Household Water Treatment Uptake during a Public Health Response to a Large Typhoid Fever Outbreak in Harare, Zimbabwe


Maho ImanishiPatience F. KwezaRachel B. SlaytonTanaka Urayai,Odrie ZiroWellington MushayiMonica Francis-Chizororo,Lazarus R. KuonzaTracy AyersMolly M. FreemanEmmaculate Govore,Clemence DuriProsper ChonziSekesai Mtapuri-Zinyowera,Portia ManangaziraPeter H. KilmarxEric MintzDaniele Lantagnethe Zimbabwe Typhoid Fever Outbreak Working Group 2011–2012.


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.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, the U.S. Agency for International Development, and the U.S. Government.

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