| dc.description.abstract | Isiolo County accommodates nomadic pastoralists with sedentary lifestyles. Since 2010, the
county has had cholera incidences every year apart from 2014. In 2013 alone for instance, Isiolo
confirmed 8 deaths from cholera (WHO, 2013); in 2016, 10 people were confirmed positive and
500 others treated from exposure (Relief web, 2016); in 2018, Isiolo was one of the six counties
that contributed a cumulative of 2943 cholera cases with 55 fatalities (Reliefweb, 2018). There is
a dearth of evidence on factors associated with the re-emergence and spread of cholera in Isiolo
County. This cross sectional study applied simple random and purposive sampling of households
and health care providers respectively, to assess how knowledge and attitude factors,
environmental health factors and health system factors influence occurrence of cholera in Isiolo
County. We employed Fischer’s formula to obtain a sample of 401 respondents. Results indicate
that participants interviewed were of modal age 20-39 (60.3%). There were more female
respondents (62.6%) than male (37.4%). The majority (75.8%) were married and 76.8% had
acquired some form of education ranging from primary to tertiary level. A bigger proportion of
participants (69.3%) had no employment at all and majority of those who worked were self employed (70%) earning a monthly household income of < 1000.00 shillings. 37.2% of the
respondents reported having had at least a case of acute watery diarrhea in the past one week from
a family member aged 5 years and above. Overall, evidence from this study shows that respondents
who knew proper use of toilets (ₐOR=1.38; 95% CI 0.80,2.37) and washing hands after using the
toilet (ₐOR=3.54; 95% CI 1.42, 8.81; p=0.01) as preventive ways, were less likely to experience
occurrence of cholera compared to those who did not. Not washing hands after handling children’s
feaces (ₐOR=1.98; 95% CI 1.13, 3.46; p=0.02); consuming unwashed fruits or vegetables (ₐOR
=0.41; 95% CI 0.25, 0.69) proper cooking of food as a practice (ₐOR=0.52; 95% CI 0.28, 0.96;
p=0.04) were found to be significant predictors to occurrence of cholera. Those who were willing
to let a child receive cholera vaccine (OR=1.96; 95% CI, 1.14, 3.34); knew fever as a symptom
(ₐOR=0.57; 95% CI 0.33, 0.98; p=0.04) were also less likely to experience occurrence of cholera.
We conclude that occurrence of cholera is predicted by knowing prevention measures such as
proper use of toilet and washing hands after use of toilet. Hygiene factors including not washing
hands after handling children’s feces, consuming unwashed fruits or vegetables and proper
cooking of food were also found to be significantly associated with cholera occurrence.
Willingness to let a child receive cholera vaccine and knowledge of cholera symptoms predicted
occurrence. The study recommends extensive health education in the county with specific focus
on sensitization on the role of sanitation and general hygiene in prevention of cholera. This would
require that (i) safety of drinking water is ensured (ii) the importance of toilet ownership is
emphasized and (iii) the community is sensitized on the need to present themselves for vaccination
against cholera. County health sector stakeholders should explore opportunities to adjust the
current service delivery model to address predictor factors not proximal to the community like
hospital distance to improve access to healthcare. | en_US |
