Africa Water, Sanitation & Hygiene December 2018 Vol.13 No.6 | Page 27

Hygiene
“Manifesto to Finally Eradicate Cholera in DRC” launched
by the NGO, Solidarités International, in April 2018, and
in posts published in such blogs as défishumanitaires. And,
in late 2017, the WHO launched a new global roadmap
to eliminate cholera by 2030 that calls for a global inter-
sectoral response to cholera.
Cholera is endemic in the city of Uvira, located on the
shores of Lake Tanganyika, and is often presented as
one of the starting points for the epidemic outbreaks
affecting this region of DRC. Supported by the French
Development Agency, the Veolia Foundation, the
European Union and OXFAM Great Britain, a project
to rehabilitate Uvira’s drinking water supply network has
provided a unique opportunity to perform a rigorous
health impact evaluation of this investment.
Chronological series showing the volume of drinking
water produced for the Uvira distribution network (bottom
left hand corner), the number of cholera cases admitted
in the city (top left hand corner) and the statistical relation
between …more
This city of 250,000 lies between a lake and mountains
which surround it. Residents suffering from acute
diarrhoea seek help at cholera treatment centres (CTC)
managed by the general hospital.
With help from the national water company (Regideso)
and the Congolese Ministry of Health, the London
School of Hygiene and Tropical Medicine has exploited
the building works schedule for this water supply network
improvement works to design a pragmatic but rigorous
evaluation. The assessment relies on a “stepped wedge”
trial based on the randomised rollout of the improved
water supply network to understand both the impact on
cholera and how behaviours change when drinking water
sources are closer and run continuously. The assessment
also includes a time-space analysis to measure the impact
on cholera incidence, as well as a biomolecular sub-
study to assess the causes of acute diarrhoea among
patients attending the CTCs and to gain insights into the
transmission pathways for these diseases.
Initial findings have already been published in well-
respected peer-reviewed scientific journals (PLOS
Medicine and PLOS ONE). One article demonstrates
that 23% of cholera cases in the city were caused by
interruptions in water supply, and that hygiene habits in
this population are diverse and directly related to both
the type of water connection and continuity of service
households have. Another article, used rapid diagnostic
tests to confirm cholera infection among CTC patients
and found that 40% of suspected cholera cases were
actually positive. This finding demonstrates the high
burden of other acute diarrhoeal diseases and the need for
comprehensive strategies which can address both cholera
and other diarrhoeal diseases.
The research continues despite challenging conditions
Forthcoming findings should help to assess the relative
health benefits of different levels of water supply
connections and improved continuity of water supply;
for example, between after a shared standpipe and an
individual household connection. Molecular biology
will help to better understand the ways in which cholera
spreads, as well as to understand the other causes of acute
diarrhoea that affect this population.
Unfortunately, the political situation remains volatile in
DRC as a whole and in South Kivu, in particular, and
security issues continue to affect the works schedule.
Against such a difficult backdrop, it is important
to remember that this project continues due to the
determination of the women and men who, in these very
challenging conditions and with limited resources, continue
to collect samples, conduct surveys and work to improve
the water supply infrastructure. They are to be praised for
their commitment to improving public health.
Source: The Conversation
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