CHAPTER ONE

INTRODUCTION

1.1 Background

 Cholera is an intestinal disease caused by the bacterium Vibrio cholera which spreads mainly through faecal contamination of water and food by infected individuals. Eating raw or undercooked seafood can also cause the infection since V. cholera was found on phyto- and zoo-plankton in marine, estuarine and riverine environments independent of infected human beings [1]. There are 240 serogroups of V. cholera, only -O1 and O139 –are pathogenic. Even though the global cholera burden is underestimated because of factors such as low reporting, limited epidemiological surveillance, and a lack of laboratory capacity, studies estimate that 1.3 to 4.0 million cholera cases and 21, 000 to 143,000 cholera- related deaths occur each year world-wide. The geographically biased nature of the disease is because some countries bear far more of the burden than others. In countries where cholera is endemic, an estimated 2.8 million cases of the disease are recorded annually and about 1.4 billion people are at risk [2]. A global strategy on cholera control, Ending Cholera: A global roadmap to 2030, with target to reduce cholera deaths by 90% was launched in 2017. [2]

Africa and Southern Asia account for 99% of all cholera cases worldwide. A majority of cholera epidemics and deaths have been reported in sub-Saharan Africa where the risk of cholera infection is high due to low health literacy [3]. Typical at-risk areas where basic infrastructure is not available and camps for internally displaced people where the minimum requirements of clean water and sanitation are not met [4]. The greatest risk occurs in overpopulated communities and refuge settings characterized by poor sanitation, unsafe drinking water and increased person to person transmission. A lot of the hotspots are in Africa, and nearly 40 million to 80 million people live in cholera hotspots on the continent alone [5]. The approximations of populations living in hotspot in some specific African countries include the Democratic Republic of Congo—23.8 million, Ethiopia—5.9 million, Nigeria—8.8 million, Kenya—2.8 million, Tanzania—6.5 million, and Cameroon—4.5 million [3].

However, risk factors for cholera in Cameroon have not been evaluated systematically. Numerous possible explanations for the outbreak reoccurrence exist, including poor hygiene and sanitation and environmental factors [5].The 2010 cholera epidemic in Cameroon affected 10,741 people and killed 650. An ever increasing number of cholera cases were registered almost everywhere in the first week of 2011 in Cameroon. The South West Region of Cameroon was affected by this epidemic. Hence, it is necessary to assess the health literacy on cholera and the vaccine uptake in the Buea Health District and to provide evidence-based cholera recommendations [6].

An increasing interest of the use of oral cholera vaccination as an additional strategy to water and sanitation interventions against endemic and epidemic cholera has been implemented. There are two internationally-available and WHO prequalified oral cholera vaccines: an inactivated vaccine containing killed whole-cells of V. cholerae O1 with recombinant cholera toxin B-subunit and a bivalent inactivated vaccine containing killed whole cells of V. cholerae O1 and V. cholerae O139.[7] To improve cholera control efforts in addition to maintaining and improving existing water supply, sanitation and hygiene behavior measures, the World Health Oraganization has considered the use of vaccines as an additional public health tool. Therefore, it is important to understand the current levels of knowledge of a given community to implement campaign programs, vaccination programs, and other preventive measures [8].

1.2 Problem statement

Cholera continues to be a significant public health problem in many developing countries causing substantial morbidity and mortality. It is an indicator of socioeconomic problems and is a global threat to public health. While studies have investigated functional, interactive, and critical health literacy on foodborne diseases, as well as the development of a cholera-focused health literacy tool, we could not find limited studies on the knowledge, attitudes, and practices of consumers in poor urban neighborhoods on cholera from a health literacy perspective. Therefore, this study attempts to examine individual’s basic knowledge of cholera risk factors, knowledge of cholera signs, personal hygiene practices, the vaccine of interest and food safety practices using a health literacy framework in a cholera-endemic community.

1.3 Research Questions

• How can cholera be prevented?
• Have you been vaccinated against cholera?
• What knowledge do you have about the vaccine of interest?

1.4 Research Hypotheses

• An increase in Heath literacy on cholera prevention leads to lower likelihood to have the disease.
• Negative attitude towards cholera vaccine leads to poor practice towards vaccine uptake.
• An increase in health literacy competency score is associated with the uptake of oral cholera vaccine.

1.5 Research Objectives

• General objectives

This study aims to assessing the health literacy on cholera, and the association between health literacy competency and the uptake of the oral cholera vaccine of inhabitants in the muea health area.

• Specific objectives

1. To measure the level of Health literacy on cholera prevention.
2. To know the attitude towards the uptake of the Oral cholera vaccine.
3. To determine the association between health literacy competency and the uptake of oral cholera vaccine.