4.8 Health promotion strategies

4.8.1 General considerations

Health promotion activities are an integral part of outbreak control measures. As with other interventions, they target individuals directly affected by, or vulnerable to, cholera.

The key messages to convey as part of outbreak control are found in Section 3.8.3 and Appendix 4. The form and channels of communication depend on the context, mainly the type of setting (endemic/epidemic; urban/rural, etc.) and the sociocultural characteristics of the population (language, customs, habits, beliefs, education skills, etc.).

Household resources and living conditions must be taken into account when implementing health promotion activities. In terms of prevention, access to potable water and hygiene remain a priority. Health promotion activities complement these interventions but do not replace them. Distributions should be organized whenever necessary.

Health promotion activities are maintained throughout the duration of the epidemic. Strategy, target and/or messages may change according to the evolution of the epidemic or if the messages are not heeded or the impact of activities is not satisfactory.

4.8.2 Facility-based interventions

Health promotion activities are conducted in cholera treatment facilities for patients and attendants. They are usually carried out by a dedicated health promoter(s) in large facilities, and by the medical staff in smaller facilities.
All patients and attendants in a CTC, CTU or ORP should receive before discharge information on how to manage diarrhoea at home, use ORS and avoid new cases within the household. The patient should be given a few sachets of ORS, as well as some soap, on discharge so that he can follow the recommendations given.
If the household hygiene kits are given to the person accompanying the patient on admission (Section 3.4.4), the relevant instructions and recommendations must be explained to her/him.

4.8.3 Health promotion within the population

Health promotion activities are also conducted outside cholera treatment facilities by health promoters, under the responsibility of a health promotion manager (Appendix 20). In addition to their routine activities to prevent cholera and deaths due to cholera, these teams also participate in specific activities such as distributions (e.g., of soap in neighbourhoods or villages), mass vaccination campaigns, etc.
In rural areas where communities are widely dispersed it can be difficult, or even impossible, to set up centralised prevention and treatment (e.g. distribution of clean water, cholera treatment facilities) in the short or long term. Community or family management of prevention measures and treatment may be the best, or only, strategy possible. In these contexts, key messages on prevention of the illness and patient care also include explanations, and demonstrations, of measures to be used: home water treatment with or without extra resources (i.e. disinfection with chlorine tablets or boiling water) and in the absence of a treatment facility, the preparation, use and storage of ORS distributed.