Combating the persistent cholera epidemic in the complex nomadic society of Northern Tanzania: The impact of enhanced targeted micro-scale interventions – Ngorongoro District, October 2018

  • Water or foodborne
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Background:
Since August 2015, Tanzania has experienced several waves of cholera outbreaks affecting all 26 regions. Despite several interventions by Ministry of the Health, Ngorongoro district in Arusha region has persistently reported cholera patients since April 2018. Periodic massive migration of Maasai people and their livestock in the area in search of pasture, as well as poor hygiene practices and inadequate access to safe water have hampered control efforts. We identified high-risk areas and implemented interventions to interrupt cholera transmission in this com- munity.
Methods:
During October 2018,we updated the cholera line-lists from 4 cholera treatment centers of Ngorongoro district and performed descriptive analysis to identify high-risk communities. We surveyed affected households to examine water treatment practice through testing drinking water using Free Residual Chlorine tester. We conducted rapid need assessment for drinking water using rapid rural appraisal techniques and identified partners to supply safe water. We conducted focused discussion with society elders (Laigwanans), community-based cholera committee was formed and trained on basic cholera control intervention to sustain and own the interventions. We distributed water treatment products and carried out environmental decontamination in high risk communities.
Results:
During 6th, October 2018, about 1,544 cholera cases were line-listed from Ngorongoro. The most affected villages were Nasiporiong (mean monthly incidence: 5.4/1,000), Esere (4.9/1,000), Kesile (3.9/1,000) and Ngoile (3.4/1,000). September was the month with highest incidence (5.1/1000) in a year 2018. A total of 15,000 water treatment tablets were distributed to 375 by October 2018. About 11,000L of clean and safe water was supplied each week to affected community. Following two weeks of intensive interventions Cholera incidence progressively decreased. Beginning October zero incidence was consistently reported and outbreak was successfully controlled and declared over by November.
Conclusion
Interventions to targeted communities were successful at interrupting cholera transmission during an outbreak in Ngorongoro district. Presence of extensive network of FETP residents and graduates who have demonstrated to have capacity to formulate and translate intervention in a way that are easily adaptable by local communities is a platform that local government authorities can utilize to curb emerging outbreaks and sustain intervention efforts.

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