Facilitator’s Guide: Workshop on Detection and Control of Epidemic Cholera

Since the 7th pandemic of cholera arrived in Africa in 1970, the disease has persisted in some areas as a persistent or endemic problem. In addition, large epidemics have claimed many lives. Because cholera can spread swiftly through a population, early detection of cases is necessary in order to start education and sanitation activities rapidly and to identify possible sources of infection. Training health care workers to recognize and treat cholera patients, maintaining a local reserve of rehydration supplies, and educating the public in ORS use and the need to seek treatment when diarrhea begins will avert many cholera deaths. When an epidemic of cholera does occur, many cases and deaths can be prevented if the epidemic is detected early, and if effective control measures are begun quickly. The course is designed to prepare district health personnel to detect epidemics of cholera early and to control epidemics effectively. District health personnel who attend the workshop and who carry out a series of self-study projects will learn about the epidemiology of cholera, learn how to detect epidemics of cholera, learn how to control epidemics of cholera, do projects to prepare the district for a cholera epidemic, evaluate their district's readiness to respond to an epidemic, and make an emergency response plan. The workshop is designed for district level public health personnel who have public health responsibility for a population of approximately 250,000 persons. These personnel are in the "front-line" in terms of detecting epidemics of cholera and they often are the most peripheral level at which an effective response can be mounted. Workshop participants should, in turn, train health workers in their own districts. Workshop facilitators should be public health or clinical experts who have had experience in responding to epidemics of cholera and who have experience in teaching. The participants in the workshop are district level personnel, so facilitators will usually be from the provincial, regional or national level. If facilitators and participants are from the same state or region, it will be easier for the facilitators to provide follow-up consultation and supervision. A Course Director will be in charge of most of the administrative arrangements and of overall planning for the workshop. All potential facilitators should attend the workshop themselves. They should work on the Self-Study Projects or thoroughly discuss them. Then, using the Facilitator's Guide, they should practice conducting the entire course -- several times, if possible. The facilitators should also be trained to handle any questions or concerns that may arise during the workshop. The workshop requires a significant amount of preparation, including selecting and inviting participants, arranging funding and accommodations, and preparing the workshop schedule and materials. The facilitators should also practice conducting the workshop and review the materials before the workshop begins. The workshop will cover a range of topics, including the epidemiology of cholera, detection and confirmation of epidemics, field investigation and calculation of attack rates, responding to a suspected or confirmed epidemic, health education, and being prepared for an epidemic. The workshop will use a variety of materials, including overhead projectors, flipcharts, chalkboards, and calculators. The participants will also receive a copy of the Guidelines for each participant, a copy of the Exercise Book for each participant, and a set of overhead transparencies for the workshop. The facilitators will also receive a copy of the Guidelines, the Exercise Book, and the Facilitator's Guide for each facilitator. The workshop will be conducted over several sessions, each with its own set of materials and preparations. The facilitators should practice the lectures and put the transparencies in order before each session. They should also review the calculations for the exercises and determine the primary and secondary threshold rates for each of the participant's districts. The facilitators should also obtain the name and address of the person(s) who should be notified of suspected cases and epidemics, as well as the name and address of the laboratory to which health facilities in the district should send specimens for confirmation of cholera.