Diarrhea treatment center (DTC) based diarrheal disease surveillance in settlements in the wake of the mass influx of forcibly displaced Myanmar national (FDMN) in Cox's Bazar, Bangladesh, 2018

Water, sanitation and hygiene challenges of forcibly displaced Myanmar nationals in Rohingya camps in Bangladesh

Improved water, sanitation and hygiene (WASH) facilities in water-scarce areas is one of the most important barriers to improving the standards of people's life, which is even worse in a locality with forcibly displaced people (e.g., nearly 1 million Rohingya refugees in Bangladesh). In attempting to understand the extent of vulnerability and risks of WASH facilities, their impacts, and adaptive practices in the communities, an exploratory study has been carried out in five selected camps (13, 15, 16, 24 and 27) in Cox's Bazar, Bangladesh. Examination of water facilities shows that households in camps 13, 15 and 16 suffered from an adequate supply of water during summer as there is no direct access to surface water from adjacent water reservoirs, while camps 24 and 27 have such facilities. The frequency of water shortage for drinking purposes in camps 13, 15 and 16 was not so severe as in camps 24 and 27. Drinking water collectors had to spend 3-5 h in queues. All latrines were communal/shared latrines, which made users feel uncomfortable and vulnerable. This study implies that WASH facilities need to be reinforced, and community sensitization on WASH behavior needs to be strengthened to reduce WASH-related health hazards.

Genomic epidemiology of Vibrio cholerae during a mass vaccination campaign of displaced communities in Bangladesh

Ongoing diarrheal disease surveillance throughout Bangladesh over the last decade has revealed seasonal localised cholera outbreaks in Cox's Bazar, where both Bangladeshi Nationals and Forcibly Displaced Myanmar Nationals (FDMNs) reside in densely populated settlements. FDMNs were recently targeted for the largest cholera vaccination campaign in decades. We aimed to infer the epidemic risk of circulating Vibrio cholerae strains by determining if isolates linked to the ongoing global cholera pandemic ("7PET" lineage) were responsible for outbreaks in Cox's Bazar. We found two sublineages of 7PET in this setting during the study period; one with global distribution, and a second lineage restricted to Asia and the Middle East. These subclades were associated with different disease patterns that could be partially explained by genomic differences. Here we show that as the pandemic V. cholerae lineage circulates in this vulnerable population, without a vaccine intervention, the risk of an epidemic was very high.

Water, Sanitation, and Hygiene (WASH) Practices and Outreach Services in Settlements for Rohingya Population in Cox's Bazar, Bangladesh, 2018-2021

(1) Background: This study aimed to investigate the existing water, sanitation, and hygiene (WASH) policy and practice of the study population and strengthen the evidence base by documenting changes in the WASH policy and practice over 3 years of the Rohingya refugee humanitarian crisis, Cox's Bazar, Bangladesh. (2) Methods: A cross-sectional surveillance design was followed; the sampling of the study population included the Rohingya refugee population and neighborhood host nationals who required hospitalization soon after seeking care and enrolled into the diarrheal disease surveillance in diarrhea-treatment centers. Throughout the study period of 3 years, a total of 4550 hospitalized individuals constituted the study participants. (3) Results: Among the hospitalized Rohingya refugee population; the use of public tap water increased significantly from 38.5% in year 1 to 91% in year 3. The use of deep tube well water significantly changed from 31.3% to 8.2%, and the use of shallow tube well water reduced significantly from 25.8% to 0.4%. Households using water seal latrine were 13.3% in year 1 and increased significantly to 31.7% in year 3. ORS consumption at home changed significantly from 61.5% in the first year to 82.1% in third year. Multivariable analysis demonstrated patients' age groups at 5 to 14 years, and 15 years and more, drinking non-tube well water, soap use after using toilet, use of non-sanitary toilet facility, father's and mother's lack of schooling, and some and severe dehydration were significantly associated with the Rohingya refugee population enrolled into the diarrheal disease surveillance. (4) Conclusion: The findings indicate significant advances in WASH service delivery as well as outreach activities by aid agencies for the Rohingya refugee population living in settlements.