Development of a forecasting model for cholera and an Early Action Protocol (EAP) to anticipate cholera epidemics in Cameroon

As part of its RIPOSTE program, the French Red Cross and 510 Initiative (Netherlands Red Cross) have supported the Cameroon Red Cross in the development of an Early Action Protocol (EAP) for cholera - the first EAP for epidemic to be validated by the International Federation of Red Cross and Red Crescent Societies (IFRC). This implies the strengthening and integration of epidemiological data sources, the identification of cholera outbreak risk factors, the definition of alert thresholds and of anticipatory actions to be implemented. This will enable the Cameroon Red Cross to receive funds from the IFRC’s  Disaster Response Emergency Fund to carry out anticipatory actions ahead of a forecast cholera epidemic.

Project description

Better anticipate epidemics using disaster preparedness tools

The cholera EAP was developed as part of the RIPOSTE programme, implemented by the French Red Cross, which aims to create tools and share expertise on epidemic preparedness and response within the Red-Cross and Red-Crescent Movement. Since 2021, it has developed operational tools and training curricula for epidemic prevention, preparedness and response, such as this EAP, designed to guide the rapid and effective implementation of early actions based on specific climate conditions and public health risk forecasts in Cameroon.

Identifying risk factors and early action to anticipate cholera outbreaks in Cameroon

Climate change has a significant impact on cholera epidemics, causing more intense rainfall and more frequent flooding. As cholera is a water-borne disease, experts focused on climate indicators (heavy rains, flooding), WASH infrastructure, integrating cholera case reporting systems and strengthening community-based surveillance. Then, given these main cholera risk factors, an Early warning system based on triggers was established.

The first trigger consists in river or rainfall flooding that affects more than 2,000 people, or a period of heavy rains, defined as a 4-day period with an average daily rainfall of at least 50 mm.

The second threshold consists in a minimum of 5 cases of community alerts, or 5 suspected cases, or 1 confirmed cholera case in a neighboring or border district reported by the Ministry of Health. If both of these conditions are met, then the risk of a cholera outbreak is high and anticipatory actions are triggered.

The activities defined in the EAP consist in:

• WASH activities: Carrying out a rapid vulnerability assessment, distributing water purifiers and emergency kits, disinfecting schools, markets and hospitals, and setting up sanitation of water points;
• Healthcare activities: training volunteers and supervisors in community-based surveillance (CBS), distributing Oral rehydration salts (ORS) to people suffering from diarrhoea, engaging with communities and ensuring proper gender protection and inclusion, raising awareness, and strengthening the community feedback mechanism.

To identify cholera risk factors the FRC partnershiped with the Netherlands Red Cross‘ data and digital unit 510 as well as the French School of Advanced Studies in Public Health (EHESP). Together they collected, unified and analysed data related to the various risk factors favoring cholera epidemics.

Fostering epidemic risk anticipation within the RCRC movement

The EAP is a tool developed within the RCRC movement. Once validated by the IFRC, the EAP makes the Cameroon Red Cross eligible for “forecast-based financing by the DREF”. It will receive up to 496 899,30 CHF from the IFRC-DREF to carry out preparedness, pre-positioning and anticipatory actions when pre-defined thresholds are reached.

Cameroon’s cholera EAP is the first ever EAP dealing with an epidemic risk to be validated by the IFRC. Indeed, the setting up of an EWS for epidemics is very challenging. It necessitates a sound knowledge of the risk factors as well as a strong and integrated data collection system.

Through this EAP, the French Red Cross seeks to promote and facilitate the use of other EAPs for epidemics within the RCRC Movement. A feedback document has been prepared to share the lessons learnt from this experience to other national societies of the RCRC movement. Moreover, a feasibility study for a forecast model for measles in the Democratic Republic of the Congo was carried through the RIPOSTE program. It could potentially lead to the development of an EAP in the coming years.