Empowering communities in cholera outbreak response: Local perspectives from Sidama, Ethiopia

Background: Cholera remains a persistent public health challenge in low-resource settings, where effective multi-sectoral coordination and meaningful community engagement are often limited. This cross-sectional study examined the socioeconomic and contextual factors influencing community participation during a recent cholera outbreak in Ethiopia's Sidama Region. The study assessed levels of involvement across preparedness, response, and recovery phases to inform context-specific strategies. Methods: A community-based cross-sectional survey was conducted between June and August 2023 among 613 residents in the Sidama Region following a cholera outbreak. A structured checklist assessed sociodemographic characteristics, knowledge, attitudes, practices, and engagement in preparedness, detection/response, and recovery activities. Logistic regression analysis was used to identify factors associated with low engagement. Results: Engagement was measured using Likert-scale items across preparedness, surveillance, response, and coordination domains. The overall community engagement index was 48%, indicating that fewer than half of participants were actively involved in outbreak management. Key barriers included poor socioeconomic status (33%), large household size exceeding four members (82%), and low educational attainment, with 27% having no formal education. Low engagement was significantly more likely among participants with poor wealth status (AOR 2.98), households with three or more children under 5 years (AOR 12.6), individuals with poor knowledge of cholera (AOR 2.51), and males compared to females (AOR 1.87). Conclusion: Community engagement in the cholera outbreak response was suboptimal. Poverty, large household, and low educational attainment were the principal barriers. Addressing these constraints is essential to strengthen early detection, improve response effectiveness, and sustain cholera control through enhanced community involvement.