Influence of Seasonal Hazards on Water, Sanitation, and Hygiene–Related Behavior and Implications for Cholera Transmission in Bangladesh

Stephen Lawrence Grant Copenhagen Center for Disaster Research, Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark;

Search for other papers by Stephen Lawrence Grant in
Current site
Google Scholar
PubMed
Close
,
Sina Lange Copenhagen Center for Disaster Research, Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark;

Search for other papers by Sina Lange in
Current site
Google Scholar
PubMed
Close
,
Sara Almeida Copenhagen Center for Disaster Research, Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark;

Search for other papers by Sara Almeida in
Current site
Google Scholar
PubMed
Close
,
Bilqis Hoque Environment and Population Research Centre, Dhaka, Bangladesh

Search for other papers by Bilqis Hoque in
Current site
Google Scholar
PubMed
Close
, and
Peter Kjær Mackie Jensen Copenhagen Center for Disaster Research, Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark;

Search for other papers by Peter Kjær Mackie Jensen in
Current site
Google Scholar
PubMed
Close
Restricted access

ABSTRACT.

Most cholera outbreaks in Bangladesh are seasonal, peaking in the dry and post-monsoon periods. Therefore, we investigated whether changes in water, sanitation, and hygiene (WASH) behavior in three populations in Bangladesh during the year could help explain why these two periods are particular to cholera transmission. The study used a mixed-method design, including a repeated cross-sectional study, focus group discussions, and key informant interviews. Through a repeated cross-sectional study, WASH-related variables were assessed during the dry, monsoon, and control seasons in 600 households from coastal Satkhira, inland Sirajganj, and the Dhaka slums. Seasonal behavioral changes were observed in all study areas. Dhaka and Satkhira had an increased mean distance to water sources during the dry and monsoon seasons (Dhaka: control season, 12 m [95% CI, 11–13]; dry season, 36 m [95% CI, 18–55]; and monsoon season, 180 m [95% CI, 118–243]; Satkhira: control season, 334 m [95% CI, 258–411]; dry season, 669 m [95% CI, 515–822]; and monsoon season, 2,437 m [95% CI, 1,665–3,209]). The participants attributed this to pollution of the usual water source. Perceived water quantity was lowest during the dry season in Dhaka and Sirajganj, and during the monsoon season in Satkhira. Handwashing with soap declined in all areas during the dry and monsoon seasons. Open defecation was frequent among children younger than 5 years, increasing during seasonal climate hazards. Results show that WASH-related behavior changed seasonally, increasing the risk of cholera transmission through multiple hygiene-related transmission pathways. Future research would benefit by ensuring that the length of studies covers all seasons throughout the year and also by looking in more detail at people’s behavior and hygiene practices.

Author Notes

Address correspondence to Peter Kjær Mackie Jensen, Copenhagen Center for Disaster Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5a, Bldg. 22, 1353 Copenhagen, Denmark. E-mail: mackie@sund.ku.dk

Financial support: This work was funded by the University of Copenhagen Star program and DANIDA, the Danish foreign ministry (FFU grant no. 12-040KU).

Disclosure: Study participation was voluntary. All respondents gave informed consent and were free to withdraw from the study at any time. Ethical clearance was provided by the Environment and Population Research Center Executive Committee in Bangladesh and the Bangladesh NGO Bureau.

Authors’ addresses: Stephen Lawrence Grant, Sina Lange, Sara Almeida, and Peter Kjær Mackie Jensen, Copenhagen Center for Disaster Research, Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark, E-mails: sgrant@generalmail.com, kcz584@alumni.ku.dk, sdsa@sund.ku.dk, and mackie@sund.ku.dk. Bilqis Hoque, Environment and Population Research Centre, Dhaka, Bangladesh, E-mail: bilqishaka@yahoo.com.

  • 1.

    Sack RB et al., 2003. A 4-year study of the epidemiology of Vibrio cholerae in four rural areas of Bangladesh. J Infect Dis 187: 96101.

  • 2.

    Akanda AS , Jutla AS , Islam S , 2009. Dual peak cholera transmission in Bengal Delta: a hydro climatological explanation. Geophys Res Lett 36: 96101.

  • 3.

    Wolf J et al., 2014. Assessing the impact of drinking water and sanitation on diarrhoeal disease in low- and middle-income settings: systematic review and meta-regression. Trop Med Int Health 19: 928942.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Huq A , Colwell RR , Rahman R , Ali A , Chowdhury MA , Parveen S , Sack DA , Russek-Cohen E , 1990. Detection of Vibrio cholerae O1 in the aquatic environment by fluorescent-monoclonal antibody and culture methods. Appl Environ Microbiol 56: 23702373.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Colwell RR , Huq A , 2001. Marine ecosystems and cholera. Hydrobiologia 460: 141145.

  • 6.

    Palit A , Batabyal P , 2010. Toxigenic Vibrio cholerae from environmental sources associated with the cholera outbreak after “AILA” cyclone in West Bengal, India. Lett Appl Microbiol 51: 241243.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Msyamboza KP , Kagoli M , M’bang’ombe M , Chipeta S , Masuku HD , 2014. Cholera outbreaks in Malawi in 1998–2012: social and cultural challenges in prevention and control. J Infect Dev Ctries 8: 720726.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Kirpich A , Weppelmann TA , Yang Y , Ali A , Morris JG , Longini IM , 2015. Cholera transmission in Ouest Department of Haiti: dynamic modeling and the future of the epidemic. PLoS Negl Trop Dis 9: e0004153.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Zaman K et al., 2020. Can cholera “hotspots” be converted to cholera “coldspots” in cholera endemic countries? The Matlab, Bangladesh experience. Int J Infect Dis 95: 2831.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Wagner EG , Lanoix JN , 1958. Excreta Disposal for Rural Areas and Small Communities. Available at: https://apps.who.int/iris/handle/10665/41687. Accessed December 14, 2022.

    • PubMed
    • Export Citation
  • 11.

    Ferdous J , Sultana R , Rashid RB , Tasnimuzzaman M , Nordland A , Begum A , Jensen PKM , 2018. A comparative analysis of Vibrio cholerae contamination in point-of-drinking and source water in a low-income urban community, Bangladesh. Front Microbiol 9: 489.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Dunkle SE et al., 2011. Epidemic cholera in a crowded urban environment, Port-au-Prince, Haiti. Emerg Infect Dis 17: 21432146.

  • 13.

    Mahamud AS et al., 2012. Epidemic cholera in Kakuma Refugee Camp, Kenya, 2009: the importance of sanitation and soap. J Infect Dev Ctries 6: 234241.

  • 14.

    Brown J , Cairncross S , Ensink JHJ , 2013. Water, sanitation, hygiene and enteric infections in children. Arch Dis Child 98: 629634.

  • 15.

    Gidado S , Awosanya E , Haladu S , Ayanleke HB , Idris S , Mamuda I , Mohammed A , Michael CA , Waziri NE , Nguku P , 2018. Cholera outbreak in a naïve rural community in northern Nigeria: the importance of hand washing with soap, September 2010. Pan Afr Med J 30: 5.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Zohura F et al., 2016. Observed handwashing with soap practices among cholera patients and accompanying household members in a hospital setting (CHoBI7 Trial). Am J Trop Med Hyg 95: 13141318.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Najnin N et al., 2017. Impact of adding handwashing and water disinfection promotion to oral cholera vaccination on diarrhoea-associated hospitalization in Dhaka, Bangladesh: evidence from a cluster randomized control trial. Int J Epidemiol 46: 20562066.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Luby SP , Gupta SK , Sheikh MA , Johnston RB , Ram PK , Islam MS , 2008. Tubewell water quality and predictors of contamination in three flood-prone areas in Bangladesh. J Appl Microbiol 105: 10021008.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Schwartz BS et al., 2006. Diarrheal epidemics in Dhaka, Bangladesh, during three consecutive floods: 1988, 1998, and 2004. Am J Trop Med Hyg 74: 10671073.

  • 20.

    Siddique A , Islam Q , Akram K , Mazumder Y , Mitra A , Eusof A , 1989. Cholera epidemic and natural disasters: where is the link? Trop Geogr Med 41: 377382.

  • 21.

    Grant SL , Tamason CC , Hoque BA , Jensen PKM , 2015. Drinking cholera: salinity levels and palatability of drinking water in coastal Bangladesh. Trop Med Int Health 20: 455461.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    van der Hoek W , Konradsen F , Ensink JH , Mudasser M , Jensen PK , 2001. Irrigation water as a source of drinking water: is safe use possible? Trop Med Int Health 6: 4654.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Hossain ZZ , Farhana I , Sultana R , Begum A , Jensen PKM , 2018. Fecal contamination hotspots in low-income households in Bangladesh. Int J Infect Dis 73: 55.

  • 24.

    Blanton E et al., 2015. A rapid assessment of drinking water quality in informal settlements after a cholera outbreak in Nairobi, Kenya. J Water Health 13: 714725.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Rashid M-U et al., 2016. Chlorination of household drinking water among cholera patients’ households to prevent transmission of toxigenic Vibrio cholerae in Dhaka, Bangladesh: CHoBI7 trial. Am J Trop Med Hyg 95: 12991304.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Grant SL , 2019. Exploring the Influence of Seasonal Hazards on Cholera Transmission Routes in the Light of Climate Change and the Climate Change Narrative in Bangladesh. Copenhagen, Denmark: University of Copenhagen.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Farhana I , Hossain ZZ , Tulsiani SM , Jensen PKM , Begum A , 2016. Survival of Vibrio cholerae O1 on fomites. World J Microbiol Biotechnol 32: 146.

  • 28.

    Lindeberg YL , Egedal K , Hossain ZZ , Phelps M , Tulsiani S , Farhana I , Begum A , Jensen PKM , 2018. Can Escherichia coli fly? The role of flies as transmitters of E. coli to food in an urban slum in Bangladesh. Trop Med Int Health 23: 29.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Jensen PKM , Grant SL , Perner ML , Hossain ZZ , Ferdous J , Sultana R , Almeida S , Phelps M , Begum R , 2020. Historical and contemporary views on cholera transmission: are we repeating past discussions? Can lessons learned from cholera be applied to COVID-19? Acta Pathol Microbiol Immunol Scand 129: 421430.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 1457 694 98
Full Text Views 250 110 1
PDF Downloads 149 17 3
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save