Knowledge, attitude and practices on cholera in an arid county, Kenya, 2018: A mixed-methods approach

BACKGROUND: Cholera remains a public health problem in Kenya despite increased efforts to create awareness. Assessment of knowledge, attitude and practice (KAP) in the community is essential for the planning and implementation of preventive measures. We assessed cholera KAP in a community in Isiolo County, Kenya. METHODS: This cross-sectional study involved a mixed-methods approach utilizing a questionnaire survey and focus group discussions (FGDs). Using multistage sampling with household as the secondary sampling unit, interviewers administered structured questionnaires to one respondent aged ≥18 years old per household. We created knowledge score by allotting one point for each correct response, considered any total score ≥ median score as high knowledge score, calculated descriptive statistics and used multivariate logistic regression to examine factors associated with high knowledge score. In FGDs, we randomly selected the participants aged ≥18 years and had lived in Isiolo for >1 year, conducted the FGDs using an interview guide and used content analysis to identify salient emerging themes. RESULTS: We interviewed 428 participants (median age = 30 years; Q1 = 25, Q3 = 38) comprising 372 (86.9%) females. Of the 425/428 (99.3%) who had heard about cholera, 311/425 (73.2%) knew that it is communicable. Although 273/428 (63.8%) respondents knew the importance of treating drinking water, only 216/421 (51.3%) treated drinking water. Those with good defecation practice were 209/428 (48.8%). Respondents with high knowledge score were 227/428 (53.0%). Positive attitude (aOR = 2.88, 95% C.I = 1.34–6.20), treating drinking water (aOR = 2.21, 95% C.I = 1.47–3.33), age <36 years (aOR = 1.75, 95% C.I = 1.11–2.74) and formal education (aOR = 1.71, 95% C.I = 1.08–2.68) were independently associated with high knowledge score. FGDs showed poor latrine coverage, inadequate water treatment and socio-cultural beliefs as barriers to cholera prevention and control. CONCLUSIONS: There was a high knowledge score on cholera with gaps in preventive practices. We recommend targeted health education to the old and uneducated persons and general strengthening of health education in the community.