High Awareness, Poor Practice: The Cholera Prevention Knowledge-Attitude-Practice Gap in Ada Foah, Ghana-A...

Cholera persists as a public health threat in Ghana, particularly in coastal communities with inadequate water, sanitation and hygiene (WASH) infrastructure. This study assessed the knowledge, attitudes and practices (KAP) toward cholera among residents of Ada Foah, a high-risk coastal district in Ghana, to identify gaps and inform targeted interventions.

A community-based analytical cross-sectional study was conducted among 400 adults (≥18 years) selected via multi-stage systematic random sampling. Data were collected using a pretested, structured questionnaire and analysed using descriptive statistics, chi-square tests, exploratory factor analysis (EFA) and multivariable logistic regression. To address quasi-complete separation in the practice model, Firth's penalized likelihood regression was applied.

Awareness of cholera was high (93.5%), but significant knowledge gaps persisted regarding aetiology and symptoms. Although attitudes were predominantly positive (80.5% rated as 'Good'), preventive practices were inconsistent. Notably, 43.5% never treated drinking water, and 40.3% reported practising open defecation 'sometimes/always'. Higher educational attainment and peri-urban residence were significant predictors of good knowledge (p < 0.05). EFA revealed four distinct practice dimensions: core hygiene, Proactive Food and Water Safety, health system engagement, and risk recognition. Willingness to accept oral cholera vaccine was high (67.0%) despite low awareness (43.0%). Firth's regression confirmed that positive attitude was inversely associated with adequate practice (aOR = 0.04, 95% CI: 0.01-0.18), whereas the four practice factors showed expected directional associations.

A significant attitude-behaviour gap exists, with high awareness and positive attitudes not translating into consistent preventive practices. Cholera control in Ada Foah requires a multifaceted strategy integrating targeted health education, sustainable WASH infrastructure improvements and strategic deployment of oral cholera vaccines.