Abstract

Cholera is a public health problem and a leading cause of mortality in Sub-Saharan Africa. The presence of Cholera is communities highlight a deficit at the level of accessibility and availability to water, hygiene and sanitary facilities. Recently, the Tiko Health District was affected by cholera which was fueled by the consistent cholera outbreak in neighbouring countries.

The study aim at assessing the level of preparedness of communities and health facilities in controlling a cholera outbreak in the Tiko Health District.

A cross-sectional study was conducted targeting hospitals and inhabitants above 21 years living in the selected study areas. Data collection was done with the usage of well-structured questionnaires and observational checklist. The data was then analyzed using SPSS version 26.Descriptive statistics was used to summarize data and logistic regression was used to determine the factors associated.

Out of the 511 inhabitants enrolled in the study, the mean age of participants was 40.9 ± 12. Half of the participants, 277 (54.2%) were of age group 21-40years with 298(58.3%) females been the predominant gender. Majority of the study population 30.3% came from Mutengene. The study revealed, 57.7% of the participants had good knowledge on cholera and 61.8% reported to be adequately prepared in controlling a cholera outbreak. Living close to a health facility, treating water before drinking, knowing key times of the day to wash hands and having a toilet were independently associated with preparedness at P< 0.05. Concerning health facilities assessment, 69.2% of health facilities were adequately prepared.

More than half of the participants were adequately prepared in controlling a cholera outbreak. Half of the participants had good knowledge on Cholera. A statistical significant association(P<0.05) was found between preparedness and having a toilet, living close to a health facility, knowing key times of the day to wash hands and treating water before drinking. Health facilities were seen to be more prepared than communities with over 69.2% of health facilities being adequately prepared.

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae [1].Cholera affects both children and adults and results to severe watery diarrhea with or without vomiting. According to WHO, serotype O1 and O139 are mostly responsible for Cholera outbreaks, having an incubation period of 12 hours to 5 days [2].

Cholera is a waterborne disease which can easily spread when there is poor water, sanitation and hygiene practices (WaSH). According to updated data from World Health Organization (WHO), unsafe WASH practices accounts for an estimated 8.29 million deaths and 49.8 million disability-adjusted life years in 2016, with a mortality rate of 11.7 deaths per 100,000 people. The highest mortality rates associated with inadequate WASH were seen in low- and middle-income countries of South-East Asia and Africa, with 15.4 and 45.8 deaths per 100 000, respectively[3].

Cholera been among one of the diseases related to inadequate WASH affects 1.3 to 4 million people globally with a mortality rate of 21 to 143 deaths per 1,000 people. The cholera burden in the world has mostly affected Africa, Asia and Middle East[4].Sub-Saharan Africa has  accounted for approximately 60% cases and 68% of fatalities globally[5]. In Cameroon, the annual number of reported cases had increased over the years with 4026 cases in 1991, 5796 in 1996, 8005 in 2004 ,10,759 in 2010 and 26,621 cases in 2014[6].Despite the increase in the number of cases, the case fatality rate(CFR) has subsequently reduced over the years, with values of 12% in 1991, 8.3% in 1996, and 6.3% in 2010[7].

Of recent, a cholera outbreak was declared in Cameroon on the 29 of October 2021[8].The annual number of reported cases from the day the outbreak was declared to the 23 May 2023,was 16 859 suspected cases[9].Case fatality of 2% have been reported from the 6 regions of the country which was higher than WHO standard of CFR<1%[8].In response to the outbreak, cholera campaigns were implemented in the  different regions affected by the outbreak[10].

The increase in the number of individuals affected and a CFR>1% reported during the recent outbreak might be as a results of limited access to safe drinking water, poor hygienic practices, poor sewage disposal and recurrent cholera outbreak in neighbouring countries like Nigeria and Congo[6]. Moreover, the humanitarian crisis which occurred in the Southwest and Northwest region of the country has further led to displacement of people to inadequate and overcrowded camps. Furthermore, the climatic condition of the country prompt it to be at risk of natural disaster such as heavy rainfall and flooding which can subsequently increase the rate of cholera transmission[8].To conclude, a study carried out in Douala, Cameroon revealed wells as reservoirs of  vibrio cholerae[11].

1.2 Statement of problem

The Tiko Health district was among the epicenters during the recent cholera outbreak in Cameroon. To respond to the outbreak, a WaSH campaign was implemented in the Tiko Health District. Throughout the campaign period, the community was sensitized on cholera infections and preventions, application of safe excreta disposal, availability and use of safe drinking water and handwashing practices as well as cholera vaccins were given.

Although the outbreak was controlled, it is not clear whether or not inhabitants and health facilities in the Tiko Health District have consistently adhered to intervention guidelines and changed their practices to positive healthy WaSH behavior, which will promote the level of preparedness of the district in case of any subsequent outbreak.

1.3 Research Questions

1. What is the level of preparedness in controlling a cholera outbreak among the inhabitants of the Tiko Health District?
2. How knowledgeable are the inhabitants of Tiko Health District on the prevention of cholera?
3. What are the factors associated to the level of preparedness among the inhabitants of the Tiko Health District in controlling a cholera outbreak?
4. What is the level of preparedness of Health Facilities in controlling a cholera outbreak in the Tiko Health District?

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