Knowledge, Attitude, and Practice of Community towards Cholera in High-risk Districts of Kandahar Province Afghanistan
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Abstract
Background: Afghanistan remains highly vulnerable to cholera outbreaks because of limited access to safe water, poor sanitation, and low community awareness. Kandahar Province experiences recurrent seasonal outbreaks. We aimed to assess the community knowledge, attitudes, and practices (KAP) regarding cholera in four high-risk districts.
Methods: A descriptive cross-sectional survey was conducted in 2022 in Dand, Daman, Spin Boldak, and Panjwai districts, Afghanistan using probability-based cluster sampling. A structured, pretested questionnaire was administered to 852 adults. Data were analyzed using Epi Info 7.2.3 and Stata 18. Descriptive statistics, chi-square tests, and logistic regression were performed, with P<0.05 considered statistically significant.
Results: Among 852 respondents, most were male (62.44%), married (87.79%), unemployed (77.46%), and illiterate (69.84%). Awareness of diarrheal diseases was high (88.33%), but misconceptions remained: 59.74% believed cholera is transmitted by insects and 56.57% by direct person to person contact. Most recognized contaminated water (79.81%) and food (76.52%) as transmission routes, but only 60.56% identified cholera as contagious. Although attitudes were generally positive, preventive practices were inadequate: only 34.97% boiled drinking water, 60.09% practiced open defecation, and 26.52% did not wash hands after toilet use. Only 30% achieved higher overall KAP scores. Female gender, higher education, and employment were significantly associated with better KAP.
Conclusion: Important gaps in cholera knowledge and preventive practices persist in high-risk districts of Kandahar. Despite generally positive attitudes, unsafe water use, poor sanitation, and misconceptions continue to hinder cholera control. Targeted health education and strengthened interventions are needed to improve community resilience and reduce cholera transmission.
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