Comparing sociocultural features of cholera in three endemic African settings

Abstract

BackgroundCholera mainly affects developing countries where safe water supply and sanitation infrastructure are often rudimentary. Sub-Saharan Africa is a cholera hotspot. Effective cholera control requires not only a professional assessment, but also consideration of community-based priorities. The present work compares local sociocultural features of endemic cholera in urban and rural sites from three field studies in southeastern Democratic Republic of Congo (SE-DRC), western Kenya and Zanzibar.MethodsA vignette-based semistructured interview was used in 2008 in Zanzibar to study sociocultural features of cholera-related illness among 356 men and women from urban and rural communities. Similar cross-sectional surveys were performed in western Kenya (n = 379) and in SE-DRC (n = 360) in 2010. Systematic comparison across all settings considered the following domains: illness identification; perceived seriousness, potential fatality and past household episodes; illness-related experience; meaning; knowledge of prevention; help-seeking behavior; and perceived vulnerability.ResultsCholera is well known in all three settings and is understood to have a significant impact on people’s lives. Its social impact was mainly characterized by financial concerns. Problems with unsafe water, sanitation and dirty environments were the most common perceived causes across settings; nonetheless, non-biomedical explanations were widespread in rural areas of SE-DRC and Zanzibar. Safe food and water and vaccines were prioritized for prevention in SE-DRC. Safe water was prioritized in western Kenya along with sanitation and health education. The latter two were also prioritized in Zanzibar. Use of oral rehydration solutions and rehydration was a top priority everywhere; healthcare facilities were universally reported as a primary source of help. Respondents in SE-DRC and Zanzibar reported cholera as affecting almost everybody without differentiating much for gender, age and class. In contrast, in western Kenya, gender differentiation was pronounced, and children and the poor were regarded as most vulnerable to cholera.ConclusionsThis comprehensive review identified common and distinctive features of local understandings of cholera. Classical treatment (that is, rehydration) was highlighted as a priority for control in the three African study settings and is likely to be identified in the region beyond. Findings indicate the value of insight from community studies to guide local program planning for cholera control and elimination.

Cholera, Migration, and Global Health – A Critical Review

“…Conflicts and refugee situations severely disrupt social determinants of health, and refugees commonly have inadequate access to quality health services. 58 In refugee camps, poverty, overcrowding, unclean water, and inadequate sanitation further increase cholera risk. Health and hygiene concerns may be subjugated to more immediate concerns for security, food, and shelter.…”

Sociocultural determinants of anticipated oral cholera vaccine acceptance in three African settings: a meta-analytic approach

“…Paradoxically, SE-DRC has the greatest number willing to purchase the medium-price and high-price OCVs. People in W-Kenya and Zanzibar are economically better off as seen from gross domestic product per capita [ 31 ] and self-reported reliability of income among study respondents [ 18 ]. The seeming contradiction of greatest willingness to purchase OCVs among those with least economic resources may be explained by the serious trouble caused by cholera in SE-DRC, where public health facilities are often inaccessible or non-functional.…”

“…Studies of sociocultural aspects of cholera and determinants of anticipated OCV acceptance were undertaken in three cholera-endemic settings in Africa [ 15 – 17 ]. A comparison of sociocultural features of cholera illness experience and meaning have been reported by Schaetti and colleagues [ 18 ]. Common and distinctive sociocultural determinants of anticipated OCV acceptance that may affect uptake and effectiveness of OCVs in cholera-endemic areas of three countries in Sub-Saharan Africa are presented in this cross-setting analysis.…”

The effects of utility evaluations, biomedical knowledge and modernization on intention to exclusively use biomedical health facilities among rural households in Mozambique

“…Additionally, uncertainty about causes of illness and its treatment has been shown to encourage integrative/complex health seeking strategies (Alvesson et al, 2013;Mayxay et al, 2013;Schaetti et al, 2013). Thus, increasing knowledge of biomedicine should generally be associated with the choice of biomedical services.…”