A cholera prevention program developed by students of the Hebrew University-Hadassah Medical School's International Masters in Public Health Program has been adopted by the Red Cross in Kenya.
The system, which was utilized by the Red Cross in the displaced persons camps during the recent political crisis in Kenya, was found to be highly effective in prevention and management of the disease. The International Committee of the Red Cross (ICRC) and the International Federation of Red Cross and Red Crescent Movement (IFRC) is now preparing to implement the program beyond the camps.
The students – medical and public health practitioners from Kenya, Ethiopia, Nigeria, Colombia, Uzbekistan, India and the United States – have been studying in Israel on the one-year International Master's Program in Public Heath at the Hebrew University-Hadassah Medical School's Braun School of Public Health and Community Medicine. Their participation in the program was facilitated by scholarships from the Pears Foundation and Legacy Heritage Fund.
Despite the fact that cholera is one of the most understood and preventable diseases, the World Health Organization estimates that there were about 180,000 cholera cases in 2007, and that it still accounts for 65 percent of deaths in cases of diarrheal diseases in children under five years old in developing countries.
In Kenya, there are reported outbreaks of cholera 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 cholera.
According to the students, the disease can be prevented and fatalities easily avoided if prevention efforts are integrated into routine health care and outbreaks of the disease are reported early enough in accordance to WHO requirements. However, according to the student's team leader, Solomon Nzioka from Kenya, cholera outbreaks typically become political issues, with an underestimated number of cases reported. He asserts that cholera outbreaks seem to follow a cyclic pattern, which begins with the denial of an initial outbreak by government officials - usually through fear of perceived economic loss in tourism.
"When people continue to die and the outbreak continues to spread, then officials undertake late 'fire-fighting' measures to combat the outbreak," Nzioka explains, speaking from his own experiences in the field. "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."
Effective treatment is dependent on reporting of suspected cases and early diagnosis. The comprehensive cholera program devised by the students aims 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 of suspected cholera cases; improve management of patients; prevent the spread of the disease; and post-epidemic investigation and education.
According to Nzioka, in the past, the Kenyan government mainly played a regulatory role in the area of preventive health services, with NGOs providing the bulk of services such as water and sanitation facilities at community level. However, since late 1990's, many donors have shifted their focus to HIV, and so the impact of diseases such as cholera has largely been neglected.
Adoption of the control program in Kenya's Bungoma district 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.
While the program is currently only being considered in Kenya, the students hope that it will soon be utilized in other countries, such as Nigeria and Ethiopia, where they say cholera is rife.
The program was developed within the framework of the control of communicable diseases course organized by Prof. Charles Greenblatt and Dr. Jake Jacobson. The students' project supervisor, Prof. Mark Spigelman says that the team is planning to submit their proposal to the WHO to be considered for implementation worldwide.
Since its establishment over 35 years ago, the School's intensive one-year IMPH program has attracted 600 students from 85 countries around the world — from as near as the Palestinian Authority and as far away as Mongolia and Cameroon. Many have become government ministers, consultants to international organizations, hospital directors, and professors at schools of public health in almost 100 different countries.