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.

Figure 1.

Map of Harare, Zimbabwe, showing total number of confirmed and suspected cases of typhoid fever by suburbs, October 1, 2011–April 30, 2012 (N = 4,002*).

Figure 2.

Total number of confirmed and probable cases of typhoid fever in Harare, Zimbabwe, by suburb and month of illness onset, and the timing of typhoid fever prevention campaigns and the survey, October 1, 2011–April 30, 2012 (N = 4,181).

Figure 3.

Presence and free chlorine residual (FCR) of stored drinking water on the day of unannounced visit, Dzivaresekwa and Kuwadzana suburbs, Harare, Zimbabwe, March 2012.