Distinguishing social and cultural features of cholera in urban and rural areas of Western Kenya: Implications for public health

Abstract

Urban and rural areas have distinctive health problems, which require consideration. To examine sociocultural features of cholera and its community context, a semi-structured explanatory model interview based on vignettes depicting typical clinical features of cholera was used to interview 379 urban and rural respondents in Western Kenya. Findings included common and distinctive urban and rural ideas about cholera, and its prevention and treatment. The three most commonly perceived causes among urban and rural respondents collectively were drinking contaminated water, living in a dirty environment and lacking latrines. However, a dirty environment and flies were more prominently perceived causes among urban respondents. Rural respondents were less likely to identify additional symptoms and more likely to identify biomedically irrelevant perceived causes of cholera. Oral rehydration therapy was the most frequently reported home treatment. Health facilities were recommended unanimously at both sites. For prevention, rural respondents were more likely to suggest medicines, and urban respondents were more likely to suggest health education and clean food. Findings indicate community priority, demand for and potential effectiveness of enhanced efforts to control cholera in Western Kenya, and they suggest strategies that are particularly well suited for control of cholera in urban and rural areas.

Keywords:

• cholera
• urban–rural comparison
• cultural epidemiology
• illness explanatory models
• Western Kenya

Acknowledgements

The authors appreciate the contributions of the following people: Dr. Felix N. Kioli, research assistants, public health officers of Siaya and Kisumu East districts – namely, Fredrick Osanya, Philip Agutu and Elijah Oyola – and the district health management teams for both districts. Funding from the Bill & Melinda Gates Foundation is gratefully acknowledged. The authors alone are responsible for the views expressed in this publication, and they do not necessarily represent the decisions, policy or views of the World Health Organization.