Factors associated with the recurrence of cholera outbreaks in Bunyole east county, Butaleja district Uganda: a comparative study.

Abstract

Background: Despite the strides that have been made around the globe in the area of sanitation, infrastructure and education, cholera continues to ravage communities in low income countries like Uganda. Bunyole East County has experienced recurrent cholera outbreaks over the years but there has been limited research on the reasons why these outbreaks have continued to occur in the district. Objective: To assess the factors influencing the recurrence of cholera outbreaks in Bunyole East County so as to help the policy makers and development partners prevent future outbreaks. Methods: A comparative cross sectional study was conducted in Butaleja district. Bunyole East County, a county with high cholera recurrence was compared to Bunyole West County, a county with no cholera recurrence. Both quantitative and qualitative methods were used and multistage cluster sampling was used to select household heads to be interviewed. Seven Key informant interviews and four focussed group discussion were held to explore the factors influencing cholera recurrence in these counties. Chi square tests were performed to test differences between the counties. Results: A total of 210 households in Bunyole West County and 209 in Bunyole East County were interviewed. Overall, the knowledge levels on spread of cholera, prevention and hand washing were 53.7%, 46.8% and 11.5% respectively. There were significant differences in religion (p<0.001), tribe (p<0.01), and occupation (p<0.001) between the selected counties. A significantly (p<0.01) higher proportion of respondents from Bunyole East county had no knowledge on how cholera is spread 14.3% vs 4.8%, no knowledge on how cholera is prevented 15.7% vs 5.3%, and no knowledge on when hands should be washed with soap 11.4% vs 2.9%, than those in Bunyole West county. Cholera outbreaks occurred during the rainy season and those over 35 years most were the most affected. The low water table in Bunyole East sub counties made the construction of sanitary facilities harder than in Bunyole West and a functional Cholera surveillance system was lacking in the district. Conclusion and recommendation: The knowledge levels on cholera prevention and spread was lower in Bunyole East County than in Bunyole West County. There is need for continuous sensitization on cholera in the district in order to improve on community awareness. Communities in the cholera recurrent area should be supported to construct flood resilient sanitary facilities.