Evidence-Based WASHmobile Anticipatory Action Framework to Reduce Cholera Outbreaks during Extreme Weather Events in the Democratic Republic of the Congo
Abstract
Extreme weather contributes to cholera outbreaks globally. We examined associations between extreme weather and cholera through 4 years of surveillance at 115 healthcare facilities in the Democratic Republic of the Congo, and built an anticipatory action framework through WASHmobile for water, sanitation, and hygiene mobile messaging during extreme weather. Drought and wet conditions were defined using 3-month Standardized Precipitation Indices with CHIRPS data. A test-negative design assessed associations between extreme weather and culture-confirmed Vibrio cholerae among 1,068 diarrhea patients. Odds of cholera were higher during drought (OR: 1.94, 95% CI: 1.17-3.20) and extreme wet conditions (OR: 2.22, 95% CI: 1.39-3.55). During drought conditions in our randomized controlled trial of 2334 participants, handwashing with soap significantly declined in the standard arm but not the WASHmobile arm. Findings informed an anticipatory action framework where pre-defined climate triggers activate WASHmobile as an early warning system to reduce cholera outbreaks during extreme weather.
Related
- Association between Ebola prevention training and prevention-related cognitive and behavioral factors among Chinese expatriates in the Democratic Republic of the Congo: a cross-sectional study informed by the RANAS framework.
- From anticipatory fear to relational trust: women's experiences of gynecological examination in Turkey: a qualitative study
- Disruption of Anticipatory Insulin Secretion in Patients with Hyperglycemia and Obesity
- The Neural Mechanism of Motion Sickness Alleviation by Anticipatory Sound
- Reduced Anticipatory Pleasure in Early-Onset Severe Cannabis Use Disorder: A Retrospective, Cross-Sectional Study.
BibTeX
@misc{endres2026evidencebased,
title = {{Evidence-Based WASHmobile Anticipatory Action Framework to Reduce Cholera Outbreaks during Extreme Weather Events in the Democratic Republic of the Congo}},
author = {Kelly Endres and Presence Sanvura and Jean-Claude Bisimwa and Alves Namunesha and Willy Felicien and Lucien Bisimwa and Alain Mwishingo and Camille Williams and Jamie Perin and Justin Bengehya and Ghislain Maheshe and Jean-Claude Kulondwa and Cirhuza Cikomola and Anna Dimitrova and Christine Marie George},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.22.26366235},
url = {https://www.medrxiv.org/content/10.64898/2026.10.22.26366235v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Evidence-Based WASHmobile Anticipatory Action Framework to Reduce Cholera Outbreaks during Extreme Weather Events in the Democratic Republic of the Congo
AU - Kelly Endres
AU - Presence Sanvura
AU - Jean-Claude Bisimwa
AU - Alves Namunesha
AU - Willy Felicien
AU - Lucien Bisimwa
AU - Alain Mwishingo
AU - Camille Williams
AU - Jamie Perin
AU - Justin Bengehya
AU - Ghislain Maheshe
AU - Jean-Claude Kulondwa
AU - Cirhuza Cikomola
AU - Anna Dimitrova
AU - Christine Marie George
PY - 2026
DA - 2026/10/22
PB - medRxiv
DO - 10.64898/2026.10.22.26366235
UR - https://www.medrxiv.org/content/10.64898/2026.10.22.26366235v1
AB - Extreme weather contributes to cholera outbreaks globally. We examined associations between extreme weather and cholera through 4 years of surveillance at 115 healthcare facilities in the Democratic Republic of the Congo, and built an anticipatory action framework through WASHmobile for water, sanitation, and hygiene mobile messaging during extreme weather. Drought and wet conditions were defined using 3-month Standardized Precipitation Indices with CHIRPS data. A test-negative design assessed associations between extreme weather and culture-confirmed Vibrio cholerae among 1,068 diarrhea patients. Odds of cholera were higher during drought (OR: 1.94, 95% CI: 1.17-3.20) and extreme wet conditions (OR: 2.22, 95% CI: 1.39-3.55). During drought conditions in our randomized controlled trial of 2334 participants, handwashing with soap significantly declined in the standard arm but not the WASHmobile arm. Findings informed an anticipatory action framework where pre-defined climate triggers activate WASHmobile as an early warning system to reduce cholera outbreaks during extreme weather.
ER -