ArticlePloS one2022
How does handwashing behaviour change in response to a cholera outbreak? A qualitative case study in the Democratic Republic of the Congo.
Article in PloS one, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 17 citations in OpenAlex.
- Knowledge of cholera, handwashing practice and its associated factors in Hayayaabe IDP camp, Borama, Somaliland: a community-based study.BMC public health · 2025Article
- Predictors of Cholera and Acute Watery Diarrhea among Climate-Vulnerable People Living in Cabo Delgado, Mozambique: A Cross-Sectional Study.The American journal of tropical medicine and hygiene · 2025Article
- Determinants of access to basic handwashing facilities and handwashing with soap in low-income areas of four Kenyan cities.PLOS global public health · 2025Article
- Cholera Outbreaks in Low- and Middle-Income Countries in the Last Decade: A Systematic Review and Meta-Analysis.Microorganisms · 2024Review
- The determinants of handwashing in humanitarian crisis setting during the COVID-19 pandemic: a multi-country analysis.Health promotion international · 2024Article
- Impacts of climate change on diarrhoeal disease hospitalisations: How does the global warming targets of 1.5-2°C affect Dhaka, Bangladesh?PLoS neglected tropical diseases · 2024Article
- Article
- Social and Behavioural Change Communication Challenges, Opportunities and Lessons from Past Public Health Emergencies and Disease Outbreaks: A Scoping Review.Annals of global health · 2024Article
- A stitch in time: The importance of water and sanitation services (WSS) infrastructure maintenance for cholera risk. A geospatial analysis in Harare, Zimbabwe.PLoS neglected tropical diseases · 2023Article
- Potential threats of cholera amidst COVID pandemic in the Democratic Republic of Congo; bridging the gaps: a review.Annals of medicine and surgery (2012) · 2023Article
- The Cholera outbreak in Karachi, Pakistan: Challenges, efforts and recommendations.Annals of medicine and surgery (2012) · 2022Article
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHandwashing with soap has the potential to curb cholera transmission. This research explores how populations experienced and responded to the 2017 cholera outbreak in the Democratic Republic of the Congo and how this affected their handwashing behaviour.
methodsCholera cases were identified through local cholera treatment centre records. Comparison individuals were recruited from the same neighbourhoods by identifying households with no recent confirmed or suspected cholera cases. Multiple qualitative methods were employed to understand hand hygiene practices and their determinants, including unstructured observations, interviews and focus group discussions. The data collection tools and analysis were informed by the Behaviour Centred Design Framework. Comparisons were made between the experiences and practices of people from case households and participants from comparison households.
resultsCholera was well understood by the population and viewed as a persistent and common health challenge. Handwashing with soap was generally observed to be rare during the outbreak despite self-reported increases in behaviour. Across case and comparison groups, individuals were unable to prioritise handwashing due to competing food-scarcity and livelihood challenges and there was little in the physical or social environments to cue handwashing or make it a convenient, rewarding or desirable to practice. The ability of people from case households to practice handwashing was further constrained by their exposure to cholera which in addition to illness, caused profound non-health impacts to household income, productivity, social status, and their sense of control.
conclusionsEven though cholera outbreaks can cause disruptions to many determinants of behaviour, these shifts do not automatically facilitate an increase in preventative behaviours like handwashing with soap. Hygiene programmes targeting outbreaks within complex crises could be strengthened by acknowledging the emic experiences of the disease and adopting sustainable solutions which build upon local disease coping mechanisms.
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