Assesment Of Knowledge, Attitude And Practice Towards Cholera Prevention And Control
[A CASE STUDY OF ILORIN METROPOLIS KWARA STATE, NIGERIA]

Cholera preparedness workshop held from 31st May – 1st June, 2017 in Abuja to develop Cholera preparedness plan as the season set in. NCDC/partners provided onsite support in Kwara, Zamfara and Kebbi States. NCDC/partners are providing onsite support in Borno State. Cholera Preparedness Checklist sent to all States to assess their level of preparedness with recommendations for prevention of and response to an outbreak. RDT procured by NCDC and WHO currently being prepositioned in affected States. States are enjoined to intensify surveillance, implement WASH activities and ensure early reporting [1].
The 2010 outbreak of cholera and gastroenteritis and the attendant deaths in some regions in Nigeria brought to the forefront the vulnerability of poor communities and most especially children to the infection. The outbreak was attributed to rain which washed sewage into open wells and ponds, where people obtain water for drinking and household needs. The regions ravaged by the scourge include Jigawa, Bauchi, Gombe, Yobe, Borno, Adamawa, Taraba, FCT, Cross River, Kaduna, Osun and Rivers. Figure 1 depicts major outbreak locations. Even though the epidemic was recorded in these areas, epidemiological evidence indicated that the entire country was at risk, with the postulation that the outbreak was due to hyper-virulent strains of the organism [5].

Figure 1: Map of Nigeria showing main regions affected by 2010 cholera outbreak.
Source: NCDC 2015
1.3 JUSTIFICATION FOR THE STUDY
In August 2010: Cholera in Nigeria reached epidemic proportions after widespread confirmation of the disease outbreaks in 12 of its 36 states. 6400 cases were reported with 352 reported deaths. The health ministry blamed the outbreak on heavy seasonal rainfall and poor sanitation. On 7 June 2017, World Health Organization (WHO) was notified of a cholera outbreak in Kwara State, Nigeria, where the event currently remains localized [4]. The first cases of acute watery diarrhoea were reported during the last week of April 2017 and a sharp increase in the number of cases and deaths has been observed since 1 May 2017. However, the number of new cases reported has shown a decline over the last four reporting weeks. As of 30 June 2017, a total of 1558 suspected cases of cholera have been reported including 11 deaths (case fatality rate: 0.7%). Thirteen of these cases were confirmed by culture in laboratory. 50% of the suspected cases reported are male and 49% are female (information for gender is missing for 1% of the suspected cases). The disease is affecting all age groups. Between 1 May and 30 June 2017, suspected cholera cases in Kwara State were reported from five local government areas; Asa (18), Ilorin East (450), Ilorin South (215), Ilorin West (780), and Moro (50) (information for local government areas is missing for 45 of the suspected cases). Poor sanitation conditions observed in the affected communities is one of the predisposing factors for this cholera outbreak. An important risk factor is the lack of access to clean drinking water and poor hygiene conditions [8].
1.4 RESEARCH QUESTION
The following research questions will be asked and answered in the study:
1.     Does poor environmental sanitation lead to cholera outbreak?
2.     Does washing of hands before eating help to prevent cholera infection?
3.     Can drinking and bathing with contaminated water lead to cholera outbreak?
4.     Does poorly kept toilet cause cholera outbreak?
5.     Is cholera outbreak rampant during the rainy season?
6.     Does the use of pipe borne water for drinking and cooking help reduce cholera outbreak?
7.     Does boiling of water reduce the risk of cholera infection?  
1.5 OBJECTIVE OF THE STUDY
1.5.1 GENERAL OBJECTIVE:
To determine the level of knowledge, attitude and practices of people of Ilorin metropolis towards cholera transmission and prevention
1.5.2 SPECIFIC OBJECTIVES OF THE STUDY:
1.     To identify the causes and effects of cholera in Ilorin.
2.     To ascertain if cholera outbreak is usually rampant during the rainy season in Ilorin.
3.     To identify the problems associated with the prevention of cholera in Ilorin.
4.     To determine the ways of preventing cholera outbreak in Ilorin.
1.6 RESEARCH HYPOTHESIS:
1.6.1 The lower the knowledge on transmission and prevention of cholera the poorer the practice
1.6.2 Negative attitude towards cholera lead to poor practice towards prevention of cholera.
1.7   SIGNIFICANCE OF THE STUDY:
The research work is important in several ways both to the Health personnel and the individuals within the society. Firstly, this study will expose to us some of the causes of cholera outbreak in Ilorin and also proffer ways of preventing cholera outbreak within our community.    
This study will also be of importance to the health personnel and our community health workers in the sense that it will expose to them the various preventive measures to put in place to avoid cholera outbreak in our community and Kwara State at large.
This study is also to be relevant to the government by providing the number of cholera outbreak within the Nigeria economy and also presenting the figures of victims who dies as a result of this disease, by this the government will swing into action by providing various measures in other to prevent further outbreak of the disease.  
1.8     SCOPE/DELIMITATION OF THE STUDY:
The study will be set out to determine the Knowledge, attitude and practice towards cholera outbreak in Ilorin metropolis, Kwara State. Therefore, the study is restricted to only community health workers, and other health related personnel in Ilorin, Kwara State. Respondents may include students, teachers, civil servants, youths, and drivers.
1.9     OPERATIONAL DEFINITION OF TERMS:                                                                  
Cholera: - Is an acute diarrheal infection caused by ingestion of food or water contaminated with the bacterium, Vibrio cholera
Outbreak: -. A sudden, violent, or spontaneous occurrence, especially of disease or strife
Infection: -.  Is the invasion of body tissues by disease-causing microorganisms, their multiplication and the reaction of body tissues to these microorganisms and the toxins that they produce.
Transmission: - The act or process of transferring a disease from a person to another.  
WHO: - World Health Organization.
Threat: -. An expression of an intention to inflict pain, injury, evil, or punishment.  An indication of impending danger or harm, one that is regarded as a possible danger; a menace.
Contamination: Is the term describing the state of a person or material on coming in contact with the disease pathogen.
Disease: Can be seen as a depart from the normal healthy state of the body soul and mind of a human being, which manifests itself in an abnormal development of the physical, physiological and mental state of the human being concerned.  
Epidemiology: The study of disease that affect large numbers of people. Traditionally, epidemiologists have been concerned primarily with infectious diseases such as typhoid and influenza that arise and spread rapidly among the population as epidemics.
Environment: This is the physical, chemical, and biological condition of the region in which one lives.
Knowledge of cholera: The ability of a person to have correct understanding of cholera in terms of causative agent, mode of transmission, signs and symptoms, treatment and prevention.
Attitudes towards cholera: Beliefs on susceptibility, seriousness and threat of cholera.
Practice of cholera prevention: Routine activities and actions of individual or group for prevention of malaria. These include the use of proper hand washing practice, Sanitation is the means of promoting hygiene through the prevention of human contact with dangers of waste especially sewage, by proper treatment and disposal of the waste, often mixed into wastewater.
CFR: Stands for Case Fatality Rate, it is the proportion of deaths within a designated population of cases (people with medical condition), over the course of disease. It is expressed in percentage.