Open Access Open Badges Research article

Comparing sociocultural features of cholera in three endemic African settings

Christian Schaetti12, Neisha Sundaram12, Sonja Merten12, Said M Ali3, Erick O Nyambedha4, Bruno Lapika5, Claire-Lise Chaignat6, Raymond Hutubessy7 and Mitchell G Weiss12*

Author Affiliations

1 Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, PO Box, 4002, Basel, Switzerland

2 University of Basel, Petersplatz 1, 4003 Basel, Switzerland

3 Public Health Laboratory Ivo de Carneri, PO Box 122, Wawi, Chake-Chake, Pemba, Zanzibar, United Republic of Tanzania

4 Department of Sociology and Anthropology, Maseno University, Private Bag, Maseno, Kenya

5 Department of Anthropology, University of Kinshasa, PO Box 127, Kinshasa XI, Democratic Republic of Congo

6 Global Task Force on Cholera Control, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland

7 Initiative for Vaccine Research, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland

For all author emails, please log on.

BMC Medicine 2013, 11:206  doi:10.1186/1741-7015-11-206

Published: 18 September 2013



Cholera mainly affects developing countries where safe water supply and sanitation infrastructure are often rudimentary. Sub-Saharan Africa is a cholera hotspot. Effective cholera control requires not only a professional assessment, but also consideration of community-based priorities. The present work compares local sociocultural features of endemic cholera in urban and rural sites from three field studies in southeastern Democratic Republic of Congo (SE-DRC), western Kenya and Zanzibar.


A vignette-based semistructured interview was used in 2008 in Zanzibar to study sociocultural features of cholera-related illness among 356 men and women from urban and rural communities. Similar cross-sectional surveys were performed in western Kenya (n = 379) and in SE-DRC (n = 360) in 2010. Systematic comparison across all settings considered the following domains: illness identification; perceived seriousness, potential fatality and past household episodes; illness-related experience; meaning; knowledge of prevention; help-seeking behavior; and perceived vulnerability.


Cholera is well known in all three settings and is understood to have a significant impact on people’s lives. Its social impact was mainly characterized by financial concerns. Problems with unsafe water, sanitation and dirty environments were the most common perceived causes across settings; nonetheless, non-biomedical explanations were widespread in rural areas of SE-DRC and Zanzibar. Safe food and water and vaccines were prioritized for prevention in SE-DRC. Safe water was prioritized in western Kenya along with sanitation and health education. The latter two were also prioritized in Zanzibar. Use of oral rehydration solutions and rehydration was a top priority everywhere; healthcare facilities were universally reported as a primary source of help. Respondents in SE-DRC and Zanzibar reported cholera as affecting almost everybody without differentiating much for gender, age and class. In contrast, in western Kenya, gender differentiation was pronounced, and children and the poor were regarded as most vulnerable to cholera.


This comprehensive review identified common and distinctive features of local understandings of cholera. Classical treatment (that is, rehydration) was highlighted as a priority for control in the three African study settings and is likely to be identified in the region beyond. Findings indicate the value of insight from community studies to guide local program planning for cholera control and elimination.

Endemic cholera; Sociocultural features; Community study; Eastern Africa