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

Francesco Di Gennaro Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy;
Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy;

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Edoardo Occa Doctors with Africa CUAMM, Maputo, Mozambique;

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Ketan Chitnis Unicef Mozambique, Maputo, Mozambique;

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Giorgia Guelfi Doctors with Africa CUAMM, Maputo, Mozambique;

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Andrea Canini Doctors with Africa CUAMM, Maputo, Mozambique;

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Inusso Chuau Unicef Mozambique, Maputo, Mozambique;

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Simone Cadorin Doctors with Africa CUAMM, Maputo, Mozambique;

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Davide F. Bavaro Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy;

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Lucy Ramirez Doctors with Africa CUAMM, Maputo, Mozambique;

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Claudia Marotta Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy;

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Sergio Cotugno Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy;

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Francesco V. Segala Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy;

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Angelo Ghelardi Unicef Mozambique, Maputo, Mozambique;

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Annalisa Saracino Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy;

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Isabel M. Periquito Unicef Mozambique, Maputo, Mozambique;

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Giovanni Putoto Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy;

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Ally Mussa Nucleo de Investigacao Operacional de Pemba, Pemba, Mozambique

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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.

Author Notes

Address correspondence to F. Di Gennaro, Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, p.zza G Cesare 13, Bari, Italy. E-mail: francesco.digennaro1@uniba.it

Authors’ addresses: Francesco Di Gennaro, Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy, and Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy, E-mail: francesco.digennaro1@uniba.it. Edoardo Occa, Giorgia Guelfi, Andrea Canini, Simone Cadorin, and Lucy Ramirez, Doctors with Africa CUAMM, Mozambique, E-mails: e.occa@cuamm.org, g.guelfi@cuamm.org, andrea.canini1@gmail.com, s.cadorin@cuamm.org, and l.ramirez@cuamm.org. Ketan Chitnis, Inusso Chuau, Angelo Ghelardi, and Isabel M. Periquito, Unicef Mozambique, Mozambique, E-mails: kchitnis@unicef.org, ichuau@unicef.org, aghelardi@unicef.org, and iperiquito@unicef.org. Davide F. Bavaro, Sergio Cotugno, Francesco V. Segala, and Annalisa Saracino, Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy, E-mails: davidebavaro@gmail.com, sergio.cotugno@gmail.com, fvsegala@gmail.com and annalisa.saracino@uniba.it. Claudia Marotta and Giovanni Putoto, Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy, E-mails: marotta.claudia@gmail.com and G.putoto@cuamm.org. Ally Mussa, Nucleo de Investigacao Operacional de PembaMozambique, E-mail: alymussamanuel@yahoo.com.br.

  • 1.

    Blake A et al., 2018. Temporo-spatial dynamics and behavioural patterns of 2012 cholera epidemic in the African mega-city of Conakry, Guinea. Infect Dis Poverty 7: 13.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Mireku-Gyimah N , Apanga PA , Awoonor-Williams JK , 2018. Cyclical cholera outbreaks in Ghana: filth, not myth. Infect Dis Poverty 7: 51.

  • 3.

    Dureab FA , Shibib K , Al-Yousufi R , Jahn A , 2018. Yemen: cholera outbreak and the ongoing armed conflict. J Infect Dev Ctries 12: 397403.

  • 4.

    United States Institute of Peace , 2022. New US Plan To Address Conflict Could Boost Mozambique’s Gains. Available at: https://www.usip.org/publications/2022/04/new-us-plan-address-conflict-could-boost-mozambiques-gains. Accessed September 10, 2022.

    • PubMed
    • Export Citation
  • 5.

    Lequechane JD , Mahumane A , Chale F , Nhabomba C , Salomão C , Lameira C , Chicumbe S , Semá Baltazar C , 2020. Mozambique's response to cyclone Idai: how collaboration and surveillance with water, sanitation and hygiene (WASH) interventions were used to control a cholera epidemic. Infect Dis Poverty 9: 68.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Marotta C et al., 2021. Mozambican Adolescents and Youths during the COVID-19 Pandemic: Knowledge and Awareness Gaps in the Provinces of Sofala and Tete. Healthcare 9: 321.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Pozniak A , Atzori A , Marotta C , Di Gennaro F , Putoto G , 2020. HIV continuity of care after Cyclone Idai in Mozambique. Lancet HIV 7: e159e160.

  • 8.

    Institut for Health Metrics and Evalutation (IHME) Mozambique. Available at: https://www.healthdata.org/mozambique. Accessed July 30, 2022.

    • PubMed
    • Export Citation
  • 9.

    Di Gennaro F , Marotta C , Pizzol D , Chhaganlal K , Monno L , Putoto G , Saracino A , Casuccio A , Mazzucco W , 2018. Prevalence and predictors of malaria in human immunodeficiency virus infected patients in Beira, Mozambique. Int J Environ Res Public Health 15: 2032.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Di Gennaro F et al., 2022. High prevalence of mental health disorders in adolescents and youth living with HIV: an observational study from eight health services in Sofala Province, Mozambique. AIDS Patient Care STDS 36: 123129.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Marotta C , Di Gennaro F , Pizzol D , Madeira G , Monno L , Saracino A , Putoto G , Casuccio A , Mazzucco W , 2018. The At Risk Child Clinic (ARCC): 3 years of health activities in support of the most vulnerable children in Beira, Mozambique. Int J Environ Res Public Health 15: 1350.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    The Lancet , 2017. Yemen and cholera: a modern humanity test. Lancet 390: 626.

  • 13.

    World Health Organization/United Nations Children's Fund , 2013. Ending Preventable Child Deaths from Pneumonia and Diarrhoea by 2025 The integrated Global Action Plan for Pneumonia and Diarrhoea. Geneva, Switzerland, WHO/UNICEF.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Bi Q , Ferreras E , Pezzoli L , Legros D , Ivers LC , Date K , 2017. Protection against cholera from killed whole-cell oral cholera vaccines: a systematic review and meta-analysis. Lancet Infect Dis 17: 10801088.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Federspiel F , Ali M , 2018. The cholera outbreak in Yemen: lessons learned and way forward. BMC Public Health 18: 1338.

  • 16.

    World Health Organization , 2017. Available at: http://apps.who.int/iris/bitstream/handle/10665/255575/WHO-IVB-17.03-eng.pdf?sequence=1. Accessed April 26, 2018.

    • PubMed
    • Export Citation
  • 17.

    Chao DL , Longini IM Jr , Morris JG Jr , 2014. Modeling cholera outbreaks. Curr Top Microbiol Immunol 379: 195209.

  • 18.

    Shannon K , Hast M , Azman AS , Legros D , McKay H , Lessler J , 2019. Cholera prevention and control in refugee settings: successes and continued challenges. PLoS Negl Trop Dis 13: e0007347.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    World Health Organization Weekly Bulletin on Outbreaks and Other Emergencies – Week 15: 4 – 10 April 2022, Data as reported by: 17:00; 10 April 2022. Available at: https://apps.who.int/iris/bitstream/handle/10665/353065/OEW15-0410042022.pdf. Accessed September 11, 2022.

    • PubMed
    • Export Citation
  • 20.

    Das M , Singh H , Girish Kumar CP , John D , Panda S , Mehendale SM , 2020. Non-vaccine strategies for cholera prevention and control: India's preparedness for the global roadmap. Vaccine 38(Suppl 1): A167A174.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Taylor DL , Kahawita TM , Cairncross S , Ensink JH , 2015. The impact of water, sanitation and hygiene interventions to control holera: a systematic review. PLoS One 10: e0135676.

    • PubMed
    • Search Google Scholar
    • Export Citation
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