Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Independent Consultant, Goma, Democratic Republic of the Congo.
PLoS One. 2022 Apr 12;17(4):e0266849. doi: 10.1371/journal.pone.0266849. eCollection 2022.
Handwashing with soap has the potential to curb cholera transmission. This research explores how populations experienced and responded to the 2017 cholera outbreak in the Democratic Republic of the Congo and how this affected their handwashing behaviour.
Cholera cases were identified through local cholera treatment centre records. Comparison individuals were recruited from the same neighbourhoods by identifying households with no recent confirmed or suspected cholera cases. Multiple qualitative methods were employed to understand hand hygiene practices and their determinants, including unstructured observations, interviews and focus group discussions. The data collection tools and analysis were informed by the Behaviour Centred Design Framework. Comparisons were made between the experiences and practices of people from case households and participants from comparison households.
Cholera was well understood by the population and viewed as a persistent and common health challenge. Handwashing with soap was generally observed to be rare during the outbreak despite self-reported increases in behaviour. Across case and comparison groups, individuals were unable to prioritise handwashing due to competing food-scarcity and livelihood challenges and there was little in the physical or social environments to cue handwashing or make it a convenient, rewarding or desirable to practice. The ability of people from case households to practice handwashing was further constrained by their exposure to cholera which in addition to illness, caused profound non-health impacts to household income, productivity, social status, and their sense of control.
Even though cholera outbreaks can cause disruptions to many determinants of behaviour, these shifts do not automatically facilitate an increase in preventative behaviours like handwashing with soap. Hygiene programmes targeting outbreaks within complex crises could be strengthened by acknowledging the emic experiences of the disease and adopting sustainable solutions which build upon local disease coping mechanisms.
用肥皂洗手具有遏制霍乱传播的潜力。本研究探讨了人群如何体验和应对 2017 年刚果民主共和国的霍乱疫情，以及这如何影响他们的洗手行为。
通过当地霍乱治疗中心的记录确定霍乱病例。通过在同一社区中确定最近没有确诊或疑似霍乱病例的家庭，招募对照个体。采用多种定性方法了解手卫生习惯及其决定因素，包括非结构化观察、访谈和焦点小组讨论。数据收集工具和分析以行为中心设计框架为指导。比较了病例家庭和对照家庭的经验和做法。
霍乱被人群所理解，被视为持续存在的常见健康挑战。尽管自我报告的行为有所增加，但在疫情期间，人们普遍观察到用肥皂洗手的情况很少。在病例组和对照组中，由于食物短缺和生计挑战的竞争，个人无法优先考虑洗手，并且环境中几乎没有提示洗手或使其变得方便、有回报或值得练习的因素。病例家庭的人洗手的能力进一步受到他们接触霍乱的限制，除了疾病之外，霍乱还对家庭收入、生产力、社会地位和控制感造成了严重的非健康影响。
即使霍乱疫情可能会破坏行为的许多决定因素，但这些变化并不会自动促进预防性行为（如用肥皂洗手）的增加。针对复杂危机中的疫情的卫生方案可以通过承认疾病的本地经验并采用基于本地疾病应对机制的可持续解决方案来加强。
