Knowledge, Attitudes and Practices on Cholera and Water, Sanitation, and Hygiene among Internally Displaced Persons in Cabo Delgado Province, Mozambique

Abstract

In disaster situations, cholera outbreaks represent a public health emergency due to their high fatality rates and high spreading risk through camps for refugees and internally displaced persons (IDPs). The aim of this study is to examine water, sanitation, and hygiene attitudes and cholera knowledge, attitude, and practice (KAP) among people living in resettlement sites in Cabo Delgado, the northernmost province of Mozambique. Between January 1 and March 31, 2022, a cross-sectional survey was conducted by administering a face-to-face interview to IDPs and residents in six relocation sites in Cabo Delgado Province. A total of 440 people were enrolled in the study. Overall, 77.8% (N = 342) were female, 61% (N = 268) were younger than 35 years old, and 60.5% (N = 266) reported primary school to be the highest education level. Seventy-five percent (N = 334) of participants lived with children under 5 years old. Thirty-one percent (N = 140) and 11.8% (N = 52) of the respondents reported, respectively, at least one cholera case and at least one diarrheal-related death among their family members in the previous 2 years. In multivariate analysis, being female, being younger than 35 years old, having attained a higher education level, owning a phone, or having soap at home were factors significantly associated with improved cholera KAP. In severely deconstructed social contexts, continuous education and community sensitization are crucial to achieve and maintain positive cholera prevention attitudes.

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“…Moreover, cyclones Idai and Kenneth created in 2019, respectively, 478,000 and 24,000 new IDPs. In this context, where overpopulation and low hygienic-sanitary conditions coexist, cholera outbreaks, along with other vaccine-preventable diseases such as measles, were more frequently reported (30).…”

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“…20 Barriers to hand washing in some areas included the lack of soap and water and insufficient knowledge of key moments for hand washing. 21,28,29 In camp settings, people were highly dependent on soap distribution. Data from the Maratane refugee camp highlighted that only 11 per cent of assessed households had a hand washing facility at home and that soap and/or ash was present at only half of the hand washing stations.…”

“…However, cost concerns lead many to rely on herbal remedies and home treatments or to seek traditional medical care as first-line treatment. 29,33,36,38,39 This is particularly an issue for female caregivers. It is not uncommon for multiple forms of care to be sought, particularly for small children, and traditional healers, called curandeiros, are often first consulted followed by a visit to a health facility.…”

“…Knowledge of transmission routes and prevention -such as maintaining hand washing -has been reported to be very low in Nampula, 24 while in Cabo Delgado the data appear quite positive: study respondents reported behaviours to reduce cholera infection risks including cooking food (89 per cent), boiling water (90 per cent) and properly disposing of human waste (90.8 per cent). 29 However, high levels of knowledge do not necessarily seem to translate into practice. This could be due to structural factors such as poor access to safe water and sanitation, alongside low perception of risk and other confounding factors.…”

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“…This is against the backdrop of the Sustainable Development Goals (SDGs) launched in September 2015 that committed to "adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations" (2). Evidence has shown that lack of safely managed sanitation is among the leading cause of mortality and morbidity especially among children under five years old (3)(4)(5). Furthermore, lack of safely managed sanitation leads to economic loses as a result of productive man hours spent tending to the sick especially for women, premature death and treatment costs (6).…”