Artibonite Department, Haiti DINEPA, CDC, ACTED, UNICEF A Survey of Knowledge, Attitudes, and Practices (KAP) Related to Cholera Treatment and Prevention Artibonite Department, Haiti DINEPA, CDC, ACTED, UNICEF 11/25/2010 * PRELIMINARY RESULTS. NOT TO BE DISSEMINATED. FURTHER ANALYSES ONGOING.

Background Artibonite Region Objectives Heavily affected by cholera outbreak 2 large scale control efforts: Hygiene education Hygiene kit distribution (ORS, soap, Aquatabs) Objectives Describe water treatment, hygiene and sanitation practices Evaluate penetration of cholera prevention messages Document receipt and proper use of distributions * PRELIMINARY RESULTS. NOT TO BE DISSEMINATED. FURTHER ANALYSES ONGOING.

Methods- Quantitative Multistage cluster survey Included Section Communales targeted for distributions 35 clusters selected population proportional to size St Marc urban area excluded from sampling Data collection (Nov 12 – Nov 19) 18 enumerators, 6 supervisors Goal 15 questionnaires per cluster (14-16) Completed 512 questionnaires 8 urban clusters, 26 rural clusters * PRELIMINARY RESULTS. NOT TO BE DISSEMINATED. FURTHER ANALYSES ONGOING.

Demographics Age (Mean ± SD), years 41.5 ± 14.9 People in house (median, IQR) 6 (4-8) Economic indicators, % Percent owning functioning radio 54.7 Percent owning TV 12.8 Percent owning cell phone 70.7 Education- literacy female head of household,% Reads Creole easily 25.0 Reads Creole with some difficulty 16.0 Cannot read Creole 59.0 All results are preliminary and not to be distributed. Based on unweighted results. Targeted female heads of households. * PRELIMINARY RESULTS. NOT TO BE DISSEMINATED. FURTHER ANALYSES ONGOING.

WATER AND SANITATION

Primary Water Source Since Cholera Outbreak % Piped water 33.0 Hand-dug well 20.3 Borehole with hand pump 12.3 Treated kiosk water 10.9 River water/canal 6.6 Community water filtration 5.8 Bottled or sachet water 1.8 Trucked Water 1.4 Other 8.0 * PRELIMINARY RESULTS. NOT TO BE DISSEMINATED. FURTHER ANALYSES ONGOING.

River Water Exposure Since Cholera Outbreak % Occasionally drinks river water 41.9 Swims, bathes, works or bathes in river 73.1 * PRELIMINARY RESULTS. NOT TO BE DISSEMINATED. FURTHER ANALYSES ONGOING.

Before cholera outbreak, % Since cholera outbreak, % Reported Water Treatment Practices Before and Since the Cholera Outbreak Water treatment Before cholera outbreak, % Since cholera outbreak, % P-value Boil 2.0 3.9 0.68 Filter 7.6 7.9 0.94 Chemical treatment (chlorine) 29.1 87.4 0.01 * PRELIMINARY RESULTS. NOT TO BE DISSEMINATED. FURTHER ANALYSES ONGOING.

Sanitation % Use of toilet 1.0 Latrine with cement slab 40.5 Latrine without cement slab 37.0 Plastic bag 2.3 Open defecation 19.8 * PRELIMINARY RESULTS. NOT TO BE DISSEMINATED. FURTHER ANALYSES ONGOING.

KNOWLEDGE AND PRACTICES

Preferred Sources of Information % 1. Radio 55 2. Truck with megaphone 19 3. Church 14 * PRELIMINARY RESULTS. NOT TO BE DISSEMINATED. FURTHER ANALYSES ONGOING.

Knowledge % Heard about cholera outbreak 99.4 Identifies diarrhea as a symptom of cholera 95.8 Reported ways cholera can be contracted1: Contaminated or untreated water 63.4 Contaminated or undercooked food 31.1 Contact with cholera patient 19.1 Reported ways of preventing cholera1: Boil or treat water 68.1 Wash hands with soap and water 71.8 * PRELIMINARY RESULTS. NOT TO BE DISSEMINATED. FURTHER ANALYSES ONGOING.

Reported Health Seeking Behavior % Would seek treatment immediately if had cholera 97.6 Time to nearest health center 0-30 minutes 57.7 31-60 minutes 28.4 > 60 minutes 13.9 Household member had cholera 27.0 (n=132) Affected member treated at CTC1 or hospital 89.3 (n=118) 1. Cholera Treatment Center * PRELIMINARY RESULTS. NOT TO BE DISSEMINATED. FURTHER ANALYSES ONGOING.

Reported Hand Washing Practices % Reports washing hands with soap or detergent 97.5 Reports washing hands with soap at the following times: Before eating 67.7 After using the latrine 64.6 * PRELIMINARY RESULTS. NOT TO BE DISSEMINATED. FURTHER ANALYSES ONGOING.

Knowledge and Practices Regarding ORS Reports knowing how to prepare correctly 322 64.8 (n=322) Of those who report knowing how to prepare, demonstrates how to prepare correctly 256 78.3 (n =256 ) * PRELIMINARY RESULTS. NOT TO BE DISSEMINATED. FURTHER ANALYSES ONGOING.

Knowledge and Practices Regarding Aquatabs Reports knowing how to use aquatabs 78.4 Taste Strong- I don’t like it 7.5 Some taste, but it’s fine 76.2 No taste 2.8 If available, would use to treat drinking water 97.8 * PRELIMINARY RESULTS. NOT TO BE DISSEMINATED. FURTHER ANALYSES ONGOING.

DISTRIBUTIONS

Received Distributions median (IQR) % with ≥ 1 remaining Received instructions (%) Received any distribution 55.5 X Soap (bars) 29.8 6 (5-15) 42.0 ORS (sachets) 36.8 3 (2-5) 77.8 83.1 Received Aquatabs (tabs) 51.6 50 (20-100) 76.2 87.8 PUR (sachets) 2.8 * PRELIMINARY RESULTS. NOT TO BE DISSEMINATED. FURTHER ANALYSES ONGOING.

FREE CHLORINE LEVELS

Measured Free Chlorine Levels None (0 mg/L) % Detectable chlorine (≥0.1 mg/L) All tested samples (n=411) 37.2 62.8 Reported chemical treatment of water tested (n=348) 29.6 73.4 HH having aquatabs (n=147) 27.2 72.8 * PRELIMINARY RESULTS. NOT TO BE DISSEMINATED. FURTHER ANALYSES ONGOING.

Methods- Qualitative 7 focus group discussions (FGDs) held in areas where distributions had reportedly been completed All FGD participants were female 5 key informant interviews Held at Saturday market in the St. Marc/Artibonite sub-region * PRELIMINARY RESULTS. NOT TO BE DISSEMINATED. FURTHER ANALYSES ONGOING.

Key Qualitative Findings Lack of resources was cited as the biggest obstacle to water treatment Impressions regarding distribution sessions varied widely Preferred methods of distribution Female-only distributions   Ticketed distributions * PRELIMINARY RESULTS. NOT TO BE DISSEMINATED. FURTHER ANALYSES ONGOING.

Conclusions Water sources variable Significant exposure to potentially unsafe water sources Reported rates of chemical treatment of water have increased Majority of respondents aware of cholera outbreak and symptoms of infection Challenges identified in distribution coverage Only 55% respondents reported receiving any distribution * PRELIMINARY RESULTS. NOT TO BE DISSEMINATED. FURTHER ANALYSES ONGOING.

Conclusions Significant demand for aquatabs Chlorine residuals Over 60% had evidence of free chlorine in tested water In HH with aquatabs, 27% had no evidence of free chlorine * PRELIMINARY RESULTS. NOT TO BE DISSEMINATED. FURTHER ANALYSES ONGOING.

Recommendations Further analysis of distributions are pending Institute monitoring of distributions Consider voucher system Test chlorine residuals Additional focus groups with people responsible for distributions to determine best practices (Agency, Casecs) * PRELIMINARY RESULTS. NOT TO BE DISSEMINATED. FURTHER ANALYSES ONGOING.