Communication framework during cholera outbreaks
Annex to the:
Toolkit E – Tanzania Hygiene Communication in Emergencies Guidelines (final draft, 2010)
and
Toolkit F - WASH guidelines for cholera prevention, preparedness and control (final draft, 2010)
Part of the:
Water, Sanitation and Hygiene (WASH) Emergency Preparedness and Response Toolkits
For use on the Mainland and in Zanzibar, United Republic of Tanzania
(Acknowledgements at the end of the document)
17
Annex 1 - Communication framework during cholera outbreaks
Key questions / Summary of understanding so far /
What are people (examine different groups) doing that presents a risk to hygiene and public health? (See more detailed assessment checklist) / · Relatively high coverage of latrines (approx. 70%).
· Low coverage and use of improved latrines & the majority do not have handwashing facilities.
· Low prevalence of handwashing with soap in adults and children.
· Drinking water sources not protected.
· Water from water vendors not clean.
· Water is not stored or drawn safely at home.
· Children’s faeces are not seen as dangerous
· Leftover food not reheated thoroughly and fruits are not washed.
· Fruit juices and ice-lollies use contaminated water.
· Poor hygiene amongst food sellers /cooks
· Communal gatherings - food is not prepared hygienically
· Washing of deceased cholera patients leads to further transmission.
· People scared to disclose sickness or death
· Indiscriminate refuse disposal causes tips that are breeding grounds for flies
· Delay in seeking treatment
What feasible priority actions or practices are required to protect their health? / · Handwashing with soap at key times
· Treating drinking water by boiling, use of chlorine / WaterGuard or other treatment method
· ORT (ORS, zinc, other liquids and feeding) especially for children
· Using /digging latrines or improving latrines by adding handwashing facilities?
· Safe disposal of children’s faeces
· Reheating food until hot
· Cover food
· Seek treatment early, take liquid on the way
· Report cases and deaths and get professional help for the burial
What are the key obstacles that make these practices difficult or prevent people from taking action? (As they see it) / · They believe that cholera is caused by witchcraft
· Do not believe that proposed solution will make a difference
· They do not think that children’s faeces are harmful
· They do not like the taste of boiled or chlorinated water
· Fear that they will not be allowed to bury their loved ones properly
What motivates people who already practice the desired behaviour? (Doers and non doers) / (Assessment to be carried out)
What are the different primary target or audience groups? / Mothers with young children, older women, men, school children, youths, water vendors, food vendors, people with disabilities
Who might influence the primary target groups? (Family members, friends or change agents e.g. celebrities, sports personalities, teachers etc.) / Traditional leaders, traditional healers, TBAs,
What might influence these different target groups?
(E.g. nurture, disgust, affiliation, convenience etc.) / · Mothers like to feel they are doing the best for their children.
· Fathers like to feel they are protecting their family.
· No one likes to think they might be eating shit
What are the trusted methods of communication used by the different target groups? (Ask who do you go to for advice) / Older women/TBAs Radio, CORPs, Street Government,
What methods of mobilising communities are available (e.g. strong leadership, religious institutions, women’s groups, social networks, local NGOs etc.) / Religious leaders, PHAST extension workers?
What outreach workers are available? / TRCS volunteers, CHWs, TBAs
What else can be done to enable men, women and children to take action? (E.g. provision of WASH facilities, distribution of hygiene items or household water treatment technologies) / Mass distribution of soap or chlorine?
Functioning hand-washing stations next to public latrines?
What advocacy initiatives are required at the national or local level? / Need for more environmental health workers? Authorities to be held responsible for producing cholera plans? Increased/ more timely funding for cholera response?
Aim: To ensure that men, women and children are given information on how to protect themselves from cholera and are mobilised to take action to reduce the risk of cholera
Objectives: Define objectives for each different target group
Indicators: Select 3 indicators ONLY based on priority actions outlined below. For example:
At least 25% increase in hand-washing after defaecation and before preparing or eating food, within 4 months (in target group).
At least 25% increase in use of HHWTSS, (household water treatment and safe storage) within 4 months (where promoted)
At least 25% increase in knowledge of 3 key actions to prevent cholera, within 4 months in target group
Target Group / Key messages /concepts/actions desired / Communication methods & locations / Communicators/ person responsible /Primary Target Audience[1] / The primary target audience is at the heart of your communication efforts. The success of the hygiene communication will be measured by change or action in this group.
General Community / General information in fact sheet:
Cholera is spreading through consumption of contaminated food or water / made dirty by vibrio cholerae.
Normally the disease is spread by not observing sanitation and hygiene principles.
Absence of clean environment or a sick person contaminates water and food, in that way spreads disease to others who use that water or food.
1. Signs and symptoms of cholera
2. Mode of transmission
3. Location of treatment centres
4. Preventative & control measures: see below (personal hygiene, food, water, environmental sanitation & hygiene, home based care with ORS / fluids/ funeral safeguards)
a. Do not drink local brew during cholera outbreak
b. Do not hide a patient with cholera symptoms – take him/her immediately to the treatment centre
Your health is in your hands – wash your hands with soap and flowing water:
1. After helping someone who is sick
2. After visiting/using toilet
3. After touching child’s faeces (after cleaning child’s bottom)
4. Before eating and feeding a child
5. Before preparing/cooking food
6. Before breast feeding your child
Gatherings are contributing to spread of cholera
1. Avoid gatherings during cholera outbreak
2. It is not allowed to eat or drink at any gatherings e.g. at funerals or celebrations, weddings, open markets etc. during cholera outbreak
3. Bodies of people who have died of cholera are very infectious / Household information and leaflets/fact sheet
Information provided in mosque, church etc.
Information provided at community meetings, markets, bus station, bars and clubs, clinics etc.
National and local radio spots
Newspapers
Musical events
Mobile video units (note – could use experience of people severely affected by cholera in Pemba to prepare a video to influence others)
Public address system
Lamgambo
Mobile phones / Community based volunteers (e.g. CORPs, Red cross volunteers)
Shehias, religious leaders, Imams
Community leaders and committee members
Water user associations
Name radio stations and contacts
Clinic staff/ Environmental health officers
District health committees
Mothers (of young children) / What to do if you or your child has diarrhoea and vomiting:
1. Use ORS immediately made using safe water (boiled or treated with chlorine)
2. In case you don’t have ORS drink plenty of safe water
3. Immediately go to the nearest health facility while drinking safe water on the way
4. Dirty clothes from the cholera patient should be washed in disinfectant /chlorine or boiled
Only drink safe water:
1. All drinking water should be boiled or treated with chlorine
Be very careful with food:
1. Do not eat fruits without washing: fruits should be cleaned with safe flowing water before eating
2. Food should be well cooked and eaten while hot
3. Don’t eat cold leftovers – reheat all food well
Feed your child safely:
1. A child under 6 months should be exclusively breast fed and should stay with the mother as far as she is conscious
2. Cholera does not spread by breast feeding, mother’s milk is always very safe for a child even if a mother is having cholera
3. For a child above 6 months should not be given cold food, heat it thoroughly
Your health is in your hands – keep them clean:
1. Wash your hands with soap:
· After using a latrine
· After cleaning child’s bottom
· Before eating and before feeding a child
· Before preparing food
· Before breastfeeding
2. Do not wash hands in the same water / bowl
Dispose of faeces safely:
1. Use a toilet properly
2. Construct and use latrine if you don’t have one
3. If you have not completed construction of a toilet bury your faeces (child’s and adult)
4. Make sure a toilet is always clean / Household visits
Information given by outreach workers and volunteers at women’s group meetings
Information and leaflets provided at clinic / TRCS, CHW, TBAs
NGOs, extension workers
Nurses and doctors
Religious leaders
Primary School Children / 1. If you see a pupil vomiting and diarrhoea, immediately give ORS (mixture of salt and sugar), take him/her to the nearest treatment centre
2. Yes – as a precaution we are required to always drink safe water boiled or treated
3. Be careful with foods-don’t eat cold or open food
4. It is essential to use toilet when you are at school and at home. Toilets should be kept clean, to protect spread cholera by flies from the toilet
5. Wash hands with clean water and soap after visiting toilet or after playing and before eating.
6. You should also wash your hands if you help to feed a young child or change his/her nappy or after helping a sick person
7. No - you should not eat fruits that are not washed well
8. Don’t touch vomit, spread chlorine to protect spread of bacteria, take the patient to treatment centre while giving him/her ORS (mixture of sugar and salt) or safe water on the way.
9. Yes - you must inform the teacher as soon as possible / Include in school lessons and assembly
Information: posters / flyers on school notice boards and other prominent places
Drama
Competitions, games
Music
Children’s councils
Peer educators
Information given at parent groups
Madrassas and Sunday schools / Teachers
Environmental health staff. TRCS staff and volunteers
NGOs working with children
Shehias, religious leaders, Imams
Secondary School Children / 1. As above
2. Spread the word and help protect your family and community / Leaflets, booklets
Peer educators / MOE
Food & Fruit Vendors / Do not contribute to spread of cholera
If your customer dies of cholera to whom will you sell tomorrow?
Maintain good health of your customer
1. Clean utensils with hot water and soap
2. Keep utensils clean
3. Serve only boiled or treated water for drinking or making juices,
4. Serve hot food,
5. Keep special hand-washing facility with soap for your customers,
6. Wash hands with soap after visiting toilet and before preparing food,
7. Prepare food in clean environment
8. Wash fruits and vegetables that are eaten raw with safe water
9. Sell unpeeled and unsliced fruits / Fact sheets
Rapid orientation/training and certification system? / Environmental health officers
Market inspectors
Community volunteer
Water Vendors / Sell clean and safe water (a vendor who cares for his customers sells them safe water, sells water from safe source)
1. Collect water from safe sources
2. Keep the surroundings of the water source in clean and hygienic condition, avoid haphazard spilling of water
3. Do not allow buckets or containers to be contaminated through poor drainage or putting buckets inside each other
4. Wash your hands with soap before fetching / collecting water
5. Use appropriate water storage and clean containers regularly with soap and water
6. Water containers should be cleaned regularly
7. Advise your customers to boil all water or treat it with chlorine during a cholera outbreak, as any water can be contaminated, even if it looks clean
Depending on the source:
1. Chlorinate water source & monitor the chlorine residual / Fact sheets
Rapid orientation
Public address / EHOs
Water department
NGOs
Other (i.e. identified as a result of ongoing assessment during response)
Secondary Target Audiences[2] / The secondary target audience is in a position to influence the primary target audience. The above message/actions/concepts will also apply to the secondary target audiences but additional messages may also be important
Teachers / 1. You can make a difference in the cholera outbreak
2. Diarrhoea and cholera are responsible for the loss of hundreds of millions of school days every year; handwashing with soap can reduce diarrheal disease by nearly half.
3. The handwashing habits you teach in school will last a lifetime.
4. You can easily include handwashing with soap in many lessons.
5. Making HW stations is a good activity for school children and can influence their families. / Teacher training and in-service education / MoE
Religious Leaders / 1. You can make a difference in the cholera outbreak
2. Many religious faiths call for washing and cleanliness before prayer or during other religious rituals; only hands that have been washed with soap are truly clean.
3. The health of your congregants, particularly the children among them, is imperilled by lack of handwashing with soap.
4. One million lives could be saved each year through handwashing with soap?? / Briefing/orientation /leaflets at religious conventions
Local meetings / MOHSW
Youth groups/women’s groups etc. / 1. You can make a difference in the cholera outbreak
2. Spread the word on simple precautions you and your members can take
3. Handwashing with soap can reduce diarrheal disease by nearly half.
4. Include information about handwashing in your usual activities.
5. Make sure you provide handwashing facilities and use running water and soap at youth clubs or meeting venues. / MOHSW
Journalists, radio and TV producers / 1. Key facts about cholera prevention and control addressing myths, beliefs and practices
2. Signs and symptoms
3. Mode of transmission