GTA

Support: Epidemiology and Disease Control Division (EDCD), Nepal, Seti Provincial Hospital (Kailali), Health Facilities in Kathmandu Valley and Kailali District

Partners: International Vaccine Institute (IVI), Korea

Status: Phased out

Objectives: The ECHO-N project aims to enhance Nepal’s capacity to detect, respond to, and prevent cholera outbreaks by strengthening sentinel surveillance for acute watery diarrhea (AWD) at 27 health facilities in Kathmandu Valley and 11 health facilities in Kailali District. The project supports real-time clinical surveillance and microbiological confirmation to accurately identify suspected cholera cases.

Stool samples from AWD patients undergo Rapid Diagnostic Testing (RDT) and culture confirmation, ensuring accurate case detection and timely reporting. Beyond surveillance, Cost of Illness (COI) Surveys are conducted through structured interviews with cholera-affected patients and their families to capture direct medical expenses, non-medical costs, and productivity losses, providing critical evidence on the economic burden of cholera at the household level.

The project directly supports the Epidemiology and Disease Control Division (EDCD) in using surveillance data and economic evidence to guide evidence-based cholera control policies, including:

• Targeted deployment of Oral Cholera Vaccines (OCV)
• Improved water, sanitation, and hygiene (WASH) interventions
• Strengthened outbreak preparedness and response at national and local levels

The project also contributes to local capacity building by training healthcare providers in surveillance techniques, laboratory procedures, and data reporting, fostering a sustainable surveillance and response system for cholera prevention and control.

Outcomes: The project successfully established a functional sentinel surveillance network across 38 health facilities (27 in Kathmandu Valley and 11 in Kailali), enabling real-time data collection on AWD trends, suspected cholera cases, and laboratory-confirmed infections. Standardized protocols for stool sample collection, RDT use, and culture confirmation were developed and implemented, ensuring consistent, high-quality data across all surveillance sites. This enhanced laboratory capacity for cholera diagnosis and improved early warning and response mechanisms. The project also generated valuable economic data through Cost of Illness Surveys, highlighting the financial burden of cholera on affected families including out-of- pocket medical expenses, non-medical costs, and lost income.

Findings from the surveillance and economic assessments were regularly shared with EDCD and other key stakeholders through collaborative workshops, ensuring that data-driven policy decisions were aligned with Nepal’s national cholera control strategies. Additionally, the project strengthened the capacity of local health facilities by training healthcare workers in surveillance methods, laboratory techniques, and data reporting, fostering long-term preparedness for future outbreaks.

The surveillance data provided critical epidemiological insights, such as:

• Seasonal trends of cholera transmission
• Identification of geographic hotspots
• Determination of high-risk age groups

These insights have already contributed to the design of targeted interventions, such as OCV campaigns and WASH improvements, helping reduce cholera risk in vulnerable communities. Overall, the project demonstrates a sustainable model for cholera surveillance, prevention, and control, strengthening Nepal’s public health response and resilience against future cholera outbreaks.