1. 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.

2. 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.

3. 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.

5. 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.

6. WATER AND SANITATION

7. 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.

8. 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.

9. 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.

10. 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.

11. KNOWLEDGE AND PRACTICES

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

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. DISTRIBUTIONS

19. 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.

20. FREE CHLORINE LEVELS

21. 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.

22. 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.

23. 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.

24. 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.

25. 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.

26. 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.