Social dynamics influencing cholera risk in the City of Goma, Democratic Republic of Congo: a qualitative study.

backgroundCholera remains a major and increasing global public health problem for all people without adequate access to safe water. Goma, in the eastern Democratic Republic of Congo (DRC), has been a major cholera hotspot in Africa since 1994 and is currently experiencing one of the largest outbreaks in the world. This article contributes to the existing scholarship on cholera risk by utilizing a variety of qualitative research methods. Goma offers several advantages to a study of cholera as a city on the shores of Kivu Lake, but where the majority of population does not have access to clean water and experiences recurrent cholera epidemic outbreaks.

methodsTwo local members of our research team are experts in public health and conducted all the interviews in Swahili and French. They also led transect walks and a participatory mapping workshop. Data were collected between 2021 and 2022 in six areas of Goma. Data were analysed using a qualitative software Open code 4.03 to generate codes for a thematic purpose.

resultsOur results show that the lack of water infrastructure was the main issue with cholera risk in Goma as it prompted use of unsafe drinking water from Lake Kivu, the small Lake vert and Mubambiro River. Additionally, there were specific social groups with an increased risk based on age and gender, health status, some occupational risks, and socio-economic status. Cholera risks were framed in relation to broader life-threatening events, such as natural disasters, that occurred in the city. Cholera risk was also ascribed to challenges with care seeking and treatment, and issues with implementation of prevention strategies. Finally, the lack of empowerment of local communities in cholera prevention measures was considered a secondary source of risk due to the emphasis on the public health outreach practices and short-term emergency responses.

conclusionThis work broadens our understanding of factors that contribute to cholera risk in Goma. These factors should be addressed by implementing diverse strategies that involve the affected communities rather than focusing on rapid public health outreach response interventions. In addition, the, development and the maintenance of a safe and reliable water infrastructures in the city is essential to reduce the chronic nature of cholera infection in the city of Goma.