# A Ring Water, Sanitation, and Hygiene Intervention to Reduce Cholera in Hotspots in Bangladesh

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2021 · $645,281

## Abstract

PROJECT SUMMARY
Background: Worldwide there are estimated to be 2.9 million cholera cases annually. Effective targeted water,
sanitation, and hygiene (WASH) interventions are urgently needed to reduce cholera globally. Our study in
Bangladesh found that individuals living within 50 meters of a cholera patient were at 30 times higher risk of
developing cholera than the general population during the first week after the index patient sought care at a
health facility. However, there has been little work done to develop and evaluate interventions for this high risk
population. Objective: Our objective is to develop and evaluate the effectiveness of a ring WASH intervention in
reducing cholera infections and increasing sustained WASH behaviors in transmission hotspots around cholera
cases. Previous studies: Our research group developed the Cholera-Hospital-Based-Intervention-for-7-Days
(CHoBI7), a WASH intervention delivered to cholera patients and their household members in a health facility.
Our randomized controlled trial (RCT) in Bangladesh of CHoBI7 demonstrated this intervention was effective in
significantly reducing cholera, and led to sustained increases in handwashing with soap and improved drinking
water quality 12 months post-intervention in cholera patient households. This intervention, however, solely
focused on cholera patients households. There are no studies to date that have evaluated the impact on
reducing cholera of delivering a ring WASH intervention to households living near cholera patients. Design and
Setting: The Director of Disease Control at the Bangladesh Ministry of Health and Family Welfare would like to
take CHoBI7 to scale across Bangladesh, and has requested we build evidence on scalable approaches for
delivering CHoBI7 in a ring around cholera patient households. This study will have 3 phases. During the
formative research and planning phase we will develop a scalable, theory and evidence based ring WASH
intervention through in-depth interviews, focus group discussions, workshops, and a pilot. During the
intervention implementation and evaluation phase we will conduct a RCT to prospectively follow 3120
participants from 1040 households living in 40 rings around cholera cases to evaluate the effectiveness of the
intervention in: (1) reducing cholera infections during the first week after the index patient in the ring seeks care
at a health facility; and (2) increasing handwashing with soap and stored water quality over a 12 month period.
The first arm will receive the standard recommendation given in Bangladesh during diarrhea outbreaks on oral
rehydration solution use and a leaflet on WASH practices during a single visit. The second arm will receive this
message and the ring WASH intervention which includes two home visits and mobile health messages. Whole
genome sequencing will be performed on water and clinical Vibrio cholerae strains collected to investigate
spatiotemporal transmission dynamics of V. cholerae in ho...

## Key facts

- **NIH application ID:** 10064129
- **Project number:** 5R01AI148332-02
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Christine Marie George
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $645,281
- **Award type:** 5
- **Project period:** 2019-12-02 → 2025-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10064129

## Citation

> US National Institutes of Health, RePORTER application 10064129, A Ring Water, Sanitation, and Hygiene Intervention to Reduce Cholera in Hotspots in Bangladesh (5R01AI148332-02). Retrieved via AI Analytics 2026-06-11 from https://api.ai-analytics.org/grant/nih/10064129. Licensed CC0.

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