Drinking contaminated BI 6727 water ranked as the second most prominent cause in total followed by flies, which were seen as disease transmitters in both communities. Flies, which can actually transmit V. cholerae [24,25], were mostly mentioned in connection with uncovered, i.e. unprotected, food, which was more prominently reported in the peri-urban community: Table 4 Perceived causes for a cholera vignette in peri-urban and rural Zanzibar, n = 356 “Yes, because usually flies carry dirt and spread it everywhere, especially in the food.” (Housewife from Chumbuni, 32 years old) “It is possible that the flies coming from the toilet contaminate the food.” (Male coffee seller from Mwambe, 50 years old) Among the causes not related to the faecal-oral route of transmission, God’s will was the most prominent category and ranking higher among rural residents.
A statement from a 30-year-old female farmer from Mwambe helps to explain the commonly expressed notion regarding this finding, i.e. that God overrules people’s prevention efforts if only it wished: “There is no cause except God’s will, which cannot be changed; and it is not caused by dirty environment because there are some dirty places where people do not get the disease.” Further perceived causes not linked to cholera disease aetiology �C like witchcraft, malaria and worms �C had lower prominence ratings since they were almost never mentioned spontaneously nor identified as most important. And these categories were more characteristic for the rural compared with the peri-urban community.
A substantial proportion of the respondents from Mwambe �C more than one-tenth, compared to only two peri-urban residents �C had no idea what could have made the person suffer from the symptoms described in the vignette (coded as cannot say). Among rural respondents who could not spontaneously identify a cause, women featured significantly more often than men (19.6% vs. 7.1%, p = 0.016, Wilcoxon test) (not shown in Table Table44). Self treatment and help seeking for cholera The most prominent self treatment at home in the rural community was herbal treatment, followed by giving antibiotics or other drugs like pain killers or antacids and then home-made or ready-to-use oral rehydration solution (ORS) (Table (Table55 upper panel).
In contrast, the peri-urban residents’ preference for herbal treatment was less pronounced as they primarily suggested giving someone like the person described in the cholera vignette more water or other liquids, like tea or porridge, or ORS. For most respondents, local herbal treatment, Anacetrapib used for relief or cure of symptoms, comprised concoctions of water with locally grown spices like cumin or cloves, or with leaves, barks and roots of herbs and trees (e.g. mpatakuva (Plectranthus spp.), neem tree, guava). Doing nothing at home, i.