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Effect of Cholera Awareness on Cholera Prevention Practices among Residents of Urban Slum Communities in Nigeria

Abstract

Cholera remains an important public health concern in Nigeria, particularly in densely populated urban communities where inadequate access to safe water, poor sanitation, overcrowding, poor waste management, and limited access to healthcare services may increase the risk of transmission. Cholera is an acute diarrhoeal disease primarily associated with ingestion of food or water contaminated with toxigenic Vibrio cholerae. Without timely treatment, severe dehydration can develop rapidly and may result in death. Cholera awareness provides residents with information about the causes and modes of transmission of cholera, signs and symptoms, risk factors, safe water practices, sanitation, food hygiene, hand hygiene, environmental cleanliness, and appropriate healthcare seeking. Cholera prevention practices refer to behaviours adopted by individuals and households to reduce the risk of cholera transmission, including treatment and safe storage of drinking water, handwashing, proper sanitation, safe food preparation and storage, appropriate waste disposal, environmental cleanliness, and prompt healthcare seeking when symptoms occur. Residents of urban slum communities may face additional challenges arising from overcrowding, inadequate water and sanitation infrastructure, irregular waste collection, open defecation, limited drainage, and restricted access to reliable health information. Effective cholera awareness may improve residents' understanding of transmission and encourage the adoption of appropriate prevention practices. Against this background, this study investigates the effect of cholera awareness on cholera prevention practices among residents of urban slum communities in Nigeria. The study is anchored on the Health Belief Model, Social Cognitive Theory, and Knowledge-Attitude-Practice framework. The Health Belief Model explains preventive health behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding residents' decisions to adopt cholera prevention practices. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, social influences, behavioural capabilities, and environmental conditions in shaping health behaviour. The Knowledge-Attitude-Practice framework provides a basis for examining how improved knowledge and attitudes resulting from cholera awareness may influence preventive practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how cholera awareness may influence cholera prevention practices among residents of urban slum communities in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from adult residents of selected urban slum communities in Nigeria using a structured interviewer-administered questionnaire and an observational environmental health checklist. A multistage sampling technique will be employed to select states, local government areas, urban slum communities, households, and eligible residents. Where feasible, selected communities or participant groups will be assigned to intervention and comparison groups. Residents in the intervention group will receive structured cholera awareness education covering cholera transmission, signs and symptoms, safe drinking-water practices, household water treatment, safe water storage, hand hygiene, sanitation, food hygiene, waste disposal, environmental cleanliness, recognition of dehydration, and the importance of prompt healthcare seeking. Cholera prevention practices will be assessed using indicators such as household water treatment, safe water storage, handwashing, sanitation practices, food hygiene, proper waste disposal, environmental cleanliness, avoidance of contaminated food and water, and timely healthcare seeking when diarrhoeal symptoms occur. Descriptive statistics will be used to summarize residents' sociodemographic characteristics, cholera awareness, exposure to education, and prevention practices. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and multiple regression analysis, will be used to determine the effect of cholera awareness on cholera prevention practices. Appropriate diagnostic tests will also be conducted to assess the reliability of the research instrument, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that cholera awareness has a significant positive effect on cholera prevention practices among residents of urban slum communities in Nigeria. Residents exposed to structured cholera awareness education are expected to demonstrate improved knowledge of cholera transmission, symptoms, and prevention and greater adoption of appropriate preventive behaviours. Education may encourage household water treatment, safe water storage, improved hand hygiene, safer food practices, appropriate sanitation, proper waste disposal, improved environmental cleanliness, and timely healthcare seeking when symptoms occur. However, awareness alone may not guarantee sustained prevention practices because residents may continue to face structural barriers such as inadequate water and sanitation infrastructure, overcrowding, irregular waste collection, limited access to clean water, poverty, and limited availability of affordable water-treatment materials. Consequently, cholera awareness is expected to be most effective when supported by reliable water and sanitation services, improved drainage and waste management, accessible healthcare facilities, disease surveillance, and sustained community engagement. The study is expected to contribute to the literature on cholera prevention, environmental health, health education, sanitation, water safety, infectious disease prevention, urban health, and public health in Nigeria by providing empirical evidence on the effect of cholera awareness on cholera prevention practices among residents of urban slum communities. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Nigeria Centre for Disease Control and Prevention (NCDC), National Primary Health Care Development Agency (NPHCDA), Federal Ministry of Water Resources and Sanitation, state ministries of health, local government authorities, environmental health agencies, healthcare providers, community health workers, development partners, and policymakers regarding strategies for reducing cholera transmission. The study will also provide evidence-based recommendations for strengthening community-based cholera education, improving access to safe water and sanitation, strengthening waste management and drainage systems, improving disease surveillance, promoting household water treatment, and encouraging appropriate cholera prevention practices among residents of urban slum communities across Nigeria.

Keywords: Cholera awareness, cholera prevention practices, urban slum communities, cholera, safe water, sanitation, hygiene, waterborne diseases, environmental health, health education, disease prevention, public health, Nigeria.