Table 4. Twenty consistently recommended WASH interventions for cholera prevention and control.
| Recommendation |
Total (n) |
WHO, 2004 | Oxfam, 2012 | ACF, 2013 |
UNICEF, 2013 | MSF, 2017 |
Sphere, 2018 |
ICDDR’B, 2018 |
GTFCC, 2019 | Transmission domain |
|---|---|---|---|---|---|---|---|---|---|---|
| Improving the access to water sources and/or quantity of water | ||||||||||
| Assessment and mapping of existing water sources (i.e. availability, types, access, quantity of water, risks of contamination) | 8 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | Household/ Community |
| Installation or repair of temporary or permanent improved water sources (e.g. boreholes, protected wells, protected hand pumps, protected springs, water tankers, water distribution systems including taps to households or public spaces and/or protection of the water source) | 7 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | × | ✓ | Household/ Community |
| Improving the quality of water: water treatment at source | ||||||||||
| A free residual chlorine (FRC) concentration of >0.5mg/l measured at source | 8 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | Community |
| Highly turbid water, at source, should not be chlorinated and filtration, coagulation-flocculation or other pre-treatments should be used to reduce turbidity before treatment | 7 | ✓ | ✓ | ✓ | × | ✓ | ✓ | ✓ | ✓ | Community |
| Bulk or batch chlorination of water sources (e.g. in-line chlorination of water distribution systems, temporary bladders, water tanks and trucking), with dosage determined by jar tests | 7 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | × | Community |
| Improving the quality of water: point of use (POU) and safe storage | ||||||||||
| Promotion of household water treatment products/technologies | 8 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | Household |
| Distribution of household water treatment products/technologies | 7 | × | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | Household |
| Promotion of cleaning, coverage and/disinfection of safe water storage containers | 7 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | × | ✓ | Household |
| Highly turbid water, at point of use, should not be chlorinated and filtration, coagulation-flocculation or other pre-treatments should be used to reduce turbidity before treatment | 7 | ✓ | ✓ | ✓ | × | ✓ | ✓ | ✓ | ✓ | Household |
| Monitoring of water quality at the household | 7 | × | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | Household |
| Behaviour change interventions to improve personal, domestic and food hygiene practices | ||||||||||
| Promotion of handwashing after defecation, before eating, before preparing food, before feeding a child, after cleaning a child's faeces and after contact with a cholera case | 8 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | Household |
| Promotion of safe water collection, treatment and storage (e.g. for drinking and cooking) | 7 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | × | ✓ | Household |
| Promotion of safe food preparation, cooking and storage (e.g. covering food to avoid flies and contamination, promotion of breastfeeding) | 7 | ✓ | ✓ | × | ✓ | ✓ | ✓ | ✓ | ✓ | Household |
| Promotion of safe defecation practices (e.g. no open defecation, use of latrines, cleaning of latrines, safe disposal of child faeces) | 7 | ✓ | ✓ | × | ✓ | ✓ | ✓ | ✓ | ✓ | Household/ Community |
| Hygiene promotion through house-to-house visits or community meetings | 7 | × | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | Household/ Community |
| Hygiene promotion and cholera awareness using mass media (e.g. radio, television, SMS, social media) | 8 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | Household/ Community |
| Distribution of hygiene materials or non-food items (NFIs) | ||||||||||
| Distribution of soap to households | 7 | × | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | Household |
| Installation of handwashing points in public places (e.g. markets, schools, public toilets) | 7 | × | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | Household/ Community |
| Promotion and distribution of disinfection and cleaning of households and community spaces and/or distribution of materials | ||||||||||
| Promotion of safe laundry practices, including disinfection of clothes and bedding of cholera cases with chlorine, boiling for 5 minutes or drying in the sun; alternatively burn or bury with the deceased | 7 | ✓ | × | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | Household |
| Improving dead body management and safe funeral practices | ||||||||||
| Disinfection of corpses with chlorine, and fill mouth and anus with cotton wool soaked in chlorine | 7 | ✓ | ✓ | ✓ | ✓ | ✓ | × | ✓ | ✓ | Household/ Community |
✓ - Present in guideline; × - Not found in guideline; “Household” and “Community” denote the two levels of cholera transmission and where WASH interventions would be implemented and used; WHO- World Health Organization, MSF- Médecins Sans Frontières, ICDDR’B- International Centre for Diarrhoeal Disease Research Bangladesh, ACF- Action Contre la Faim, UNICEF- United Nations Children’s Fund, GTFCC- Global Task Force on Cholera Control