Twin Innovative strategy to sustain cholera prevention: Evidence from Kilifi HDSS.

Objectives: To describe cholera outbreak trends; show geographical distribution of cholera cases; describe a new cholera communication strategy; and show that the new strategy protects the community from cholera in subsequent outbreaks.

Methods: We reviewed case reports from facilities within KHDSS and samples were sent for laboratory confirmation. We performed GIS spatial analysis on the data showing the distribution of cases. Cholera hotspot areas were identified for intervention. Cholera communication strategy focusing on empowering the community to realize unhygienic conditions of water, food, poor sanitation and personal hygiene was introduced and its impact assessed in subsequent outbreaks.

Results: Suspected cases were 125 between June 2009 and February 2010. The positives were (43%), negatives (47%) and Epi-linked (10%). In the subsequent outbreak between April-May 2010, we observed 90 suspected cases, (9%) positives, (4%) negatives, (81%) epi-linked and (6%) samples were not collected. No cholera cases were reported in the cholera hotspot areas.

Conclusion: Cases of cholera declined with subsequent outbreaks and no case was reported in the hotspot areas. Our intervention worked well suggesting a replicable approach in other epidemic areas.