title: Household water treatment uptake during a public health response to a large typhoid fever outbreak in Harare, Zimbabwe.
abstract: Locally manufactured sodium hypochlorite (chlorine) solution has been sold in Zimbabwe since 2010. During October 1, 2011-April 30, 2012, 4,181 suspected and 52 confirmed cases of typhoid fever were identified in Harare. In response to this outbreak, chlorine tablets were distributed. To evaluate household water treatment uptake, we conducted a survey and water quality testing in 458 randomly selected households in two suburbs most affected by the outbreak. Although 75% of households were aware of chlorine solution and 85% received chlorine tablets, only 18% had reportedly treated stored water and had the recommended protective level of free chlorine residuals. Water treatment was more common among households that reported water treatment before the outbreak, and those that received free tablets during the outbreak (P < 0.01), but was not associated with chlorine solution awareness or use before the outbreak (P > 0.05). Outbreak response did not build on pre-existing prevention programs.
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts.
authors.forename: Maho
authors.initials: M
authors.lastname: Imanishi
authors.forename: Patience F
authors.initials: PF
authors.lastname: Kweza
authors.forename: Rachel B
authors.initials: RB
authors.lastname: Slayton
authors.forename: Tanaka
authors.initials: T
authors.lastname: Urayai
authors.forename: Odrie
authors.initials: O
authors.lastname: Ziro
authors.forename: Wellington
authors.initials: W
authors.lastname: Mushayi
authors.forename: Monica
authors.initials: M
authors.lastname: Francis-Chizororo
authors.forename: Lazarus R
authors.initials: LR
authors.lastname: Kuonza
authors.forename: Tracy
authors.initials: T
authors.lastname: Ayers
authors.forename: Molly M
authors.initials: MM
authors.lastname: Freeman
authors.forename: Emmaculate
authors.initials: E
authors.lastname: Govore
authors.forename: Clemence
authors.initials: C
authors.lastname: Duri
authors.forename: Prosper
authors.initials: P
authors.lastname: Chonzi
authors.forename: Sekesai
authors.initials: S
authors.lastname: Mtapuri-Zinyowera
authors.forename: Portia
authors.initials: P
authors.lastname: Manangazira
authors.forename: Peter H
authors.initials: PH
authors.lastname: Kilmarx
authors.forename: Eric
authors.initials: E
authors.lastname: Mintz
authors.forename: Daniele
authors.initials: D
authors.lastname: Lantagne
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002713:Chlorine / Q000494:pharmacology; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks / Q000517:prevention & control*; D060766:Drinking Water; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011634:Public Health; D011795:Surveys and Questionnaires; D014435:Typhoid Fever / Q000453:epidemiology* / Q000517:prevention & control*; D018508:Water Purification / Q000379:methods*; D014881:Water Supply; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology
chemical_list: D060766:Drinking Water; D002713:Chlorine