Abstract

Research Article

Cholera: Knowledge, Attitudes and Practices from Indigenous Peoples of Mombénzélé in Likouala to the Republic of Congo

Médard Amona*, Yolande Voumbo Matoumona Mavoungou, Tatia Adoua Doukaga, Martin Herbas Ekat, Youssef Ludovic Hervé Gnekoumou Libaba, Youba Kandako, Vincent Dossou Sodjinou and Pascal Ibata

Published: 21 July, 2026 | Volume 9 - Issue 1 | Pages: 45-54

Introduction: In the Republic of Congo, Mombénzélé village’s an area endemic for cholera where environmental and socio-economic factors favor the persistence of the epidemic. This study assessed the knowledge, attitudes, and practices (KAP) of the indigenous peoples of Mombénzélé regarding cholera to design culturally appropriate and sustainable prevention strategies.
Materials and methods: This was a preliminary cross-sectional pilot study, descriptive and analytical in nature, conducted from April 21 to 31, 2026, in the indigenous community of Mombénzélé (Impfondo district, Republic of Congo). The study assessed adults. Convenience sampling was used. Data were collected via a questionnaire in Lingala and face-to-face interviews, with secure data entry on tablets. Analysis using SPSS, including socio-demographic profiles, KAP variables, and chi-square tests (p < 0.05), was conducted in strict compliance with ethical principles and anonymization guidelines. 
Results: The population studied is predominantly male (60%) and without formal education (92%). Cholera is largely unknown to 92% of individuals, who believe exclusively in mystical causes. Hygiene practices are dangerous, with a complete lack of water treatment (100%) and systematic recourse to traditional healers (60%). Vulnerability is exacerbated by open defecation (56% in the river) and a refusal to use chlorinated water (88%). Sociodemographic factors significantly influence behaviors, notably age, which impacts funeral practices (p = 0.033), and educational level, which determines access to the river (p = 0.0033). The main activity influences the consumption of treated water (p = 0.0218) and determines (p = 0.000026) funeral practices. Household size impacts the perception of cholera lethality (p = 0.009) and guides the choice of funeral practices (p = 0.045).
Discussion: A cholera epidemic has struck the Mombénzélé village, affecting 96% of adults and exacerbated by a complete lack of awareness of the symptoms and a rejection of chlorinated water. The health crisis has driven 76% of the population to traditional medicine. 
Conclusion: To contain the health crisis in Mombénzélé, it’s essential to deploy a strategy combining the training of bilingual mediators and the improvement of water infrastructure, in order to overcome the lack of information on the transmission of cholera and to adapt prevention to the realities and cultural barriers of the indigenous community.

Read Full Article HTML DOI: 10.29328/journal.ijcmbt.1001040 Cite this Article Read Full Article PDF

Keywords:

Cholera; Knowledge; Attitudes; Practices; Indigenous peoples; Republic of Congo

References

  1. Global Task Force on Cholera Control (GTFCC). Field Response Manual for Cholera Outbreaks [Internet]. Geneva: GTFCC; Dec 2024 [cited 1 Jul 2026]. Available from:https://www.gtfcc.org/wp-content/uploads/2024/12/manuel-d-intervention-du-gtfcc-sur-le-terrain-en-cas-depidemie-de-cholera.pdf.
  2. World Health Organization. Cholera [Internet]. Geneva: WHO; 5 Dec 2024 [cited 1 Jul 2026]. Available from: https://www.who.int/fr/news-room/fact-sheets/detail/cholera.
  3. World Health Organization. Regional Office for Africa. Cholera Outbreak in the Republic of the Congo: Situation Report No. 43 [Internet]. Brazzaville: WHO; 2026 May 1 [cited 2026 July 1]. Available from:https://www.afro.who.int/sites/default/files/2026-05/sitrep_n43_cholera_republique_du_congo_au_01_%20mai_2026.pdf.
  4. Amona M, Matoumona Mavoungou YV, Doukaga TA, Ekat M, Mabiala A, Mankou M, et al. Cholera: Determinants of the Disease and Prospects for Control in the Congo-Ubangui River Corridor in the Republic of Congo. Int J Dermatol Clin Res. 2026;12(1):17-27. Available from: https://dx.doi.org/10.17352/2455-8605.000058.
  5. Cooper S, Mwamba J, Ilunga M. Climate change, population displacement, and the resurgence of waterborne diseases in Central and Sub-Saharan Africa. Field Actions Sci Rep. 2025;27(1):45-52.
  6. Mba D, et al. Outbreak of cholera in the Southwest region of Cameroon, 2021-22: epidemiological description and risk factors. BMC Public Health. 2024 Dec 25;24(1):356.
  7. Ilic I, Ilic M. Global Patterns of Trends in Cholera Mortality. Nalin D, Frean J, editors. Too Med Infect Dis. 2023 Mar 13;8(3):169. Available from: https://doi.org/10.3390/tropicalmed8030169.
  8. Breurec S, Franck T, Njamkepo E, Mbecko JR, Rauzier J, Sanke-Waïgana H, et al. Seventh Pandemic Vibrio cholerae O1 Sublineages, Central African Republic. Emerg Infect Dis. 2021 Jan;27(1):262-6. Available from: https://dx.doi.org/10.3201/eid2701.200375.
  9. Mboringong AB, Ngomtcho SCH, Ndip Ndip R, Esso Endalle L, Dibog LB, Mendjime P, et al. Trends of cholera epidemics and associated mortality factors in Cameroon: 2018-2023: a cross-sectional study. BMC Public Health. 2025 May 16;25:1816. Available from: https://dx.doi.org/10.1186/s12889-025-23007-5.
  10. UNESCO [United Nations Educational, Scientific and Cultural Organization]. Central African Republic (CAR): Policy Brief on Education [Internet]. Dakar: UNESCO; [01 July 2026]. Available from: https://www.iicba.unesco.org/fr/central-african-republic-car.
  11. Ndjebet C, Ngono F. The resource spaces of Baka hunter-gatherers in Cameroon (CARPE): A precise demographic and socio-economic report that maps the use of the forest for hunting and rituals. Yaoundé: CARP; 2020.
  12. Bahuchet S. The Pygmies of today in Central Africa. Journal of Africanists. 1991;61(1):5-35.
  13. Bompangue D, Giraudoux P, Handschumacher P, Piarroux M, Sudre B, Ekwanzala M, et al. Lakes as source of cholera outbreaks, Democratic Republic of Congo. Emerg Infect Dis. 2008 May;14(5):798-800. Available from: https://dx.doi.org/10.3201/eid1405.071260.
  14. Rebaudet S, Sudre B, Faucher B, Piarroux R. Environmental determinants of cholera outbreaks in inland Africa: a systematic review of main transmission foci and propagation routes. J Infect Dis. 1 Nov 2013;208 Suppl 1:S46-54. Available from: https://dx.doi.org/10.1093/infdis/jit195.
  15. Chipeta MG, Kumaran EPA, Browne AJ, Kashef Hamadani BH, Haines-Woodhouse G, Sartorius B, et al. Mapping local variation in household overcrowding across Africa from 2000 to 2018: a modeling study. Lancet Planet Health. 2022 Aug 3;6(8):e670-e681. Available from: https://dx.doi.org/10.1016/S2542-5196(22)00149-8.
  16. World Bank. Housing Crisis and Slum Upswing: The Housing Sector Review in Sub-Saharan Africa [Internet]. Washington, DC: World Bank; [Accessed July 3, 2026]. Available from: World Bank.
  17. Murhabazi JN, Kimanuka CR, Tsongo KZ, Kabesha BTA, Birikunjira WB, Inipavudu BJ, Munembwe CB, Zita MM, Wembonyama OS. Household knowledge, attitudes, and practices regarding prepayment for healthcare in an urban African setting: The case of the city of Goma (Karisimbi and Goma Health Zones) in eastern DRC. Kivu Medical Journal 2024; 2(2), 1-11.
  18. Sambo DA, Menga HNT. Factors Associated with the Recurrence of Cholera in the Souari Dépôt District of Garoua (North Cameroon): A KAP Study. Health Res Afr. Apr 2024;2(4):19-23. Available from: http://hsd-fmsb.org/index.php/hra
  19. Kayembe HCN, Bompangue D, Linard C, Muwonga J, Moutschen M, Situakibanza H, Ozer P. Modalities and preferred routes of geographic spread of cholera from endemic areas in eastern Democratic Republic of the Congo. PLoS One. 2022 Feb 7;17(2):e0263160. Available from: https://dx.doi.org/10.1371/journal.pone.0263160.
  20. Yannick Musawu Kabadi et al. Obstacles to cholera elimination in Pakadjuma, Kinshasa, Democratic Republic of Congo. PAMJ-One Health. 2025;17:17. Available from: https://dx.doi.org/10.11604/pamj-oh.2025.17.17.48242.
  21. Africa Centers for Disease Control and Prevention. Cholera in African Union Member States [Internet]. Addis Ababa: Africa CDC; 2023 May 31 [cited 2026 July 3]. Available from: au.int.
  22. Kashinde MT, Kyombo MG, Senga R, Ngona MC, Kalonji T, Mpangi S, et al. Knowledge, attitudes and practices of populations living in cholera endemic areas in North Kivu Province. Health Sci Dis. 2023 Apr;24(4):82-87.
  23. Elimian KO, Musah A, Ochu CL, Onwah SS, Oyebanji O, Yennan S, et al. Identifying and quantifying the factors associated with cholera-related death during the 2018 outbreak in Nigeria. Pan Afr Med J. 2020 Dec 22;37:368.
  24. Kayembe HC, Bompangue D, Linard C, Mandja BA, Batumbo D, Matunga M, et al. Drivers of the dynamics of the spread of cholera in the Democratic Republic of the Congo, 2000-2018: An eco-epidemiological study. PLoS Negl Too Say. 2023 Aug 28;17(8): e0011597. Available from: https://dx.doi.org/10.1371/journal.pntd.0011597.
  25. Ssemanda I, Kibwika B, Namusoosa R, Kwesiga B, Bulage L, Migisha R, Ario AR. Evaluation of response to a cholera outbreak in January 2024 using the 7-1-7 timeliness metrics: a case study of Elegu Point of Entry, Uganda. BMC Public Health. 2024 Dec 4;24(1):3370. Available from: https://dx.doi.org/10.1186/s12889-024-20886-y.
  26. Maisha FM, Mbasa NM, Ulikuwe KM, Kahatwa S, Mulligan CJ, Morris JG, Bardosh K. Social dynamics influencing cholera risk in the City of Goma, Democratic Republic of Congo: a qualitative study. BMC Public Health. 2025 May 15;25:1782.
  27. Lantagne D, Yates T. Household Water Treatment and Cholera Control. J Infect Dis. 2018;218(Suppl 3):S147-S153.
  28. Ofouémé Berton Y. Water supply for rural populations in Congo-Brazzaville. Les Cahiers d'Outre-mer. 2010;63(249):7-30.
  29. World Bank. Supporting access to clean water: an essential contribution to progress in the Democratic Republic of Congo (DRC) [Online]. November 15, 2023 [accessed July 4, 2026]. Available from: https://www.banquemondiale.org/fr/news/feature/2023/11/15/supporting-drinking-water-access-a-key-to-progress-in-afe-1123-democratic-republic-of-congo-drc.
  30. Alain Bakito Mbonkumu et al. Analysis of the causes of the persistence of open defecation among the population of the Bokoli and Mipale health areas in the Ntandembelo Rural Health Zone in the Maïndombe province of the Democratic Republic of Congo. PAMJ-One Health. 2026;19:7. Available from: https://dx.doi.org/10.11604/pamj-oh.2026.19.7.49967.
  31. United Nations Children's Fund, World Health Organization. The State of Hand Hygiene in the World: A Global Call to Action to Make Hand Hygiene a Political and Practical Priority [Internet]. New York: UNICEF/WHO; 2021 [updated Oct 2021; cited 5 Jul 2026]. Available from: UNICEF.
  32. White S, Mutula AC, Buroko MM, Heath T, Mazimwe FK, Blanchet K, et al. How does handwashing behavior change in response to a cholera outbreak? A qualitative case study in the Democratic Republic of the Congo. PLoS One. 12 Apr 2022;17(4):e0266849. Available from: https://dx.doi.org/10.1371/journal.pone.0266849.
  33. Checchi F, Eamer G, Katshitshi J, Robles Dios L, Kai A. Effect of a safe and dignified burial intervention on Ebola virus transmission in the eastern Democratic Republic of the Congo, 2018-19: a propensity score analysis. Lancet Global Health. 2025 Sep;13(9):e1617-e1626. Available from: https://dx.doi.org/10.1016/S2214-109X(25)00220-7.
  34. Diarra T, Okeibunor J, Diallo AB, et al. Epidemic Response amidst Insecurity: Addressing the Ebola Virus Epidemic in the Provinces of North Kivu and Ituri. J Immunol Sci. 2023 May 12;Suppl 3:1-10. Available from: https://dx.doi.org/10.29245/2578-3009/2023/S3.1102.
  35. World Health Organization. Regional Office for Africa. Promoting the role of traditional medicine in health systems: African Region strategy [Internet]. Brazzaville: WHO; 2000 [cited 5 Jul 2026]. Available from: IRIS.
  36. Oxfam GB. Gender and vulnerability to cholera in Sierra Leone: Gender analysis of the 2012 cholera outbreak and an assessment of Oxfam's response. Oxford: Oxfam GB; June 2013. Oxfam Research Report. ISBN 978-1-78077-349-0.
  37. UNICEF DRC. Clean water: a women's issue [Internet]. Kinshasa: UNICEF Democratic Republic of Congo; 2017 [updated August 29, 2017; cited 5 July 2026]. Available from: https://www.unicef.org/drcongo/recits/leau-potable-une-affaire-de-femmes.
  38. Global Network of NAPs. Women, Key to Climate Action: Peace Initiatives [Internet]. Ottawa: IISD; 2026 [cited 2026 Jul 5]. Available from:https://napglobalnetwork.org/wp-content/uploads/2026/01/Livrable-5-a-LE-CLIMAT-A3-v2.pdf.
  39. Kubheka BZ, Carter V, Mwaura J. Social media health promotion in South Africa: Opportunities and challenges. Afr J Prim Health Care Fam Med. 2020 Jul 9;12(1):e1-e7. Available from: https://dx.doi.org/10.4102/phcfm.v12i1.2389.
  40. Rizig M, McLaughlin C, Narayan VA, Salama M, Udeh-Momoh CT, Rwafa-Madzvamutse CR, et al. Strengthening Africa's brain health and economic resilience. Nat Med. 2025;31(8):2506-2517. Henrard G. Illiteracy in health. Santé Conjuguée. Oct 2009;(50):69-72. Available from: https://dx.doi.org/10.1038/s41591-025-03863-9.
  41. Bekele BK, Uwishema O, Bisetegn LD, Moubarak A, Charline M, Sibomana P, et al. Cholera in Africa: A Climate Change Crisis. J Epidemiol Glob Health. 2025 Apr 30;15(1):68. Available from: https://dx.doi.org/10.1007/s44197-025-00386-x.
  42. Koua EL, Moussana FH, Sodjinou VD, et al. Exploring the burden of cholera in the WHO African region: patterns and trends from 2000 to 2023 cholera outbreak data. BMJ Glob Health. 2025;10(1):e016491.
  43. Ngwa MC, Young A, Liang S, Blackburn J, Mouhaman A, Morris JG Jr. Cultural influences behind cholera transmission in the Far North Region, Republic of Cameroon: a field experience and implications for operational level planning of interventions. Pan Afr Med J. Dec 15, 2017;28:311.
  44. Agundu I, Oluwayomi O, Ford T. Exploring the Impact of Traditional Practices on Vibrio cholerae Outbreaks in Rural Nigerian Communities: A Field Study with Educational and Behavioral Interventions. Int J Environ Res Public Health. 2025 Mar 24;22(4):483. Available from: https://dx.doi.org/10.3390/ijerph22040483.
  45. Ståhl M. Looking back, looking ahead - land, agriculture and society in East Africa: A Festschrift for Kjell Havnevik. Uppsala: Nordiska Afrikainstitutet; 2015. 240 p.
  46. Mweso O, Shula A, Sialubanje C, Chanda SL, Shinjeka T, Mwangilwa K, et al. Descriptive study of cholera-related deaths in communities during Zambia's 2023-2024 outbreak: key insights. BMJ Open. 2025 Oct 21;15(10):e102709. Available from: https://dx.doi.org/10.1136/bmjopen-2025-102709.
  47. Matias WR, Teng JE, Hilaire IJ, Harris JB, Franke MF, Ivers LC. Household and Individual Risk Factors for Cholera among Cholera Vaccine Recipients in Rural Haiti. Am J Trop Med Hyg. 2017 Aug;97(2):436-442. Available from: https://dx.doi.org/10.4269/ajtmh.16-0407.

Figures:

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?