Cholera prevention in Ecuador : community-based approaches for behavior change

The study developed a health intervention model -- Community-Based Participatory Intervention (CPI) -- to train two state-based Regional Teams, who in turn trained four Community Teams; in all, 55 people were trained in the use of the CPI model. The Community Teams analyzed local beliefs and behaviors, with a focus on three core behavioral clusters: (1) the quality of stored- or piped-in water; (2) washing and drying of hands and washing of food and dishes; and (3) disposal of excreta. The Teams also worked with community members to design interventions. All four communities chose to secure household water tanks; develop a community health education campaign aimed at water storage and maintenance and cleaning of water tanks; and disseminate information about infectious disease. The activity produced a core of committed national and regional professionals (and NGO staff) who are experienced in using the community-based model, a replicable methodology for community-based research, public health interventions designed and monitored by the communities themselves, a manual on latrine use and maintenance, health education activities focusing on infectious disease, and a brief video on the CPI process. The impact of this behavioral change effort on cholera incidence will be monitored through direct data -- how many cases of cholera appear in the four communities within a set time period. Behavioral change indicators will also be used -- quality of water and its storage, handwashing and other food preparation issues, and household and personal defecation patterns. (Author abstract, modified)