Knowledge of Cholera Lacking in Regions Where the Disease is Most Prevalent

The findings of a recent study suggest that knowledge of cholera and its symptoms is sorely lacking among female caretakers in the Indian sub-continent—despite the fact that the disease has been present in the region for centuries.

A preliminary pilot study published online on February 9th by the Journal of Health, Population and Nutrition sought to assess the current level of understanding of the troubling infectious disease among female caretakers in Bangladesh, where the World Health Organization estimates there are as many as 110,000 cases each year. The authors of the study—from the Department of Public Health, Global Health Section at the University of Copenhagen in Denmark—administered a qualitative questionnaire to 85 such caretakers in an effort to evaluate their ability to identify cholera and its transmission.

Since women typically oversee most household activities and duties, including childcare, cooking, cleaning and water and food acquisition in Bangladeshi society, it is imperative that these women have proper background knowledge of the disease. According to the study authors, they also serve as “gatekeepers to seeking and providing treatment for cholera within a household.”

The questionnaire revealed that although female caretakers are generally aware of the term “cholera,” only 29% knew that diarrhea is associated with the disease, while only 56% identified a link between contaminated water and cholera, and a mere 8% linked the disease with poor sanitation or hygiene. In addition, “shame and stigma” were cited as a “negative” effect of cholera by 54% of the respondents, while death was only cited by 47%.

“What we found in this study was a disconnect between the medical and/or research interpretation of the term ‘cholera’ and the general public’s interpretation in Bangladesh,” study co-author Charlotte Tamason, PhD, a former doctoral student at the University of Copenhagen told Contagion. “We've since done further research, which is in the process of publication, [and have] found that respondents with lower incomes used the terms ‘cholera’ and ‘diarrhea’ interchangeably, but that these two terms were only used to describe what medical doctors would consider severe diarrheal illness. It is imperative that researchers and healthcare professionals understand the colloquial definitions of illnesses.”

Dr. Tamason, who has worked in Bangladesh since 2011, added that she believes that the confusion in terminology is due, at least in part, to the culture of the region, where “hundreds… of English words and phrases have been incorporated into local languages… but take on different meanings.” She noted that the country’s Cholera Hospital in Dhaka was founded in the mid-20th century, but was recently renamed International Centre for Diarrhoeal Disease Research, Bangladesh.

“It is an incredible institution that has done miracles for helping the Bangladesh population by reducing diarrhea morbidity and mortality,” she explained. “However, you can see how this association between severe symptoms and the western words ‘diarrhea’ and ‘cholera’ might have come to be. Even though a term, like cholera or even diarrhea, might be used colloquially, it may have a different meaning than the researchers or health professionals understand. When you try to reach at-risk populations with health-related messaging, [our study shows that] key points in understanding and perceived importance might be lost.”

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.