Healthcare Seeking Behavior and Disease Perception Toward Cholera and Acute Diarrhea Among Populations Living in Cholera High-Priority Hotspots in Shashemene, Ethiopia.

Abstract

Healthcare seeking behavior (HSB) and community perception on cholera can influence its management. We conducted a cross-sectional survey to generate evidence on cholera associated HSB and disease perception in populations living in cholera hotspots in Ethiopia. A total of 870 randomly selected households (HHs) in Shashemene Town (ST) and Shashemene Woreda (SW) participated in our survey in January 2022. Predominant HHs (91.0%; 792/870) responded "primary health center" as the nearest healthcare facility (HCF). Around 57.4% (247/430) of ST HHs traveled <30 minutes to the nearest HCF. In SW, 60.2% (265/440) of HHs travelled over 30 minutes and 25.9% (114/440) over 4 km. Two-thirds of all HHs paid <USD1 travel cost; SW residents had slightly higher cost burden. When cholera symptoms occur, 68.0% (83/122), 75.5% (114/151), 100.0% (52/52), and 100.0% (426/426) of 0-4, 5-14, 15-17, and ≥18 years, respectively, in ST sought healthcare at our sentinel-HCFs. In SW, younger children visited our sentinel-HCFs slightly more (82.6%, 86.7% in 1-4, 5-14 years, respectively) than older age groups (74.4%, 75.6% in 15-17, ≥ 18 years, respectively). Relatively more adults in ST (12.0%; 51/426) sought over-the-counter drugs at pharmacies than those in SW (2.5%; 11/435). Around 73.8% (642/870) of HHs were aware of cholera disease and 66.7% (428/642) of HHs considered eating unclean food as main causes of cholera. Variations in cholera prevention practices between rural and urban residents were shown. Addressing differences in HSB per age groups is needed for community engagement for early case detection and case management; critical in reducing cholera deaths and transmission.