Haiti's progress in achieving its 10-year plan to eliminate cholera: hidden sickness cannot be cured

Abstract

Since the beginning of the cholera epidemic in Haiti 5 years ago, the prevalence of this deadly water-borne disease has fallen far below the initial rates registered during its explosive outset. However, cholera continues to cause extensive suffering and needless deaths across the country, particularly among the poor. The urgent need to eliminate transmission of cholera persists: compared to the same period in 2014, the first 4 months of 2015 saw three times the number of cholera cases. Drawing upon epidemiology, clinical work (and clinical knowledge), policy, ecology, and political economy, and informed by ethnographic data collected in a rural area of Haiti called Bocozel, this paper evaluates the progress of the nation’s 10-year Plan for the Elimination of Cholera. Bocozel is a rice-producing region where most people live in extreme poverty. The irrigation network is decrepit, the land is prone to environmental shocks, fertilizer is not affordable, and the government’s capacity to assist farmers is undermined by resource constraints. When peasants do have rice to sell, the price of domestically grown rice is twice that of US-imported rice. Canal water is not only used to irrigate thousands of acres of rice paddies and sustain livestock, but also to bathe, wash, and play, while water from wells, hand pumps, and the river is used for drinking, cooking, and bathing. Only one out of the three government-sponsored water treatment stations in the research area is still functional and utilized by those who can afford it. Latrines are scarce and often shared by up to 30 people; open defecation remains common. Structural vulnerabilities cut across all sectors – not just water, sanitation, health care, and education, but agriculture, environment, (global and local) commerce, transportation, and governance as well. These are among the hidden sicknesses that impede Haiti and its partners’ capacity to eliminate cholera.

Epidemiological and molecular forensics of cholera recurrence in Haiti

“…Our results remain relevant today and highlight the necessity to improve both the quality of epidemiological cholera surveillance 69 and the effectiveness of the struggle to limit cholera transmission in Haiti. Four years later, suspected cholera cases records have become more exhaustive in Haitian treatment institutions, even though cholera surveillance has still not been extended to the community level, as planned by the 2016–2018 mid-term development of the national plan for cholera elimination by the Haitian government 70 .…”

Household and Individual Risk Factors for Cholera among Cholera Vaccine Recipients in Rural Haiti

“…Our study highlights risk factors for cholera in a high-risk rural population that has received OCV, as well as some, but neither complete nor systematic water and sanitation interventions. 19 , 20 We found that among individuals vaccinated against cholera, consistent water treatment was a key factor in reducing the risk of cholera. Having a latrine as the main household toilet, as opposed to practicing open-air defecation, was a significant risk factor for cholera among this group.…”

“…19 Individual nongovernmental organizations constructed wells, established water purification stations, distributed water disinfection tablets, and built latrines. 20 …”

Laboratory evaluation of immunochromatographic rapid diagnostic tests for cholera in Haiti

“…[ 1 ] Epidemics such as that in Haiti have highlighted the debilitating impact of cholera on underserved regions already lacking the robust water, sanitation, and healthcare systems required to prevent and control outbreaks. [ 2 ] However, recent years have also brought significant advances in our understanding of the clinical and public health approaches to combat the disease. [ 3 ] The mobilization of these cholera control strategies ultimately depends on the timely and accurate identification of cholera cases.…”