Perception and Practices regarding diarrhoea management in Dibrugarh, Assam: A mixed-method study

Abstract

Background: Acute Diarrhoeal Disease (ADD) outbreak, a major public health concern, cholera  the most severe forms, frequently occurs in vulnerable settings, like tea garden communities. Timely management can reduce case fatality rate (CFR) from >10% to <1%. It’s crucial to comprehend and develop prevention and response plans, tailored to particular environment. Objectives: To assess household level water, sanitation and environmental exposure amongst affected families and to explore their perceptions of diarrhoeal illness and its management. Methods: Explanatory sequential mixed-method study was conducted in Dinjoy tea estate, Dibrugarh following diarrhoea outbreak. Quantitative data captured environmental vulnerabilities entered and analysed using SPSS 25; followed by in-depth interview through reflexive thematic analysis. Integration of both strands was achieved through force-field analysis. Results: ADD reported in 25 patients, CFR was 20%. There was substantial environmental vulnerability. Tubewell was used primary source of drinking water by 84% . Outbreak served as a turning point for risk perception.  There was hidden financial aftermath and varying beliefs on traditional and biomedical care. Community solidarity emerged as coping mechanism. Conclusion: Cholera exerts multidimensional impacts which extends beyond morbidity and mortality. Prioritizing WASH strengthening is need of hour, focusing on most vulnerable among tea tribes of Assam.