Social and cultural features of cholera and shigellosis in peri-urban and rural communities of Zanzibar

Abstract

BackgroundResponding to the high burden of cholera in developing countries, the WHO now considers vaccination as a supplement to the provision of safe drinking water and improved sanitation in the strategy for cholera control in endemic settings. Cultural concepts of illness affect many aspects of public health. In the first step of a two-step strategy to examine determinants of cholera vaccine acceptance, this study identified social and cultural features of diarrhoeal illness for cholera control in endemic communities.MethodsA cultural epidemiological study with locally adapted vignette-based interviews was conducted in two cholera-endemic communities of Zanzibar. A random sample of unaffected peri-urban (n = 179) and rural (n = 177) adults was interviewed to study community ideas of cholera and shigellosis, considering categories of distress, perceived causes, and help-seeking behaviour.ResultsCholera was recognised by 88%. Symptoms of dehydration were most prominent in reports at the peri-urban site. Interference with work leading to strain on household finances was frequently emphasised. Dirty environment was the most prominent perceived cause, followed by unsafe drinking water and germ-carrying flies. Causes unrelated to the biomedical basis of cholera were reported more often by rural respondents. Rural women had more difficulty (20%) to identify a cause than men (7.1%, p = 0.016). Peri-urban self treatment emphasised rehydration; the rural community preferred herbal treatment and antibiotics. Shigellosis was recognised by 70%. Fewer regarded it as very serious compared with cholera (76% vs. 97%, p < 0.001) and regarded it as less likely to be fatal (48% vs. 78%, p < 0.001). More respondents could not explain causes of shigellosis (23%) compared with cholera (7.3%, p < 0.001). Community respondents less frequently identified dehydration and contagiousness for shigellosis. Government facilities were preferred healthcare providers for both conditions.ConclusionsThis study clarified local views of cholera and shigellosis relevant for diarrhoeal disease control in Zanzibar. The finding that rural women were less likely than men to specify causes of cholera suggests more attention to them is required. Better health education is needed for cholera in rural areas and for shigellosis in general. This study also identified variables for subsequent analysis of social and cultural determinants of cholera vaccine acceptance.

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“…Our study assessed the knowledge of, attitudes toward, and prevention practices relating to cholera among urban slum-dwellers. We found that only 27% of the respondents could identify cholera as watery diarrhoea, which was lower than that observed in studies in Dhaka, Bangladesh, Zanzibar and Haiti where 60-89% of the population could characterize cholera as watery stool or diarrhoea (Schaetti et al, 2010), Rochars et al, 2010). Definition of cholera varies in many documents including WHO.…”

“…Our study and other studies from Bangladesh and Zanzibar showed that urban and peri-urban people are more likely to give ORS to patients primarily for the treatment of cholera than the rural people (Schaetti et al, 2010).…”

Social and cultural determinants of anticipated acceptance of an oral cholera vaccine prior to a mass vaccination campaign in Zanzibar

“…3,4 The results presented here are based on descriptive findings from a previous report that clarified similarities and differences of community views of cholera in the peri-urban and rural target populations in Zanzibar. 23 This study aimed to assess social and cultural determinants of anticipated oral cholera vaccine acceptance prior to a mass vaccination campaign in a peri-urban and a rural community of Zanzibar. Because of the reported high awareness of cholera in the study communities, 23 it was hypothesized that anticipated acceptance of the free vaccine would also be high, and that determinants of anticipated acceptance would not only include sociodemographic and economic characteristics, especially for high-priced vaccines, [24][25][26] but also socio-cultural features of illness.…”

“…23 This study aimed to assess social and cultural determinants of anticipated oral cholera vaccine acceptance prior to a mass vaccination campaign in a peri-urban and a rural community of Zanzibar. Because of the reported high awareness of cholera in the study communities, 23 it was hypothesized that anticipated acceptance of the free vaccine would also be high, and that determinants of anticipated acceptance would not only include sociodemographic and economic characteristics, especially for high-priced vaccines, [24][25][26] but also socio-cultural features of illness. Social and cultural determinants of anticipated OCV acceptance were investigated with regard to the OCV at no cost, and at three distinct price levels.…”

Cholera outbreaks in Malawi in 1998-2012: social and cultural challenges in prevention and control

“…Witchcraft and God's will as perceived causes of cholera were also reported by other studies. This study highlights the need to incorporate social and cultural issues related to cholera in health promotion messages and materials in addition to messages addressing traditional biomedical risk factors [17][18][19].…”