Household knowledge, attitudes and practices regarding water treatment and water storage at baseline and follow-up, western Kenya, 2011 and 2012.

<p>Abbreviations: No. = Number, HCF = Health care facility, FRC = Free residual chlorine.</p><p>*For some items, N may vary by small numbers.</p><p>†P<0.05 by McNemar's test.</p><p>‡P<0.05 by exact test of binomial proportion.</p><p>§Improved drinking water sources include piped water, boreholes, public taps and protected wells or springs.</p><p>Household knowledge, attitudes and practices regarding water treatment and water storage at baseline and follow-up, western Kenya, 2011 and 2012.</p

Hand Washing Station.

<p>Hand Washing Station.</p

Drinking Water Station.

<p>Drinking Water Station.</p

Assessment of water, sanitation and hygiene interventions in response to an outbreak of typhoid fever in Neno District, Malawi

<div><p>On May 2, 2009 an outbreak of typhoid fever began in rural villages along the Malawi-Mozambique border resulting in 748 illnesses and 44 deaths by September 2010. Despite numerous interventions, including distribution of WaterGuard (WG) for in-home water treatment and education on its use, cases of typhoid fever continued. To inform response activities during the ongoing Typhoid outbreak information on knowledge, attitudes, and practices surrounding typhoid fever, safe water, and hygiene were necessary to plan future outbreak interventions. In September 2010, a survey was administered to female heads in randomly selected households in 17 villages in Neno District, Malawi. Stored household drinking water was tested for free chlorine residual (FCR) levels using the N,N diethyl-p-phenylene diamine colorimetric method (HACH Company, Loveland, CO, USA). Attendance at community-wide educational meetings was reported by 56% of household respondents. Respondents reported that typhoid fever is caused by poor hygiene (77%), drinking unsafe water (49%), and consuming unsafe food (25%), and that treating drinking water can prevent it (68%). WaterGuard, a chlorination solution for drinking water treatment, was observed in 112 (56%) households, among which 34% reported treating drinking water. FCR levels were adequate (FCR ≥ 0.2 mg/L) in 29 (76%) of the 38 households who reported treatment of stored water and had stored water available for testing and an observed bottle of WaterGuard in the home. Soap was observed in 154 (77%) households, among which 51% reported using soap for hand washing. Educational interventions did not reach almost one-half of target households and knowledge remains low. Despite distribution and promotion of WaterGuard and soap during the outbreak response, usage was low. Future interventions should focus on improving water, sanitation and hygiene knowledge, practices, and infrastructure. Typhoid vaccination should be considered.</p></div

Interventions received by village, as reported by village leadership, and number and percentage of surveyed household respondents who reported attendance at community educational meetings (“typhoid talks”), September, 2010.

<p>Interventions received by village, as reported by village leadership, and number and percentage of surveyed household respondents who reported attendance at community educational meetings (“typhoid talks”), September, 2010.</p

Household safe water, hygiene, and sanitation practices among survey respondents, Neno District, Malawi, September 2010.

<p>Household safe water, hygiene, and sanitation practices among survey respondents, Neno District, Malawi, September 2010.</p

Age category-adjusted matched odds ratios of selected exposures in case patients vs. controls.

†<p>Any exposure in the seven days before illness onset.</p

Frequency of selected case-series exposures in case patients vs. FoodNet population survey exposure.

†<p>Any consumption in the seven days prior to illness onset.</p>‡<p>Foodborne Diseases Active Surveillance Network (FoodNet) Population Survey Atlas of Exposures, 2006–2007 <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0055300#pone.0055300-Centers1" target="_blank">[6]</a>.</p

Epidemic curve of infections with the outbreak strain of STEC O157, by date of onset.

<p>Epidemic curve of infections with the outbreak strain of STEC O157, by date of onset.</p