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attitude to health
knowledge, attitudes and practices
Knowledge, attitude and practices on cholera in an arid county, Kenya, 2018: A mixed-methods approach
Erick Otieno Orimbo | Elvis Oyugi | Diba Dulacha | Mark Obonyo | Abubakar Hussein | Jane Githuku | Maurice Owiny | Zeinab Gura
Date of Publication:
‘It was a ravage!’: lived experiences of epidemic cholera in rural Haiti
Yodeline Guillaume | Max Raymond | Gregory J Jerome | Ralph Ternier | Louise C Ivers
Date of Publication:
BMJ Global Health
A cholera epidemic began in Haiti over 8 years ago, prompting numerous, largely quantitative research studies. Assessments of local ‘knowledge, attitudes and practices’ relevant for cholera control have relied primarily on cross-sectional surveys. The voices of affected Haitians have rarely been elevated in the scientific literature on the topic.
We undertook focus groups with stakeholders
in the Artibonite region of Haiti in 2011, as part of planning for a public health intervention to control cholera at the height of the epidemic. In this study, we coded and analysed themes from 55 community members in five focus groups, focusing on local experiences of cholera and responses to the prevention messages.
The majority of participants had a personal experience with cholera and described its spread in militaristic terms, as a disease that ‘attacked’ individuals, ‘ravaged’ communities and induced fear. Pre-existing structural deficiencies were identified as increasing the risk of illness and death. Knowledge of public health messages coincided with some improvements in water treatment and handwashing, but not changes in open defecation in their community, and was sometimes associated with self-blame or shame. Most participants cited constrained resources, and a minority listed individual neglect, for inconsistent or unimproved practices.
The experience of epidemic cholera in a rural Haitian community at the beginning of a major outbreak included a high burden and was exacerbated by poverty, which increased risk while hindering practice of known prevention messages. To interrupt cholera transmission, public health education must be paired with investments in structural improvements that expand access to prevention and healthcare services.
Cholera outbreak in a naïve rural community in Northern Nigeria: the importance of hand washing with soap, September 2010
Saheed Gidado | Emmanuel Awosanya | Suleiman Haladu | Halimatu Bolatito Ayanleke | Suleman Idris | Ismaila Mamuda | Abdulaziz Mohammed | Charles Akataobi Michael | Ndadilnasiya Endie Waziri | Patrick Nguku
Date of Publication:
The Pan African Medical Journal
Cholera outbreaks in rural communities are associated with high morbidity and mortality. Effective interventions to control these outbreaks require identification of source and risk factors for infection. In September, 2010 we investigated a cholera outbreak in Bashuri, a cholera naïve rural community in northern Nigeria to identify the risk factors and institute control measures. We conducted an unmatched case-control study. Mean age was 29 years (± 20 years) for cases and 32 years (± 16 years) for controls; 38 (47.5%) of cases and 60 (75%) of controls were males. Compared to controls, cases were less likely to have washed hands with soap before eating (age-adjusted odds ratio (AAOR) = 0.27, 95% confidence interval (CI): 0.10-0.72) and less likely to have washed hands with soap after using the toilet (AAOR = 0.34, 95% CI: 0.15-0.75). Vibrio cholerae O1 was isolated from six stool samples but not from any open-well samples. Unhygienic handwashing practices was the key risk factor in this outbreak. We educated the community on personal hygiene focusing on the importance of handwashing with soap.
The Effect of Handwashing at Recommended Times with Water Alone and With Soap on Child Diarrhea in Rural Bangladesh: An Observational Study
Stephen P. Luby | Amal K. Halder | Tarique Huda | Leanne Unicomb | Richard B. Johnston | Zulfiqar A. Bhutta
Date of Publication:
Standard public health interventions to improve hand hygiene in communities with high levels of child mortality encourage community residents to wash their hands with soap at five separate key times, a recommendation that would require mothers living in impoverished households to typically wash hands with soap more than ten times per day. We analyzed data from households that received no intervention in a large prospective project evaluation to assess the relationship between observed handwashing behavior and subsequent diarrhea.
Fieldworkers conducted a 5-hour structured observation and a cross-sectional survey in 347 households from 50 villages across rural Bangladesh in 2007. For the subsequent 2 years, a trained community resident visited each of the enrolled households every month and collected information on the occurrence of diarrhea in the preceding 48 hours among household residents under the age of 5 years. Compared with children living in households where persons prepared food without washing their hands, children living in households where the food preparer washed at least one hand with water only (odds ratio [OR] = 0.78; 95% confidence interval [CI] = 0.57–1.05), washed both hands with water only (OR = 0.67; 95% CI = 0.51–0.89), or washed at least one hand with soap (OR = 0.30; 95% CI = 0.19–0.47) had less diarrhea. In households where residents washed at least one hand with soap after defecation, children had less diarrhea (OR = 0.45; 95% CI = 0.26–0.77). There was no significant association between handwashing with or without soap before feeding a child, before eating, or after cleaning a child's anus who defecated and subsequent child diarrhea.
These observations suggest that handwashing before preparing food is a particularly important opportunity to prevent childhood diarrhea, and that handwashing with water alone can significantly reduce childhood diarrhea.