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Social mobilization is an important component of the delivery of vaccines and has to be carried out at different levels. It plays a very critical role in success of a campaign, as was shown by the Polio eradication program in India that was supported by SMNet, a platform created for the purpose. Learnings from this has been used for other vaccine deployments in India as well. In addition, there is a social mobilization effort for routine immunization. A guideline for social mobilization was created by UNICEF specifically for cholera vaccine use during Haiti epidemic in 2010. Since there is a need to develop a roadmap for cholera control in India, especially in the known hotspots, and after natural disasters, we suggest a possible strategy that could be built on the existing framework available in India.

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BACKGROUND: To assess the effectiveness of the cholera prevention activities of the Peruvian Ministry of Health, we conducted a knowledge, attitudes, and practices (KAP) survey in urban and rural Amazon communities during the cholera epidemic in 1991. METHODS: We surveyed heads of 67 urban and 61 rural households to determine diarrhoea rates, sources of cholera prevention information, and knowledge, attitudes, and practices regarding ten cholera prevention measures. RESULTS: Twenty-five per cent of 482 urban and 11% of 454 rural household members had diarrhoea during the first 3-4 months of the epidemic. Exposure to mass media education was greater in urban areas, and education through interpersonal communication was more prevalent in rural villages. Ninety-three per cent of rural and 67% of urban respondents believed they could prevent cholera. The mean numbers of correct responses to ten knowledge questions were 7.8 for urban and 8.2 for rural respondents. Practices lagged behind knowledge and attitudes (mean correct response to ten possible: urban 4.9, rural 4.6). Seventy-five per cent of respondents drank untreated water and 91% ate unwashed produce, both of which were identified as cholera risk factors in a concurrently conducted case-control study. CONCLUSIONS: The cholera prevention campaign successfully educated respondents, but did not cause many to adopt preventive behaviours. Direct interpersonal education by community-based personnel may enhance the likelihood of translating education into changes in health behaviours. Knowledge, attitudes, and practices surveys conducted with case-control studies during an epidemic can be an effective method of refining education/control programmes.

PIP: The authors conducted a knowledge, attitudes, and practices (KAP) survey in urban and rural Amazon communities during the 1991 cholera epidemic to assess the effectiveness of the Peruvian Ministry of Health's cholera prevention activities. Diarrhea rates, sources of cholera prevention information, and knowledge, attitudes, and practices regarding 10 cholera prevention measures were determined by surveying the heads of 67 urban and 61 rural households. 25% of 482 urban and 11% of 454 rural household members had diarrhea during the first 3-4 months of the epidemic. Exposure to mass media education was greater in urban areas, while education through interpersonal communication prevailed in rural villages. 93% of rural and 67% of urban respondents believed they could prevent cholera. Rural respondents were slightly more knowledgeable than urban respondents about cholera. Overall, however, practices did not reflect their knowledge and attitudes; 75% of respondents drank untreated water and 91% ate unwashed produce.

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RESUMO

Since 1984, in Latin America donor agencies and national governments have extensively supported the implementation of the Community Oral Rehydration Units (CORUs) in an attempt to increase the access to oral rehydration therapy and improve the case management of diarrhoea at the community level. This study surveyed 40 CORUs in two regions of Peru to assess their operation, the number of patients with diarrhoea attended, and the knowledge of volunteers in charge. The results show that CORUs were mainly implemented close to existing health centres; the median of case load was 2.0 patients in the preceding month; and the volunteers' knowledge of case management was principally deficient in the diagnosis of hydration status, dietary management and in preventive measures. This lack of knowledge was replicated by professionals at the supervising health centres. Despite the fact that CORUs have been functioning for around four years, they exhibit numerous deficiencies which prevent them from fulfilling their objectives. A global review of the whole CORU strategy is called for.

PIP: In Peru, an evaluation of 20 health centers and 40 community oral rehydration units (CORUs) in southern Lima and the Sullana region (northern Peru) was done to determine the number of diarrhea cases attended by CORUs, the knowledge of the volunteers in charge, and the quality of care provided by these services. Data were collected during April-May 1991, in the middle of the cholera epidemic in Peru. 80% of health centers and 79% of CORUs had oral rehydration salts (ORS) available. 63% of these health centers stored the ORS sachets appropriately compared to just 48% of the CORUs. Health professionals caring for diarrhea cases at health centers included auxiliaries (40%), physicians (34%), and nurses (17%). Most of the CORUs (61%) were in an urban area. Urban CORUs were closer to the nearest health center than rural CORUs (1 vs. 3 km; p = 0.003). The close proximity of urban CORUs to health centers works against the CORU strategy to improve coverage of diarrhea cases and access to ORS. Almost all diarrhea cases at the CORUs had no signs of dehydration, but most received ORS solution anyhow. In fact, only 10% of CORU volunteers and 7% of health workers at the centers looked for key signs of dehydration. A CORU volunteer even referred such a case (a child) to the next level. 85% of volunteers knew how to manage complications, while just 55% of health professionals did. Few volunteers and health professionals recommended breast feeding during a diarrhea episode (38% and 41%, respectively). About 25% of both groups knew about proper dietary management. The low knowledge levels suggest failures in training activities. Only 48% of CORUs received supervision from health center based health professionals the during the last month. CORUs did not maintain records of CORU activities (e.g., number of ORS sachets distributed) which made it difficult to monitor and evaluate the performance of CORUs.

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