Establishing evidence for common-but-underresearched WASH cholera interventions

Lead organisation: Tufts University

Partnering organisations: IFRC, MSF, Solidarites and AIDES

Study locations: Democratic Republic of Congo, Bangladesh & Haiti

Principal Investigator: Daniele Lantagne


The purpose of this research is to establish the laboratory efficacy and field effectiveness of under-researched, on-going public health interventions commonly implemented to prevent cholera transmission in humanitarian crises, including: 1) household spraying; 2) distribution of household disinfection kits; and, 3) bucket chlorination. Currently, these interventions are widely implemented in cholera response activities. However, these interventions lack both the fundamental laboratory data on efficacy (e.g. when you spray chlorine on a surface with Vibrio cholerae on it, is the bacteria inactivated?) and field effectiveness (e.g. how effective are programs as implemented in emergency response). This research will fill these evidence gaps using laboratory research methods and mixed-methods field research, including household surveys, key informant interviews, focus group discussions, water quality testing, and household surface testing.

Expected outcomes:

In the absence of evidence, current consensus is household spraying is not likely efficacious, and household disinfection kits should be distributed instead. However, what should be included in kits and how to train recipients is unknown. Additionally, bucket chlorination is thought to be efficacious, but there are concerns with chlorine concentration, dosage, and maintenance of residual in households. Our outcomes will include:
- If household spraying can be efficacious at inactivating Vibrio cholerae on household surfaces, and if so, what chlorine concentration should be used and what household surfaces should be prioritized for spraying.
- What items should be included in a household disinfection kit and what is necessary to ensure kits are effectively used by recipients.
- If bucket chlorination is efficacious and effective at inactivating Vibrio cholerae, including necessary chlorine concentrations and dosages. These results can be used to prioritize efficacious and effective interventions to reduce cholera transmission.


Elrha is a registered charity in England and Wales (1177110).

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