Bridging the gaps: how knowledge and access to care influence timely cholera treatment and reduce deaths in Nampula Province, Mozambique

Abstract

Despite global efforts to improve cholera case management and reduce case fatality, persistent gaps remain in understanding local health-seeking behaviors and community knowledge. This study aimed to investigate these factors in Nampula province, Mozambique, which experiences frequent cholera outbreaks. A cross-sectional household survey was conducted from November 10–19, 2023, in urban Nampula city and the rural districts of Meconta and Monapo. A total of 831 households were enrolled. Data on healthcare access, health-seeking behavior, and cholera knowledge were collected through tablet-based questionnaires. Pearson Chi-square tests and multivariate logistic regression were used to identify factors associated with healthcare facility utilization. Walking was the primary mode of transportation to healthcare facilities (55.9%) across all sites, but rural residents generally traveled farther and longer than urban residents. Despite these disparities, 94% of participants sought care at healthcare facilities for cholera/diarrheal symptoms, with rural Meconta showing exclusive reliance on healthcare facilities. Paradoxically, households within 500 m of a healthcare facility were less likely to seek care (OR = 0.2, p = 0.0417), suggesting behavioral determinants beyond proximity. While recognition of watery diarrhea (85%) and vomiting (86%) as cholera symptoms was high, only 17% identified dehydration, and awareness of oral rehydration solution was critically low (2.2%). Healthcare workers were the main source of cholera information (61.5%). Rural participants relied more on community sources, whereas urban populations more often used television and social media. Across settings, households in which the head had technical or vocational education (OR = 19.9, p = 0.0178) or when people exhibited dehydration symptoms (OR = 4.5, p = 0.0258) were more likely to visit healthcare facilities for cholera treatment. Low awareness of dehydration, oral rehydration solution, and oral cholera vaccine persists despite high healthcare utilization. Strengthening community-based education, health worker engagement, and oral rehydration points is essential, alongside case management and vaccination, particularly in rural settings.