Emergency Management Apps

Cholera field level monitoring form

One of the fastest ways to prevent the spread of deadly infectious diseases such as Cholera is to catalog instances on a map. Emergency planners, humanitarian organizations, and public health officials can use this geospatial information to allocate resources and prevent loss of life. Oxfam has developed a guideline document which “brings together lessons learned from Oxfam’s past interventions in the prevention and control of cholera, and other related guidance”. This app has been modified for use with Fulcrum from the ‘Mini cholera survey for knowledge, attitude and practice baseline data’ (Form 1) https://www.unicef.org/cholera/Annexes/Supporting_Resources/Annex_6B/OXFAM_Cholera_guidelines.pdf.

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Cholera field level monitoring form

Name of location

Date

Demographics

Name of village

Total number of people in household

Adult male

5-15 y/o male

<5 y/o male

Adult female

5-15 y/o female

<5 y/o female

Female- or male-headed?

Number of people in family able to read and write

Female

Male

Date of interview

Interviewer

Water

From where do you get your drinking water?

How many containers for water collection do you have?

Total litres (water collection)

How many containers do you use every day for your whole family?

Total litres (every day for whole family)

Do you have a separate container for storing drinking water?

Can you show me how you take water from that container if you want a drink?

Do you consider your drinking water to be safe for drinking?

Explain answer

Do you treat your drinking water?

If no, why not?

If yes, what do you use?

Hygiene

When do you think are the important times to wash your hands?

With what do you wash your hands?

Observations

Are there faeces seen lying around the outhouse?

Ask to wash your hands – were you offered soap?

Latrine and sanitation

Where do the adults in your family defecate: during the day?

Where do the adults in your family defecate: during the night?

Where do small children (<5) defecate: during the day?

Where do small children (<5) defecate: during the night?

Do women and girls have safety problems when defecating at night?

If yes, explain:

What do you do with the faeces of small babies?

Household health

Has anyone in your household had diarrhoea (three or more loose stools in 24 hours) over the past two weeks?

If yes, who was it?

Is anyone sick in your household at the moment?

If yes, list illness

1.

Illness

Number of ill (men)

Number of ill (women)

Number of ill (Children <5)

2.

Illness

Number of ill (men)

Number of ill (women)

Number of ill (Children <5)

3.

Illness

Number of ill (men)

Number of ill (women)

Number of ill (Children <5)

4.

Illness

Number of ill (men)

Number of ill (women)

Number of ill (Children <5)

Have you heard about cholera?

Do you know anyone that has cholera in this village?

What do you think causes cholera?

How do you prevent you and your family from getting cholera?

Have you heard of ORS?

Have you heard of sugar and salt solution?

Can you tell me how to make sugar and salt solution? (Record amounts, and whether correct.)

Do you know of other home-based rehydration methods?

If yes – list them

When would you use these rehydration methods?

Who in the family would not use them?

Why do these members of the family not use the rehydration method?