A case analysis of a mass treatment approach to control GI and water-related conditions in Sudan

BACKGROUND: The efficiency of mass chlorination in controlling diarrheal diseases during acute emergencies has been extensively reported in literature. However, long-term crises received unparallel attention. Researchers have previously carried out a trial that investigated the impact of using chemical means to treat water reservoirs of Um-Baddah Nevachah, a refugee camp located in the western outskirts of Khartoum, Sudan. A double-blind community experimental trial was carried out by randomly adding either chlorine or a placebo to the major water tanks in the area. Data were collected using a mixed-methods study design. The primary input was the quantitative data derived from total coliforms lab tests and records of the local primary healthcare center, while the embedded (nested) portion generated most of the qualitative data from direct face-to-face interviews. As a case analysis, this study aims to critically appraise the original trial. In the Background the authors discussed the context of the trial, approach used, and outcomes. Discussion section included three issues related to the trial: scientific importance, challenges and strategies. DISCUSSION: Importance: There are two factors that contribute to the importance of this study: First, the integrated and systematic approach followed to resolve associated challenges. The study swiftly moved from investigating potential water contamination, to test whether it is related to an endogenous focus that auto-taints drinking water, and finally it explored the impact of tanks chlorination on public health. Second, the longstanding humanitarian context which remains largely underreported in literature. Challenges: funding limitations were among the first obstacles faced. During the fieldwork preparation phase, a lot of work was required to resolve logistical and security challenges. Keeping volunteers motivated was the biggest concern during the last phase of data collection. Strategies: The “Matrix Solutions Strategy” was developed and used to optimize scarce resources to simultaneously target multiple problems through a single intervention. CONCLUSION: Key lessons learned from the whole experience were: persistence is paramount for the success of studies in precarious situations; lateral thinking generates alternative solutions that are novel, feasibility and practical in resources-limited settings; and finally respecting local culture and regulations is essential for building trust with both authorities and vulnerable societies.