Maisha Felicien Masanga, Mbasa Ndemo Mumbere, Ulikuwe Kennedy, Kahatwa Serge, Mulligan Connie, Morris Glenn, Bardosh Kevin
Department of Sociology, college of humanity and social sciences, University of Goma.
College of Health Sciences, Université Libre des Pays des Grands Lacs.
Res Sq. 2024 Dec 9:rs.3.rs-5275711. doi: 10.21203/rs.3.rs-5275711/v1.
Cholera remains a major (and increasing) global public health problem. Goma, in the eastern Democratic Republic of Congo (DRC), has been a major cholera hotspot in Africa since 1994 and is currently experiencing one of the largest outbreaks in the world. This article contributes to the existing scholarship on cholera risk by utilizing a variety of qualitative research methods.
Data were collected between 2021 and 2022 using in-depth interviews, narrative interviews, key informant interviews, transect walks and a participatory mapping workshop, in six areas of Goma. Local understanding of cholera risk stretched across five categories.
First, specific social groups were at increased risk based on age and gender (children, women, elderly), health status (chronic diseases, exposure to cholera treatment centers [CTC]), occupational risks (fishermen, markets) and socio-economic status (impoverished households, refugees, prisoners). Second, cholera risks were framed in relation to broader events such as conflict, population growth, climate change, and volcanic eruptions. Third, the lack of water infrastructure prompted use of unsafe drinking water from Lake Kivu and surrounding lakes. Accessibility of chlorinated water sources was impacted by social connection and cost. Fourth, cholera risk was ascribed to challenges with care seeking and treatment, such as homecare practices, transportation, and substandard practices at CTCs; and issues with implementation of prevention strategies, including vaccination campaigns. Finally, public health outreach practices were viewed as sources of risk by an overemphasis of emergency response teams and insufficient empowerment of communities.
We offer new empirical perspectives on the range of factors that contribute to cholera risk in Goma. These factors should be addressed by implementing diverse strategies, rather than focusing on rapid response interventions. Specifically, development of a safe and reliable water system to treat the chronic nature of cholera infection in the DRC should be prioritized.
霍乱仍然是一个重大（且呈上升趋势）的全球公共卫生问题。自1994年以来，刚果民主共和国（DRC）东部的戈马一直是非洲主要的霍乱热点地区，目前正经历着世界上最大规模的疫情之一。本文通过运用多种定性研究方法，为现有的霍乱风险学术研究做出了贡献。
2021年至2022年期间，在戈马的六个地区采用深度访谈、叙事访谈、关键信息人访谈、横断面走访和参与式绘图工作坊收集数据。当地对霍乱风险的理解涵盖五个类别。
首先，特定社会群体因年龄和性别（儿童、妇女、老年人）、健康状况（慢性病、接触霍乱治疗中心[CTC]）、职业风险（渔民、市场从业人员）和社会经济地位（贫困家庭、难民、囚犯）而面临更高风险。其次，霍乱风险与冲突、人口增长、气候变化和火山爆发等更广泛的事件相关。第三，缺乏供水基础设施促使人们使用来自基伍湖和周边湖泊的不安全饮用水。氯化水源的可及性受到社会关系和成本的影响。第四，霍乱风险归因于寻求护理和治疗方面的挑战，例如家庭护理做法、交通以及霍乱治疗中心的不规范做法；以及预防策略实施方面的问题，包括疫苗接种运动。最后，公共卫生外展做法被视为风险来源，原因是应急响应团队过度强调以及社区赋权不足。
我们为导致戈马霍乱风险的一系列因素提供了新的实证观点。应通过实施多样化策略来应对这些因素，而不是专注于快速反应干预措施。具体而言，应优先发展安全可靠的供水系统，以应对刚果民主共和国霍乱感染的长期性。
