PDF(Pubmed)
Abstract：
Individuals living near cholera patients have an increased risk of cholera infections. Case-area targeted interventions (CATIs) promoting improved water, sanitation, and hygiene (WASH) present a promising approach to reducing cholera for those residing near cholera cases. However, there is limited evidence on the effectiveness and implementation of this approach in increasing WASH behaviors. We conducted a mixed-methods program evaluation in rural and urban eastern Democratic Republic of the Congo. The quantitative component included household structured observations and spot checks in CATI and control areas to assess WASH conditions and behaviors. The qualitative component included semi-structured interviews with CATI recipients, non-recipients, and implementers to assess CATI implementation. A total of 399 participants were enrolled in the quantitative evaluation conducted within 1 month of CATI delivery. For the qualitative evaluation, 41 semi-structured interviews were conducted, 30 with individuals in CATI areas (recipients and non-recipients) and 11 with CATI implementers. Handwashing with soap was low among both CATI and control area participants (1% vs. 2%, p = 0.89). Significantly more CATI area households (75%) had chlorine tablets present compared to control area households (0%) (p < 0.0001); however, the percentage of households with stored water free chlorine concentrations > 0.2 mg/L was low for both CATI and control area households (11% vs. 6%, p = 0.45). Implementers reported an insufficient supply of soap for distribution to recipients and mistrust in the community of their activities. CATI recipients demonstrated low knowledge of the correct preparation and use of chlorine for water treatment. Recipients also indicated a need for CATI implementers to engage community leaders. As CATIs are part of cholera control plans in many cholera-endemic countries, it is important to evaluate existing programs and develop evidence-based approaches to deliver CATIs that are both tailored to the local context and engage affected communities to increase WASH behaviors to reduce the spread of cholera.
摘要：
居住在霍乱患者附近的个体患霍乱感染的风险增加。案例区域针对性干预措施（CATI）促进改善水，卫生，和卫生（WASH）提出了一种有希望的方法来减少居住在霍乱病例附近的人的霍乱。然而,关于这种方法在增加WASH行为方面的有效性和实施的证据有限。我们在刚果民主共和国东部的农村和城市进行了混合方法计划评估。定量部分包括家庭结构化观察和在CATI和控制区域的抽查，以评估WASH条件和行为。定性部分包括对CATI接收者的半结构化访谈，非收件人，和实施者来评估CATI的实施。在CATI交付后1个月内，共有399名参与者参加了定量评估。对于定性评估，进行了41次半结构化访谈，30个人在CATI地区（接收者和非接收者），11个人在CATI实施者。在CATI和控制区参与者中，用肥皂洗手的比例较低(1%与2%,p=0.89）。与控制区家庭（0％）相比，有更多的CATI地区家庭（75％）存在氯片剂（p<0.0001）；但是，对于CATI和控制区家庭，储存水游离氯浓度>0.2mg/L的家庭百分比较低(11%vs.6%,p=0.45)。执行人员报告说，分配给接受者的肥皂供应不足，社区对他们的活动不信任。CATI接受者对正确制备和使用氯进行水处理的知识很少。收件人还表示，CATI实施者需要与社区领导人接触。由于CATI是许多霍乱流行国家霍乱控制计划的一部分，重要的是评估现有计划并开发基于证据的方法，以提供适合当地环境的CATI，并参与受影响的社区，以增加WASH行为，以减少霍乱的传播。
