Adherence to cholera interventions: associated factors, enablers and barriers in Chipata and George compounds of Lusaka, Zambia

Abstract

Cholera is an acute, diarrheal illness caused by the bacterium Vibrio cholerae. Cholera is strongly linked to consumption of unsafe water, food, poor sanitation and overcrowded living conditions. Despite implementation of Cholera interventions in Lusaka, Cholera continues to affect the lives of the people especially in the Peri urban areas of Lusaka. To date there is no empirical evidence on factors associated with household adherence to Cholera interventions as well as the enablers and barriers to adherence in these areas. The purpose of this study was to establish enablers and barriers and factors associated with adherence to Cholera interventions in Lusaka Zambia. The data was collected using structured interview questionnaires from 400 participants. Multistage sampling was adopted for selecting zones and Systematic random sampling for selection of households. In-depth interviews were conducted for selected heads of household and health committee chairpersons using maximum variation sampling. The study used a Sequential Explanatory Design. Epidata management software was used for database designing and questionnaire data entry and validation. The data was exported and analysed using STATA software version 13. Categorical variables such as sex were stated as proportions; Chi square test, Bivariate and multivariate logistics regression were used to test for association between independent variables and household adherence to Cholera interventions. A step wise multiple regression approach was used to select the best predictors. Thematic analysis was used to identify enablers and barriers to Cholera interventions. Only 5.8% of the households adhered to Cholera interventions. Factors associated with adherence after controlling for other variables were age of household head (AOR=0.081; 95%CI=0.016-0.409) and mode of receipt of health messages (AOR=0.219; 95%CI=0.103- 0.466). Enablers were availability of water containers, water tanks, water kiosks, health information and knowledge of hand washing behaviour. Barriers identified were contamination and water leakages, shallow wells, queues at water points, distance from water points, expensive charcoal, inadequate and expensive chlorine, fear of potential health effects from use of chlorine, shared toilets and non-collection of garbage. The households of Chipata and George Compounds still experience several barriers to Cholera interventions. This has negatively affected the households’ with the majority of the people not adhering to Cholera interventions. The study recommends increasing the number of water points for households’ easy access to water. Construction of flushable toilets due to lack of space for erection of pit latrines. Regular collection of garbage to avoid disease transmission and prevention of households from drawing water from shallow wells by burying them. Key words: Enablers, Barriers, Cholera, Interventions and Adherence.