason Harris

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