Formative Research for the Development of the CHoBI7 Cholera Rapid Response Program for Cholera Hotspots in Bangladesh
Abstract
:1. Introduction
Cholera-Hospital-Based-Intervention-for-7-Days
2. Methods
2.1. Study Overview
2.2. Ethical Approval
2.3. Component I: Exploratory Research
2.4. Component II: CHoBI7 Program Modification for Cholera Hotspots
2.4.1. Starting Point for the CHoBI7 Cholera Rapid Response Program
2.4.2. Behavioral Recommendations
2.4.3. Intervention Components
2.4.4. CHoBI7 Program Modification
2.5. Component III: CHoBI7 Cholera Rapid Response Program Pilot Study
2.5.1. Phase 1 Pilot Study Design and Data Collection
2.5.2. Phase 1 Pilot Study Intervention Delivery
2.5.3. Phase 2 Pilot Study Design and Data Collection
3. Results
3.1. Exploratory Interviews Informing Intervention Development
3.1.1. Awareness and Perceptions of Cholera and Severe Diarrhea
3.1.2. Causes and Prevention of Cholera
3.1.3. Handwashing with Soap and Water Treatment
“Many people do not do [wash hands] …sometimes, I also do not wash hands [with soap]. (Participant laughs) Yes, it happens sometimes. I myself also make mistakes. …Sometimes it happens that I did not wash my hands after coming from the toilet, as I was in a hurry, my child was crying and I needed to stop her…Yes, I couldn’t [wash my hands] due to lack of time. (Participant laughs) …No other reasons, only lack of time.” Female, cholera hotspot household, Age 30
3.2. CHoBI7 Program Modification for Cholera Hotspots
3.2.1. Information on Cholera and Cholera Prevention
3.2.2. The Story of the Busy Family
3.3. Pilot Phase 1 Findings
3.3.1. Uptake of Behavioral Recommendations and Use of Cholera Prevention Package
3.3.2. Participants’ Experiences, Preferences, and Recommendations for Intervention Delivery
Handwashing with Soap
“It would not be difficult [to wash hands], but people could think that ‘I am busy now and I have to wait 5 min for washing hands at the [shared] toilet.’” Female, cholera hotspot household, Age 25
“This [handwashing station] is very good... Look, we don’t have personal toilets, we have the shared toilet facility [in the compound]. Sometimes it is very difficult to wash hands if it is locked. Now, it is very helpful for us. No matter whether people are in the toilet or not, we can wash our hands by using this water [handwashing station in the home], which is very helpful. Because, it is not our personal toilet, we are three families using this toilet.” Female, cholera hotspot household, Age 36
Soapy Water Bottle
Water Treatment
Cue Cards
3.4. Further Program Modification
3.4.1. Ring Session
3.4.2. The Story of The Hygiene Champion
3.4.3. Hanging Multiple Soapy Water Bottles
3.4.4. New Cue Card
3.4.5. Emphasis on COVID-19
3.5. Pilot Phase 2 Findings
“It feels good that we gathered in one place [the ring session]...we had a discussion together and got advice. We were able to learn good and bad things about cholera disease. …I liked that moment [the ring session] where we all [neighbors] talked together.” Female, cholera hotspot household, Age 19
“I have learned from the story of the champion [about Aklima’s neighbor] that we have to be careful about them [neighbors] …who are not following the instructions of Dr. Chobi Apa.” Female, cholera hotspot household, Age 19
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Sack, D.A.; Sack, R.B.; Nair, G.B.; Siddique, A.K. Cholera. Lancet 2004, 363, 223–233. [Google Scholar] [CrossRef]
- Ali, M.; Nelson, A.R.; Lopez, A.L.; Sack, D.A. Updated Global Burden of Cholera in Endemic Countries. PLoS Negl. Trop. Dis. 2015, 9, e0003832. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- International Vaccine Institute. Country Investment Case Study on Cholera Vaccination: Bangladesh; International Vaccine Institute: Seoul, Korea, 2013. [Google Scholar]
- Blake, P.A.; Ramos, S.; MacDonald, K.L.; Rassi, V.; Gomes, T.A.T.; Ivey, C.; Bean, N.H.; Trabulsi, L.R. Pathogen-specific risk factors and protective factors for acute diarrheal disease in urban Brazilian infants. J. Infect. Dis. 1993, 167, 627–632. [Google Scholar] [CrossRef]
- Esrey, S.A. Water, waste, and well-being. A multicountry study. Am. J. Epidemiol. 1996, 143, 608–623. [Google Scholar] [CrossRef] [Green Version]
- D’souza, R.M. Housing and environmental factors and their effects on the health of children in the slums of Karachi, Pakistan. J. Biosoc. Sci. 1997, 29, 271–281. [Google Scholar] [CrossRef] [PubMed]
- Saha, D. Acute Diarrhoea in Children in Rural Gambia: Knowledge, Attitude and Practice, Aetiology, Risk Factors and Consequences among Children Less than Five Years of Age; University of Otago: Dunedin, New Zealand, 2013. [Google Scholar]
- Tornheim, J.A.; Morland, K.B.; Landrigan, P.J.; Cifuentes, E. Water privatization, water source, and pediatric diarrhea in Bolivia. Epidemiologic analysis of a social experiment. Int. J. Occup. Environ. Health 2009, 15, 241–248. [Google Scholar] [CrossRef] [PubMed]
- George, C.M.; Perin, J.; De Calani, K.J.N.; Norman, W.R.; Perry, H.; Davis, T.P., Jr.; Lindquist, E.D. Risk factors for diarrhea in children under five years of age residing in peri-urban communities in Cochabamba, Bolivia. Am. J. Trop. Med. Hyg. 2014, 91, 1190–1196. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Clasen, T.; Saeed, T.F.; Boisson, S.; Edmondson, P.; Shipin, O. Household water treatment using sodium dichloroisocy anurate (NaDCC) tablets: A randomized, controlled trial to assess microbiological effectiveness in Bangladesh. Am. J. Trop. Med. Hyg. 2007, 76, 187–192. [Google Scholar] [CrossRef] [PubMed]
- Sirajul Islam, M.; Brooks, A.; Kabir, M.; Jahid, I.; Shafiqul Islam, M.; Goswami, D.; Nair, G.; Larson, C.; Yukiko, W.; Luby, S. Faecal contamination of drinking water sources of Dhaka city during the 2004 flood in Bangladesh and use of disinfectants for water treatment. J. Appl. Microbiol. 2007, 103, 80–87. [Google Scholar] [CrossRef]
- Hughes, J.M.; Boyce, J.M.; Levine, R.J.; Khan, M.; Aziz, K.; Huq, M.; Curlin, G.T. Epidemiology of eltor cholera in rural Bangladesh: Importance of surface water in transmission. Bull. World Health Organ. 1982, 60, 395. [Google Scholar] [PubMed]
- Weil, A.A.; Khan, A.I.; Chowdhury, F.; LaRocque, R.C.; Faruque, A.; Ryan, E.T.; Calderwood, S.B.; Qadri, F.; Harris, J.B. Clinical outcomes in household contacts of patients with cholera in Bangladesh. Clin. Infect. Dis. 2009, 49, 1473–1479. [Google Scholar] [CrossRef] [PubMed]
- Spira, W.M.; Khan, M.U.; Saeed, Y.A.; Sattar, M.A. Microbiological surveillance of intra-neighbourhood E1 Tor cholera transmission in rural Bangladesh. Bull. World Health Organ. 1980, 58, 731–740. [Google Scholar] [PubMed]
- Glass, R.I.; Svennerholm, A.-M.; Khan, M.; Huda, S.; Imdadul Huq, M.; Holmgren, J. Seroepidemiological studies of EI Tor cholera in Bangladesh: Association of serum antibody levels with protection. J. Infect. Dis. 1985, 151, 236–242. [Google Scholar] [CrossRef] [PubMed]
- Ali, M.; Debes, A.K.; Luquero, F.J.; Kim, D.R.; Park, J.Y.; Digilio, L.; Manna, B.; Kanungo, S.; Dutta, S.; Sur, D. Potential for controlling cholera using a ring vaccination strategy: Re-analysis of data from a cluster-randomized clinical trial. PLoS Med. 2016, 13, e1002120. [Google Scholar] [CrossRef] [Green Version]
- Azman, A.S.; Luquero, F.J.; Salje, H.; Mbaïbardoum, N.N.; Adalbert, N.; Ali, M.; Bertuzzo, E.; Finger, F.; Toure, B.; Massing, L.A. Micro-hotspots of risk in urban cholera epidemics. J. Infect. Dis. 2018, 218, 1164–1168. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Finger, F.; Bertuzzo, E.; Luquero, F.J.; Naibei, N.; Touré, B.; Allan, M.; Porten, K.; Lessler, J.; Rinaldo, A.; Azman, A.S. The potential impact of case-area targeted interventions in response to cholera outbreaks: A modeling study. PLoS Med. 2018, 15, e1002509. [Google Scholar] [CrossRef] [PubMed]
- Debes, A.K.; Ali, M.; Azman, A.S.; Yunus, M.; Sack, D.A. Cholera cases cluster in time and space in Matlab, Bangladesh: Implications for targeted preventive interventions. Int. J. Epidemiol. 2016, 45, 2134–2139. [Google Scholar] [CrossRef] [PubMed]
- George, C.M.; Monira, S.; Sack, D.A.; Rashid, M.U.; Saif-Ur-Rahman, K.M.; Mahmud, T.; Rahman, Z.; Mustafiz, M.; Bhuyian, S.I.; Winch, P.J.; et al. Randomized Controlled Trial of Hospital-Based Hygiene and Water Treatment Intervention (CHoBI7) to Reduce Cholera. Emerg. Infect. Dis. 2016, 22, 233–241. [Google Scholar] [CrossRef] [PubMed]
- Roskosky, M.; Acharya, B.; Shakya, G.; Karki, K.; Sekine, K.; Bajracharya, D.; Von Seidlein, L.; Devaux, I.; Lopez, A.L.; Deen, J. Feasibility of a comprehensive targeted cholera intervention in the Kathmandu Valley, Nepal. Am. J. Trop. Med. Hyg. 2019, 100, 1088–1097. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Sikder, M.; Altare, C.; Doocy, S.; Trowbridge, D.; Kaur, G.; Kaushal, N.; Lyles, E.; Lantagne, D.; Azman, A.S.; Spiegel, P. Case-area targeted preventive interventions to interrupt cholera transmission: Current implementation practices and lessons learned. PLoS Negl. Trop. Dis. 2021, 15, e0010042. [Google Scholar] [CrossRef] [PubMed]
- George, C.M.; Monira, S.; Zohura, F.; Thomas, E.D.; Hasan, M.T.; Parvin, T.; Hasan, K.; Rashid, M.U.; Papri, N.; Islam, A.; et al. Effects of a Water, Sanitation and Hygiene Mobile Health Program on Diarrhea and Child Growth in Bangladesh: A Cluster-Randomized Controlled Trial of the CHoBI7 Mobile Health Program. Clin. Infect. Dis. 2020, 73, e2560–e2568. [Google Scholar] [CrossRef] [PubMed]
- Thomas, E.D.; Zohura, F.; Hasan, M.T.; Rana, M.S.; Teman, A.; Parvin, T.; Masud, J.; Bhuyian, M.S.I.; Hossain, M.K.; Hasan, M. Formative research to scale up a handwashing with soap and water treatment intervention for household members of diarrhea patients in health facilities in Dhaka, Bangladesh (CHoBI7 program). BMC Public Health 2020, 20, 831. [Google Scholar] [CrossRef] [PubMed]
- George, C.M.; Zohura, F.; Teman, A.; Thomas, E.; Hasan, T.; Rana, S.; Parvin, T.; Sack, D.A.; Bhuyian, S.I.; Labrique, A. Formative research for the design of a scalable water, sanitation, and hygiene mobile health program: CHoBI7 mobile health program. BMC Public Health 2019, 19, 1028. [Google Scholar]
- Dreibelbis, R.; Winch, P.J.; Leontsini, E.; Hulland, K.R.; Ram, P.K.; Unicomb, L.; Luby, S.P. 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 2013, 13, 1015. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Amin, N.; Pickering, A.J.; Ram, P.K.; Unicomb, L.; Najnin, N.; Homaira, N.; Ashraf, S.; Abedin, J.; Islam, M.S.; Luby, S.P. Microbiological evaluation of the efficacy of soapy water to clean hands: A randomized, non-inferiority field trial. Am. J. Trop. Med. Hyg. 2014, 91, 415–423. [Google Scholar] [CrossRef] [Green Version]
- Parveen, S.; Nasreen, S.; Allen, J.V.; Kamm, K.B.; Khan, S.; Akter, S.; Lopa, T.M.; Zaman, K.; El Arifeen, S.; Luby, S.P. Barriers to and motivators of handwashing behavior among mothers of neonates in rural Bangladesh. BMC Public Health 2018, 18, 483. [Google Scholar] [CrossRef] [Green Version]
- George, C.M.; Parvin, T.; Bhuyian, M.S.I.; Uddin, I.M.; Zohura, F.; Masud, J.; Monira, S.; Sack, D.A.; Perin, J.; Alam, M.; et al. Randomized Controlled Trial of the Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7) Cholera Rapid Response Program to Reduce Diarrheal Diseases in Bangladesh. Int. J. Environ. Res. Public Health 2022, 19, 12905. [Google Scholar] [CrossRef]
- Michel, E.; Gaudart, J.; Beaulieu, S.; Bulit, G.; Piarroux, M.; Boncy, J.; Dely, P.; Piarroux, R.; Rebaudet, S. Estimating effectiveness of case-area targeted response interventions against cholera in Haiti. eLife 2019, 8, e50243. [Google Scholar] [CrossRef]
- Kim, H.S.; Bigman, C.A.; Leader, A.E.; Lerman, C.; Cappella, J.N. Narrative Health Communication and Behavior Change: The Influence of Exemplars in the News on Intention to Quit Smoking. J. Commun. 2012, 62, 473–492. [Google Scholar] [CrossRef] [Green Version]
- Remein, C.D.; Childs, E.; Pasco, J.C.; Trinquart, L.; Flynn, D.B.; Wingerter, S.L.; Bhasin, R.M.; Demers, L.B.; Benjamin, E.J. Content and outcomes of narrative medicine programmes: A systematic review of the literature through 2019. BMJ Open 2020, 10, e031568. [Google Scholar] [CrossRef] [Green Version]
- Fu, S.S.; Rhodes, K.L.; Robert, C.; Widome, R.; Forster, J.L.; Joseph, A.M. Designing and evaluating culturally specific smoking cessation interventions for American Indian communities. Nicotine Tob. Res. 2014, 16, 42–49. [Google Scholar] [CrossRef] [PubMed]
- Laskow, T.; Small, L.; Wu, D.S. Narrative Interventions in the Palliative Care Setting: A Scoping Review. J. Pain Symptom Manag. 2019, 58, 696–706. [Google Scholar] [CrossRef] [PubMed]
- Zhou, C.; Occa, A.; Kim, S.; Morgan, S. A Meta-analysis of Narrative Game-based Interventions for Promoting Healthy Behaviors. J. Health Commun. 2020, 25, 54–65. [Google Scholar] [CrossRef] [PubMed]
- Hinyard, L.J.; Kreuter, M.W. Using narrative communication as a tool for health behavior change: A conceptual, theoretical, and empirical overview. Health Educ. Behav. 2007, 34, 777–792. [Google Scholar] [CrossRef] [PubMed]
- Community-level HIV intervention in 5 cities: Final outcome data from the CDC AIDS Community Demonstration Projects. Am. J. Public. Health 1999, 89, 336–345. [CrossRef] [PubMed] [Green Version]
- Mevissen, F.E.F.; Ruiter, R.A.C.; Meertens, R.M.; Schaalma, H.P. The effects of scenario-based risk information on perceptions of susceptibility to Chlamydia and HIV. Psychol. Health 2010, 25, 1161–1174. [Google Scholar] [CrossRef]
- Sitto, K.; Lubinga, E.; Geya, M. The power of narrative health communication: Exploring possible effects of first-hand experiential stories on cancer awareness amongst university students. TD J. Transdiscipl. Res. South. Afr. 2021, 17, a1008. [Google Scholar] [CrossRef]
- Kreuter, M.W.; Green, M.C.; Cappella, J.N.; Slater, M.D.; Wise, M.E.; Storey, D.; Clark, E.M.; O’Keefe, D.J.; Erwin, D.O.; Holmes, K.; et al. Narrative communication in cancer prevention and control: A framework to guide research and application. Ann. Behav. Med. 2007, 33, 221–235. [Google Scholar] [CrossRef]
- World Health Organization. Global Task Force on Cholera Control. Ending Cholera: A Global Roadmap to 2030; World Health Organization: Geneva, Switzerland, 2019. [Google Scholar]
Exploratory Interviews (December 2019 to January 2020) Explore cholera awareness, causes and prevention of cholera, and existing water treatment and handwashing practices | Female Household Members | Male Household Members | Total |
6 | 2 | 8 | |
Pilot Interviews (February to December 2020) Explore participants’ experiences, including feasibility and acceptability, with the CHoBI7 Cholera Rapid Response program | Female Household Members | Male Household Members | Total |
Pilot Phase 1 | 15 | 1 | 16 |
Pilot Phase 2 | 7 | 0 | 7 |
Original CHoBI7 Program | CHoBI7 mHealth Program | CHoBI7 Cholera Rapid Response Program | |||||
---|---|---|---|---|---|---|---|
Standard Arm | Intervention Arm | Standard Arm | mHealth with No Home Visits Arm | mHealth with Two Home Visits Arm | Standard Arm | Intervention Arm | |
Key Components | 1 health facility-based visit | 1 health facility-based visit + 3 home visits | 1 health facility-based visit | 1 health facility-based visit + mHealth program | 1 health facility-based visit + 2 home visits + mHealth program | 1 home visit | 2 home visits + 1 ring session + mHealth program |
Intervention Activities |
|
|
|
|
|
|
|
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Zohura, F.; Thomas, E.D.; Masud, J.; Bhuyian, M.S.I.; Parvin, T.; Monira, S.; Faruque, A.S.G.; Alam, M.; George, C.M. Formative Research for the Development of the CHoBI7 Cholera Rapid Response Program for Cholera Hotspots in Bangladesh. Int. J. Environ. Res. Public Health 2022, 19, 13352. https://doi.org/10.3390/ijerph192013352
Zohura F, Thomas ED, Masud J, Bhuyian MSI, Parvin T, Monira S, Faruque ASG, Alam M, George CM. Formative Research for the Development of the CHoBI7 Cholera Rapid Response Program for Cholera Hotspots in Bangladesh. International Journal of Environmental Research and Public Health. 2022; 19(20):13352. https://doi.org/10.3390/ijerph192013352
Chicago/Turabian StyleZohura, Fatema, Elizabeth D. Thomas, Jahed Masud, Md Sazzadul Islam Bhuyian, Tahmina Parvin, Shirajum Monira, Abu S. G. Faruque, Munirul Alam, and Christine Marie George. 2022. "Formative Research for the Development of the CHoBI7 Cholera Rapid Response Program for Cholera Hotspots in Bangladesh" International Journal of Environmental Research and Public Health 19, no. 20: 13352. https://doi.org/10.3390/ijerph192013352