In 2017 Somalia experienced the worst cholera outbreak in five years, with over 79,000 cases and over 1,100 deaths, mainly among children under five years (1). Longitudinal analysis of case reports confirms that despite many years of public health interventions, cholera remains a recurring and major risk to vulnerable communities in the country. To better inform emergency health intervention programmes, Africa’s Voices collaborated with researchers at the University of Cambridge’s Centre of Governance and Human Rights to evaluate our interactive radio approach to better understand perceptions of cholera risk and preparedness.
The project was part of a two-phase piece of work funded by Wellcome Trust and the Department for International Development (DfID), focusing on infectious disease outbreaks and emergency contexts. The first phase was completed in Cape Verde in 2017 and focused on Zika. The second phase, which took place between March – October 2018, centred around cholera in Somalia.
What we did
Building on our established partnership with Somali NGO Media INK and previous work with UNICEF, the project evaluated interactive radio and SMS as a means of understanding perceptions of cholera risk and preparedness among communities in the South Central Zone of Somalia. The data could serve as an early warning ahead of an outbreak but also point to specific socio-cultural factors that could influence a programmatic intervention during a future cholera outbreak.
Over the course of five weeks, we heard from 6,688 people in Mogadishu, Kismayo, Baidoa, and Beledweyne who sent in 12,005 messages in response to open-ended questions posed on interactive radio shows. 45% of them were women, 23% were displaced, and 70% under the age of 25.
63% (2,459 people) perceived their communities to be at risk of cholera. Most of them were rural dwellers. Hygiene (or lack of) was the primary reason for feeling protected or at risk, suggesting that broad knowledge of cholera risk factors is high.
How can this method be used to improve outbreak responses?
It helps focus control efforts
One of the key findings of the project was that communities with a high number of cholera cases were less likely to report feeling at risk because they have access to water. This could help focus cholera control efforts by highlighting the need to confirm whether the water sources used by the high risk groups are clean and safe.
Cholera is endemic in Somalia and outbreaks occur during both the rainy and dry seasons. Rapid understanding of community perceptions of risk and how they correlate with actual risk could help refine public health response efforts.
It’s a rapid, scalable and trusted space for two-way communication
During the recent Ebola outbreak in the Democratic Republic of Congo, there has been widespread community distrust of health agencies. Several clinics which treat EVD patients were burnt down.
There is a clear need for rapid two-way communication with at risk and affected communities to understand their concerns and refine outbreak responses to incorporate and address their fears.
PHOTO CREDIT: AMUNGA ESCUCHI, TROCAIRE