eradicating cholera in port au prince-haiti: sustainable prevention and control program presentation...

Eradicating Cholera in Port au Prince-Haiti: Sustainable Prevention and Control

Program

Presentation to the public health stakeholders in Haiti including the Presentation to the public health stakeholders in Haiti including the general Haitian community, government of Haiti, NGOs currently in Haiti general Haitian community, government of Haiti, NGOs currently in Haiti and all other interested audiencesand all other interested audiences

Author: Author: Emilia Mmbando Raila Emilia Mmbando Raila PUBH-8010-2 (PUBH-8010-2 (Promoting Population Health)Promoting Population Health)Walden UniversityWalden University

Instructor: Instructor: Dr. Relda Robertson-Beckley Dr. Relda Robertson-Beckley

General objectives of this presentation

At the end of presentation, participants should be able to:At the end of presentation, participants should be able to:

1.1. Recognize cholera as an easy to eradicate disease, its morbidity Recognize cholera as an easy to eradicate disease, its morbidity and mortality rates, prevention and control measures, theories and mortality rates, prevention and control measures, theories related to its continue existence and required possible related to its continue existence and required possible interventions interventions (Part I)(Part I)

2.2. Understand components of proposed sustainable prevention and Understand components of proposed sustainable prevention and control program to eradicate cholera in Port au Prince Haiti control program to eradicate cholera in Port au Prince Haiti (Part (Part II)II) including: including:

Program goal and objectives,Program goal and objectives, Community mobilization;Community mobilization; Audience segmentation;Audience segmentation; Needs Assessment; Needs Assessment; Potential stakeholders;Potential stakeholders; Marketing strategy;Marketing strategy; Critics on existing interventions;Critics on existing interventions; Communication and mass media plan;Communication and mass media plan; Pre-testing;Pre-testing; Program evaluation.Program evaluation.

What is Cholera?

Cholera is an acute intestinal infection caused by toxigenic Vibrio Cholera is an acute intestinal infection caused by toxigenic Vibrio cholerae bacteria of serogroups O1 and O139 that infects an individual cholerae bacteria of serogroups O1 and O139 that infects an individual following ingestion of fecal contaminated food or water.following ingestion of fecal contaminated food or water.1,2,31,2,3

SymptomsSymptoms

Profuse and watery diarrhea resulting to severe dehydration and death of Profuse and watery diarrhea resulting to severe dehydration and death of patients in case of delay in treatment; patients in case of delay in treatment; 1,21,2

Vomiting almost among all patientsVomiting almost among all patients1,21,2

ReferencesReferences1. Centers for Disease Control and Prevention (CDC, 2011). Cholera disease. Retrieved on December 8, 2011 from 1. Centers for Disease Control and Prevention (CDC, 2011). Cholera disease. Retrieved on December 8, 2011 from http://www.cdc.gov/cholera/disease.html2. Ghose. A. C. (2011). Lessons from cholera & Vibrio cholerae. Indian J Med Res 133, 64-170. Retrieved from Walden University Library through 2. Ghose. A. C. (2011). Lessons from cholera & Vibrio cholerae. Indian J Med Res 133, 64-170. Retrieved from Walden University Library through

http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=3&hid=125&sid=59502a79-b126-47d2-98b9-789f66567280%40sessionmgr111

3. WHO. (2011a). Health action in crises. Haiti: Increase in cholera cases. Retrieved on December 8, 2011 from3. WHO. (2011a). Health action in crises. Haiti: Increase in cholera cases. Retrieved on December 8, 2011 fromhttp://www.who.int/hac/crises/hti/en/

Mobility & Mortality Rates

October 21, 2010 outbreak in Haiti leads to over 7,000 deathsOctober 21, 2010 outbreak in Haiti leads to over 7,000 deaths1,3,51,3,5

Currently, 200 new cases are reported daily and expected to increase Currently, 200 new cases are reported daily and expected to increase to 1000 cases per day in April 2012, (rainy season)to 1000 cases per day in April 2012, (rainy season)55

12,5018 cases in African Region by the end of 2005 (94.8% of the 12,5018 cases in African Region by the end of 2005 (94.8% of the global cases)global cases)44

Three to five million cholera cases exist worldwide with 100,000-Three to five million cholera cases exist worldwide with 100,000-120,000 cholera-related deaths each year120,000 cholera-related deaths each year1,3,51,3,5



3. WHO. (2011). Health action in crises. Haiti: Increase in cholera cases. Retrieved on December 8, 2011 from3. WHO. (2011). Health action in crises. Haiti: Increase in cholera cases. Retrieved on December 8, 2011 fromhttp://www.who.int/hac/crises/hti/en/

4. Kirigia, J., M., et al. (2009). Economic burden of cholera in the WHO African region. Retrieved from 4. Kirigia, J., M., et al. (2009). Economic burden of cholera in the WHO African region. Retrieved from http://www.biomedcentral,com/1472-698X/9/85. Dalal, M. (2012, January 13). Cholera in Haiti: From control to elimination. Two years after a massive earthquake and subsequent cholera outbreak, Haitians 5. Dalal, M. (2012, January 13). Cholera in Haiti: From control to elimination. Two years after a massive earthquake and subsequent cholera outbreak, Haitians

are trying to improve public health. Aljazeera feature retrieved from are trying to improve public health. Aljazeera feature retrieved from http://www.aljazeera.com/indepth/features/2012/01/2012111193155842439.html

Prevention and Control Measures

Prevention measuresPrevention measures1,2,31,2,3

Availability of clean water, Availability of clean water, Proper sanitation,Proper sanitation, Food & hand hygiene and Food & hand hygiene and Health education to affected populations. Health education to affected populations.

Control measuresControl measures1,2,31,2,3

Appropriate and timely management of cases, Appropriate and timely management of cases, Avoidance of nosocomial infections, Avoidance of nosocomial infections, Availability of medical supplies, Availability of medical supplies, Promoting hygienic behaviors, improved access to clean water, effective sanitation, Promoting hygienic behaviors, improved access to clean water, effective sanitation,

vector control and good solid waste management.vector control and good solid waste management.



3. WHO. (2011). Health action in crises. Haiti: Increase in cholera cases. Retrieved on December 8, 2011 from3. WHO. (2011). Health action in crises. Haiti: Increase in cholera cases. Retrieved on December 8, 2011 fromhttp://www.who.int/hac/crises/hti/en/

Cholera control measure, Source: © 2012 Time Inc. All rights reserved. Retrieved from

http://www.time.com/time/photogallery/0,29307,2030840_2209724,00.html

Theories related to its continue existence

Theory of planned behavior (TPB);Theory of planned behavior (TPB);11

Behavioral change interventions in Haiti lags behind due to lack of actual Behavioral change interventions in Haiti lags behind due to lack of actual behavioral control component.behavioral control component.

Theory of freeing;Theory of freeing;11

Overdependence on international organizations to support the country Overdependence on international organizations to support the country without empowering Haitians to attain control over their lives.without empowering Haitians to attain control over their lives.

Social Cognitive Theory (SCT);Social Cognitive Theory (SCT);11

Individuals’ behaviors is influenced by social and physical environments, Individuals’ behaviors is influenced by social and physical environments, beliefs and perceptions. beliefs and perceptions.

ReferenceReference1. McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2008). Planning, implementing, and evaluating health promotion programs: A primer. (5th ed.). 1. McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2008). Planning, implementing, and evaluating health promotion programs: A primer. (5th ed.).

San Francisco: Pearson Benjamin Cumming.San Francisco: Pearson Benjamin Cumming.

Required interventions Environmental interventions (governmental-spearheaded):Environmental interventions (governmental-spearheaded): Sustainable Community Waster Supply and Sanitation ProgramSustainable Community Waster Supply and Sanitation Program1-41-4

Behavioral interventions:Behavioral interventions:1-41-4

Hand and food hygieneHand and food hygiene Practicing proper sanitation (use of toilets unlike 99% open defecation)Practicing proper sanitation (use of toilets unlike 99% open defecation)44

Proper collection and storage of garbage (stop countrywide littering malpractice)Proper collection and storage of garbage (stop countrywide littering malpractice) Proper disposal of children’s feces and cleansing materialsProper disposal of children’s feces and cleansing materials Household water treatment, its proper storage and useHousehold water treatment, its proper storage and use

Policy related interventions:Policy related interventions:33

Enactment/amendment of regulations to control open defecation, littering and Enactment/amendment of regulations to control open defecation, littering and sewerage disposal in Haiti sewerage disposal in Haiti

References1. Pattanayak, K. S., Poulos, C., Yang, J. & Patil, s. (2010). How valuable are environmental health interventions? Evaluation of water and

sanitation programmes in India. Economic benefits of water and sanitation programs in India.2. Said, M. D., Funke, N. Jacobs, I., Steyn, M. & Nienaber, S. (2011). The case of cholera preparedness, response and prevention in the SADC

region: A need for proactive and multi-level communication and co-ordination. ISSN 0378-4738, 37, (4), 559-566.3. Rochars. V., Tipret, J., Patrick, M., Jacobson, L., Barbour, E. K, Berendes, D., et al. (2011). Knowledge, attitudes, and practices related to

treatment and prevention of cholera, Haiti, 2010. Emerging Infectious Diseases 17, (11): 2158-2161.4. Dalal, M. (2012, January 13). Cholera in Haiti: From control to elimination. Two years after a massive earthquake and subsequent cholera 4. Dalal, M. (2012, January 13). Cholera in Haiti: From control to elimination. Two years after a massive earthquake and subsequent cholera

outbreak, Haitians are trying to improve public health. Aljazeera feature retrieved from outbreak, Haitians are trying to improve public health. Aljazeera feature retrieved from http://www.aljazeera.com/indepth/features/2012/01/2012111193155842439.html

Eradicating Cholera in Port au Prince-Haiti: Sustainable

Prevention and Control Program

Part IIPart II

Program goal and objectives

Goal: To acquire cholera free community in Port au Prince-HaitiGoal: To acquire cholera free community in Port au Prince-Haiti

Objectives:Objectives:

1.1. By the year 2015, 95% of households in Port au Prince Haiti will possess proper By the year 2015, 95% of households in Port au Prince Haiti will possess proper sanitation, waste management and water treatment facilities. sanitation, waste management and water treatment facilities.

2.2. By the year 2016, 95% of public places in Port au Prince Haiti will possess proper By the year 2016, 95% of public places in Port au Prince Haiti will possess proper sanitation and waste management facilities.sanitation and waste management facilities.

3.3. By the year 2016, 98% of fecal materials generated in Port au Prince Haiti will be By the year 2016, 98% of fecal materials generated in Port au Prince Haiti will be treated in centralized sewerage treatment facilities and effluents will be used for treated in centralized sewerage treatment facilities and effluents will be used for irrigation.irrigation.

4.4. By the year 2013, 97% of residents living in Haiti will be aware of health behaviors By the year 2013, 97% of residents living in Haiti will be aware of health behaviors associated with cholera. associated with cholera.

5.5. By the year 2015, 70% of regulations will be enacted/amended to control open By the year 2015, 70% of regulations will be enacted/amended to control open defecation and littering in Haiti. defecation and littering in Haiti.

Program activities

Objective No 1. Objective No 1.

Introducing the community led total sanitation and household water treatment to Introducing the community led total sanitation and household water treatment to the community by NGOsthe community by NGOs

Construction of sanitation facilities (ventilated improved pit latrines and pour flash Construction of sanitation facilities (ventilated improved pit latrines and pour flash toilets) at each householdtoilets) at each household

Training the community on facility operational and maintenance for 5 days by Training the community on facility operational and maintenance for 5 days by responsible NGOsresponsible NGOs

Weekly training of the community on improvised waste management household Weekly training of the community on improvised waste management household equipment by community health workersequipment by community health workers


NGO’s lobbying for the provision of governmental land for construction of public NGO’s lobbying for the provision of governmental land for construction of public sanitation facilitiessanitation facilities

Construction of sanitation facilities (ventilated improved pit latrines & pour flash Construction of sanitation facilities (ventilated improved pit latrines & pour flash toilets equiped with hand washing basins) in various public areas including markets toilets equiped with hand washing basins) in various public areas including markets by responsible NGOsby responsible NGOs

Program activities cont...

Objective No 2 cont...Objective No 2 cont... Training the identified focal persons on facility operational and maintenance for Training the identified focal persons on facility operational and maintenance for

each public facility by NGOseach public facility by NGOs

Engineering design and construction of sanitary landfill for the final disposal of Engineering design and construction of sanitary landfill for the final disposal of garbage by NGOsgarbage by NGOs

Handing over of all constructed facilities by NGOs to the government for Handing over of all constructed facilities by NGOs to the government for sustainabilitysustainability


Engineering design of sewerage treatment system (Activated Sludge Blanket) by Engineering design of sewerage treatment system (Activated Sludge Blanket) by NGOsNGOs

Construction of sewerage treatment systems by NGOsConstruction of sewerage treatment systems by NGOs

On-site training of 10 government representatives on its operational and On-site training of 10 government representatives on its operational and maintenance by NGOsmaintenance by NGOs

Handing over of all constructed facilities by NGOs to the government for Handing over of all constructed facilities by NGOs to the government for sustainabilitysustainability

Program activities cont...

Objective No 4.Objective No 4. Development, pre-test and distribution of education materialsDevelopment, pre-test and distribution of education materials

Mass campaign on cholera prevention and control measures to all Haitians in Port Mass campaign on cholera prevention and control measures to all Haitians in Port au Princeau Prince

Training of community health workers on cholera prevention and control measures Training of community health workers on cholera prevention and control measures by NGOsby NGOs


Perform social marketing to evaluate the need of policy intervention among Haitians Perform social marketing to evaluate the need of policy intervention among Haitians by NGOsby NGOs

5 Working sessions on the development, review and harmonization of policy 5 Working sessions on the development, review and harmonization of policy guidelines on sanitationguidelines on sanitation

Printing of 8000 copies of policy guidelinesPrinting of 8000 copies of policy guidelines

Dissemination of policy guidelines to each municipal councils by NGOsDissemination of policy guidelines to each municipal councils by NGOs

Mobilizing Haitians to fight cholera

Major aim is to empower Haitians (provide guidance, support and Major aim is to empower Haitians (provide guidance, support and resources to tackle cholera problem);resources to tackle cholera problem);2,32,3

Proper entry/initiation to the community settings including Proper entry/initiation to the community settings including households, schools, workplaces, IDP camps, religious places & households, schools, workplaces, IDP camps, religious places & vending areas;vending areas;22

Emphasize community readiness and commitment;Emphasize community readiness and commitment;3,43,4

Formation of task force and coalition with representatives from NGOs, Formation of task force and coalition with representatives from NGOs, health workers, policy makers, religious leaders, teachers, politicians health workers, policy makers, religious leaders, teachers, politicians and representatives from the local community.and representatives from the local community. 1-41-4

ReferencesReferences1. Katherine Penrose, K., Marcia Caldas de Castro, C. M., Werema, J. &, Ryan, T. E. (2010). Informal urban settlements and cholera risk in Dar es Salaam, 1. Katherine Penrose, K., Marcia Caldas de Castro, C. M., Werema, J. &, Ryan, T. E. (2010). Informal urban settlements and cholera risk in Dar es Salaam,

Tanzania. PLOS Neglected Tropical Diseases, 5 (1):e631 Tanzania. PLOS Neglected Tropical Diseases, 5 (1):e631 2. McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2009). Planning, implementing, and evaluating health promotion programs: A primer. (5th ed.). San Francisco: 2. McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2009). Planning, implementing, and evaluating health promotion programs: A primer. (5th ed.). San Francisco:

Pearson Benjamin Cumming. Pearson Benjamin Cumming.

3. Lantz, P.M., Viruell-Fuentes, E., Israel, B.A., Softley, D., Guzman, R. (2001). Can communities and academia work together on public health research? 3. Lantz, P.M., Viruell-Fuentes, E., Israel, B.A., Softley, D., Guzman, R. (2001). Can communities and academia work together on public health research? Evaluation results from a community-based participatory research partnership in Detroit. Journal of Urban Health, 78, 495-507Evaluation results from a community-based participatory research partnership in Detroit. Journal of Urban Health, 78, 495-507

4. Sabol, B. (2002). Innovations in collaboration for the public's health through the Turning Point Initiative: The W.K. Kellogg Foundation perspective. Journal of 4. Sabol, B. (2002). Innovations in collaboration for the public's health through the Turning Point Initiative: The W.K. Kellogg Foundation perspective. Journal of Public Health Management and Practice, 8, 6-12. Public Health Management and Practice, 8, 6-12.

5. Siegel, M. & Lotenberg D. L. (2007). Marketing public health: Strategies to promote social change. Jones & Bartlett Publishers, Inc.5. Siegel, M. & Lotenberg D. L. (2007). Marketing public health: Strategies to promote social change. Jones & Bartlett Publishers, Inc.

Audience characteristics & segmentation

Proposed Target Group: 100 households (pilot), 95% African descent Proposed Target Group: 100 households (pilot), 95% African descent and 5%African & European descent Haitians.and 5%African & European descent Haitians.

Audience characteristics: 86% live in slum conditions Audience characteristics: 86% live in slum conditions 11

Segmentation according to reachability, differential responsiveness Segmentation according to reachability, differential responsiveness

& program-based theories:& program-based theories:2-52-5

Primary audiences: students, employed Haitians, unemployed Haitians (house Primary audiences: students, employed Haitians, unemployed Haitians (house wives/husbands) and self employed Haitians (vendors along PAP streets)wives/husbands) and self employed Haitians (vendors along PAP streets)

Secondary audiences: politicians, policy makers, health workers, teachers/tutors, Secondary audiences: politicians, policy makers, health workers, teachers/tutors, religious leaders and NGOs religious leaders and NGOs

References

1. Dalal, M. (2012, January 13). Cholera in Haiti: From control to elimination. Two years after a massive earthquake and subsequent cholera outbreak, Haitians 1. Dalal, M. (2012, January 13). Cholera in Haiti: From control to elimination. Two years after a massive earthquake and subsequent cholera outbreak, Haitians are trying to improve public health. Aljazeera feature retrieved from are trying to improve public health. Aljazeera feature retrieved from http://www.aljazeera.com/indepth/features/2012/01/2012111193155842439.html http://www.aljazeera.com/indepth/features/2012/01/2012111193155842439.html

2. MacQueen, K. M., McLellan, E., Metzger, D. S., Kegeles, S., Strauss, R., Scotti, R., Blanchard, L., & II, R. T. T. (2001). What is community? An evidence-based 2. MacQueen, K. M., McLellan, E., Metzger, D. S., Kegeles, S., Strauss, R., Scotti, R., Blanchard, L., & II, R. T. T. (2001). What is community? An evidence-based definition for participatory public health. American Journal of Public Health, 91(12), 1929-1938. definition for participatory public health. American Journal of Public Health, 91(12), 1929-1938.

3. McKenzie, J.F., Pinger, R. R and Kotecki, J. E (2012). An introduction to community health. (7th edition). Jones & Bartlett Publishers, Inc.3. McKenzie, J.F., Pinger, R. R and Kotecki, J. E (2012). An introduction to community health. (7th edition). Jones & Bartlett Publishers, Inc.

4. McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2009). Planning, implementing, and evaluating health promotion programs: A primer. (5th ed.). San Francisco: 4. McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2009). Planning, implementing, and evaluating health promotion programs: A primer. (5th ed.). San Francisco: Pearson Benjamin Cumming. Pearson Benjamin Cumming.


Needs Assessment Use quantitative research to identify program focus for the target Use quantitative research to identify program focus for the target

audience (100 households as pilot) audience (100 households as pilot) 1-41-4

Validation of the prioritized needs to prevent and control cholera Validation of the prioritized needs to prevent and control cholera base on the available resources base on the available resources 1-41-4

Mapping of community capacity Mapping of community capacity 1,31,3

Mapping of NGO’s capacity Mapping of NGO’s capacity 1-41-4

References1. McKenzie, J.F., Pinger, R. R and Kotecki, J. E (2012). An introduction to community health. (7th edition). Jones & Bartlett Publishers, Inc.McKenzie, J.F., Pinger, R. R and Kotecki, J. E (2012). An introduction to community health. (7th edition). Jones & Bartlett Publishers, Inc.

2. McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2009). Planning, implementing, and evaluating health promotion programs: A primer. (5th 2. McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2009). Planning, implementing, and evaluating health promotion programs: A primer. (5th ed.). San Francisco: Pearson Benjamin Cumming. ed.). San Francisco: Pearson Benjamin Cumming.


4. Tuite, R. A., Tien, J., Eisenberg, M. , Earn, J.D. Ma, J. & Fisman, N. D. (2011).Cholera epidemic in Haiti, 2010: Using a transmission model to 4. Tuite, R. A., Tien, J., Eisenberg, M. , Earn, J.D. Ma, J. & Fisman, N. D. (2011).Cholera epidemic in Haiti, 2010: Using a transmission model to explain spatial spread of disease and identify optimal control interventions. Annals of Internal Medicine, 154:593-601.explain spatial spread of disease and identify optimal control interventions. Annals of Internal Medicine, 154:593-601.

Potential stakeholders

The general community (Haitians from 100 households as pilot The general community (Haitians from 100 households as pilot group);group);

National and International NGOs): USAID, PAHO, UNICEF, FHI, National and International NGOs): USAID, PAHO, UNICEF, FHI, MINUSTAH, WORLD BANK, PLAN, CARE, CRS, IRC, IFRC, IOM, WHO MINUSTAH, WORLD BANK, PLAN, CARE, CRS, IRC, IFRC, IOM, WHO etc working in Haiti;etc working in Haiti;

The media (Voila and Digicel mobile companies, televisions and The media (Voila and Digicel mobile companies, televisions and radio);radio);

Governmental agencies (Ministry of Health in Haiti, Ministry of Governmental agencies (Ministry of Health in Haiti, Ministry of Environment, Ministry of legal affairs)Environment, Ministry of legal affairs)

Educational institutionsEducational institutions

Religious placesReligious places

Politicians Politicians

Marketing Strategy

Rely on the identified community needs through formative research Rely on the identified community needs through formative research 33

Employ a three-stage community health advocacy covering Employ a three-stage community health advocacy covering information, theory-based social market strategy and action information, theory-based social market strategy and action 3,43,4

Marketing mix principles to be observed by addressing Marketing mix principles to be observed by addressing 1,21,2 Product: Product: Sustainable cholera prevention and control with adequate regulations Sustainable cholera prevention and control with adequate regulations Value/price: Value/price: Commitment to change among Haitians and the entire GovernmentCommitment to change among Haitians and the entire Government Package: Package: Address intrapersonal, interpersonal and community behavioral control Address intrapersonal, interpersonal and community behavioral control

interventionsinterventions Position: Position: All social marketing activities to be done during peak hoursAll social marketing activities to be done during peak hours

References

1. Christoffel, K. K. (2000). Public health advocacy: Process and product. American Journal of Public Health, Volume 90 (5), p. 722-726. 1. Christoffel, K. K. (2000). Public health advocacy: Process and product. American Journal of Public Health, Volume 90 (5), p. 722-726. Retrieved from Retrieved from http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.90.5.722

2. Poscente, N., Rothstein, M., & Irvine, M. J. (2002). Using marketing research methods to evaluate a stage-specific intervention. American 2. Poscente, N., Rothstein, M., & Irvine, M. J. (2002). Using marketing research methods to evaluate a stage-specific intervention. American Journal of Health Behavior, 26, 243-251.Journal of Health Behavior, 26, 243-251.


4. Tuite, R. A., Tien, J., Eisenberg, M. , Earn, J.D. Ma, J. & Fisman, N. D. (2011).Cholera epidemic in Haiti, 2010: Using a transmission model to 4. Tuite, R. A., Tien, J., Eisenberg, M. , Earn, J.D. Ma, J. & Fisman, N. D. (2011).Cholera epidemic in Haiti, 2010: Using a transmission model to explain spatial spread of disease and identify optimal control interventions. Annals of Internal Medicine, 154:593-601.explain spatial spread of disease and identify optimal control interventions. Annals of Internal Medicine, 154:593-601.

Critics on existing strategies

Poor implementation strategies that do not tally with audience characteristics Poor implementation strategies that do not tally with audience characteristics (poverty and low literacy levels) (poverty and low literacy levels) 22

Inadequate proper treatment and final disposal of fecal materials and normal Inadequate proper treatment and final disposal of fecal materials and normal garbage in Port au Prince and the entire country garbage in Port au Prince and the entire country 1,21,2

Inconsistent control measure due to funding problems Inconsistent control measure due to funding problems 22

Lack of behavioral control component (regulations) to control open Lack of behavioral control component (regulations) to control open defecation, littering etc defecation, littering etc 22

Failure to address Failure to address product, value/price, place, and promotion to the target product, value/price, place, and promotion to the target audienceaudience

ReferencesReferences1. Dalal, M. (2012, January 13). Cholera in Haiti: From control to elimination. Two years after a massive earthquake and subsequent cholera 1. Dalal, M. (2012, January 13). Cholera in Haiti: From control to elimination. Two years after a massive earthquake and subsequent cholera

outbreak, Haitians are trying to improve public health. Aljazeera feature retrieved from outbreak, Haitians are trying to improve public health. Aljazeera feature retrieved from http://www.aljazeera.com/indepth/features/2012/01/2012111193155842439.html

2. Ghose. A. C. (2011). Lessons from cholera & Vibrio cholerae. Indian J Med Res 133, 64-170. Retrieved from Walden University Library through 2. Ghose. A. C. (2011). Lessons from cholera & Vibrio cholerae. Indian J Med Res 133, 64-170. Retrieved from Walden University Library through http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=3&hid=125&sid=59502a79-b126-47d2-98b9-789f66567280%40sessionmgr111

3. WHO. (2011b). Weekly epidemiological record: Relevé épidémiologique hebdomadaire. 31, (86), 325–340. Retrieved from Walden University 3. WHO. (2011b). Weekly epidemiological record: Relevé épidémiologique hebdomadaire. 31, (86), 325–340. Retrieved from Walden University library through http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=3&hid=125&sid=59502a79-b126-47d2-library through http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=3&hid=125&sid=59502a79-b126-47d2-98b9-789f66567280%40sessionmgr11198b9-789f66567280%40sessionmgr111

Communication and mass media

Perform effective communication and mass media covering areas below: Perform effective communication and mass media covering areas below: 1-41-4

Persons to make social changes: (community health workers, politicians & Persons to make social changes: (community health workers, politicians & students) students)

Required actions: (use of toilets, proper use of garbage bins and general hygiene) Required actions: (use of toilets, proper use of garbage bins and general hygiene)

Key benefits: (good health, healthier environments, uninterrupted education etc)Key benefits: (good health, healthier environments, uninterrupted education etc)

Support: (religious leaders, NGOs, government, volunteers) Support: (religious leaders, NGOs, government, volunteers)

Reaching audiences: (employ simple and reliable routes of communication) Reaching audiences: (employ simple and reliable routes of communication)

Conveying actions: (showing audience what they need to do, do it many times)Conveying actions: (showing audience what they need to do, do it many times)

ReferencesReferences1. Galea, S., Factor, S. H., Palermo, A. G., Aaron, D., Canales, E., & Vlahov, D. (2002). Access to resources for substance users in Harlem, New York City: 1. Galea, S., Factor, S. H., Palermo, A. G., Aaron, D., Canales, E., & Vlahov, D. (2002). Access to resources for substance users in Harlem, New York City:

Service provider and client perspectives. Health Education and Behavior, 29, 296-311.Service provider and client perspectives. Health Education and Behavior, 29, 296-311.2. Reyburn, R., Deen, L.J., Grais F. R, Clemens, D. J., Lopez, L. A et al. (2011). The case for reactive mass oral cholera vaccinations. PLOS Neglected 2. Reyburn, R., Deen, L.J., Grais F. R, Clemens, D. J., Lopez, L. A et al. (2011). The case for reactive mass oral cholera vaccinations. PLOS Neglected

Tropical Diseases, 5 (1):e952.Tropical Diseases, 5 (1):e952.3. Reyburn , R., Kim, R. D. , Emch, M. , Khatib, A. , Seidlein, L. & Ali, M . (2011). Climate variability and the outbreaks of cholera in Zanzibar, East Africa: A 3. Reyburn , R., Kim, R. D. , Emch, M. , Khatib, A. , Seidlein, L. & Ali, M . (2011). Climate variability and the outbreaks of cholera in Zanzibar, East Africa: A

time series analysis American Society of Tropical Medicine and Hygiene, 84(6), 862–869.time series analysis American Society of Tropical Medicine and Hygiene, 84(6), 862–869.4. Siegel, M. & Lotenberg D. L. (2007). Marketing public health: Strategies to promote social change. Jones & Bartlett Publishers, Inc.4. Siegel, M. & Lotenberg D. L. (2007). Marketing public health: Strategies to promote social change. Jones & Bartlett Publishers, Inc.

Pre-testingPre-testing Perform process evaluation of the program before its actual implementation Perform process evaluation of the program before its actual implementation

1,2,41,2,4

Evaluate training materials (its helpfulness, audience’s reaction and Evaluate training materials (its helpfulness, audience’s reaction and suggestions for upcoming activities/revisions) suggestions for upcoming activities/revisions) 1,2,41,2,4

Use marketing research method to evaluate mass media and policy initiatives Use marketing research method to evaluate mass media and policy initiatives 33

Methods Methods 1-4 1-4

Sample size: 20 households and its dwellers for pretest Sample size: 20 households and its dwellers for pretest Designs: quantitative and qualitative research Designs: quantitative and qualitative research Data collection : focus group discussion, questionnaires, physical observation Data collection : focus group discussion, questionnaires, physical observation Data analysis: cleaning data and use SPSS version 19.0 for analysisData analysis: cleaning data and use SPSS version 19.0 for analysis Report development and dissemination for sharing the learned lessonsReport development and dissemination for sharing the learned lessons

References1. McKenzie, J.F., Pinger, R. R and Kotecki, J. E (2012). An introduction to community health. (7th edition). Jones & Bartlett Publishers, Inc.McKenzie, J.F., Pinger, R. R and Kotecki, J. E (2012). An introduction to community health. (7th edition). Jones & Bartlett Publishers, Inc.

2. McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2009). Planning, implementing, and evaluating health promotion programs: A primer. (5th ed.). 2. McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2009). Planning, implementing, and evaluating health promotion programs: A primer. (5th ed.). San Francisco: Pearson Benjamin Cumming. San Francisco: Pearson Benjamin Cumming.

3. Poscente, N., Rothstein, M., & Irvine, M. J. (2002). Using marketing research methods to evaluate a stage-specific intervention. American Journal 3. Poscente, N., Rothstein, M., & Irvine, M. J. (2002). Using marketing research methods to evaluate a stage-specific intervention. American Journal of Health Behavior, 26, 243-251 of Health Behavior, 26, 243-251

Siegel, M. & Lotenberg D. L. (2007). Marketing public health: Strategies to promote social change. Jones & Bartlett Publishers, Inc.Siegel, M. & Lotenberg D. L. (2007). Marketing public health: Strategies to promote social change. Jones & Bartlett Publishers, Inc.

Evaluation Plan

Together we can eradicate cholera in Haiti despite Together we can eradicate cholera in Haiti despite higher poverty and low literacy levels!higher poverty and low literacy levels!

Community empowerment, resource availability and both Community empowerment, resource availability and both willingness and commitment among Haitians will help to willingness and commitment among Haitians will help to

acquire cholera free society.acquire cholera free society.

Thanks for your time!Thanks for your time!

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Cash, A. B., Rodo, X. Kinter III, L., J. & Yunus, M. D. (2010).Disentangling the impact of ENSO and Indian Ocean variability on the Regional climate of Bangladesh: Implications for cholera risk. American Meteorological Society. 2817-2831

Centers for Disease Control and Prevention (CDC, 2011). Cholera disease. Retrieved on December 20, 2011 from http://www.cdc.gov/cholera/general/#treatmentCentral Intelligence Agency –CIA (2011). Retrieved from https://www.cia.gov/library/publications/the-world-factbook/geos/ha.html

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Katherine Penrose, K., Marcia Caldas de Castro, C. M., Werema, J. &, Ryan, T. E. (2010). Informal urban settlements and cholera risk in Dar es Salaam, Tanzania. PLOS Neglected Tropical Diseases, 5 (1):e631

Kirigia, J., M., et al. (2009). Economic burden of cholera in the WHO African region. Retrieved from http://www.biomedcentral,com/1472-698X/9/8

MacQueen, K. M., McLellan, E., Metzger, D. S., Kegeles, S., Strauss, R., Scotti, R., Blanchard, L., & II, R. T. T. (2001). What is community? An evidence-based definition for participatory public health. American Journal of Public Health, 91(12), 1929-1938.

McKenzie, J.F., Pinger, R. R and Kotecki, J. E (2012). An introduction to community health. (7th edition). Jones & Bartlett Publishers, Inc.

McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2009). Planning, implementing, and evaluating health promotion programs: A primer. (5th ed.). San Francisco: Pearson Benjamin Cumming.

Meade, C. D.& Calvo, A. (2001) Developing community-academic partnerships to enhance breast health among rural and Hispanic migrant and seasonal farm worker women. Oncology nursing forum.;28(10):1577-84.

Meade, C. D., Calvo, A. & Cuthbertson, D. (2002). Impact of culturally, linguistically, and literacy relevant cancer information among Hispanic farm worker women. Journal of Cancer Education; 28(10):50-54.

References cont…References cont…Labonte, R. et al. (2002). An integrated exploration into the social and environmental determinants of health: The Saskatchewan Population Health and Evaluation Research Unit (SPHERU). Chronic Diseases in Canada, 23, 71-76.

Lantz, P.M., Viruell-Fuentes, E., Israel, B.A., Softley, D., Guzman, R. (2001). Can communities and academia work together on public health research? Evaluation results from a community-based participatory research partnership in Detroit. Journal of Urban Health, 78, 495-507.

Pattanayak, K. S., Poulos, C., Yang, J. & Patil, s. (2010). How valuable are environmental health interventions? Evaluation of water and sanitation programmes in India. Economic benefits of water and sanitation programs in India.

Poscente, N., Rothstein, M., & Irvine, M. J. (2002). Using marketing research methods to evaluate a stage-specific intervention. American Journal of Health Behavior, 26, 243-251.

Reyburn , R., Kim, R. D. , Emch, M. , Khatib, A. , Seidlein, L. & Ali, M . (2011). Climate variability and the outbreaks of cholera in Zanzibar, East Africa: A time series analysis American Society of Tropical Medicine and Hygiene, 84(6), 862–869.

Reyburn, R., Deen, L.J., Grais F. R, Clemens, D. J., Lopez, L. A et al. (2011). The case for reactive mass oral cholera vaccinations. PLOS Neglected Tropical Diseases, 5 (1):e952.

Rochars. V., Tipret, J., Patrick, M., Jacobson, L., Barbour, E. K, Berendes, D., et al. (2011). Knowledge, attitudes, and practices related to treatment and prevention of cholera, Haiti, 2010. Emerging Infectious Diseases 17, (11): 2158-2161.

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Said, M. D., Funke, N. Jacobs, I., Steyn, M. & Nienaber, S. (2011). The case of cholera preparedness, response and prevention in the SADC region: A need for proactive and multi-level communication and co-ordination. ISSN 0378-4738, 37, (4), 559-566.

Siegel, M. & Lotenberg D. L. (2007). Marketing public health: Strategies to promote social change. Jones & Bartlett Publishers, Inc.

Tuite, R. A., Tien, J., Eisenberg, M. , Earn, J.D. Ma, J. & Fisman, N. D. (2011).Cholera epidemic in Haiti, 2010: Using a transmission model to explain spatial spread of disease and identify optimal control interventions. Annals of Internal Medicine, 154:593-601.

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eradicating cholera in port au prince-haiti: sustainable prevention and control program presentation...

Documents

cholera cases

cholera disease

eradicating cholera

cholera vibrio cholerae

cholerarelated deaths

economic burden of cholera

disease control

government of haiti