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

Abstract

Background: Acute Diarrhoeal Disease outbreak remain a major public health concern, cholera is one of the most severe forms, frequently occurs in vulnerable settings, particularly affecting tea garden communities of Assam. Timely management with rehydration therapy, case fatality rate can be reduced from >10% to <1%. It’s crucial to comprehend community experiences during epidemics to develop prevention and response plans that are tailored to particular environment.

Objectives: To assess household level water, sanitation and environmental exposure factors amongst outbreak affected families and to explore their perceptions of diarrhoeal illness and its management.

Methods: An explanatory sequential mixed-method study was conducted in Dinjoy tea estate, Dibrugarh following diarrhoea outbreak. Quantitative data captured environmental vulnerabilities followed by in-depth interview amongst affected families to explore the illness experiences, care-seeking behaviour and coping mechanisms. Quantitative data was analysed through SPSS and qualitative data through reflexive thematic analysis. Integration of both  strands was achieved through force-field analysis.

Results: 25 patients reported with Acute Diarrhoeal disease, case fatality rate of 20%. There was substantial environmental vulnerability with 84% reported tubewell as primary source of drinking water. The outbreak served as a turning point for risk perception due to unexpected deaths and also revealed environmental helplessness amongst them despite knowing risk.

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.