Knowledge and preventive practices associated with anticipatory action for climate-related cholera outbreaks in...

Background: Cholera remains a major public health concern in sub-Saharan Africa, exacerbated by extreme climatic events and inadequate WASH-related practices. As both climate change impacts and WASH practices are gender-sensitive, this study adopts a gendered perspective to examine the relationship between anticipatory action (AA) for climate-induced cholera outbreaks and knowledge, attitudes and practices (KAP) in Zambézia Province, Mozambique. Methods: A cross-sectional survey was conducted in Quelimane (urban) and Mopeia (rural) using a multistage sampling design. A total of 448 respondents were interviewed. Data were analyzed using descriptive statistics and gender-based comparisons. Negative binomial regression was applied to assess associations between KAP, gender and AA. Results: The findings revealed sociodemographic inequalities between men and women, with women being younger and more frequently widowed. A critical KAP gap was observed, with very low levels of cholera knowledge (96.2% low) and insufficient practices (86.6% low), despite generally positive attitudes toward disease prevention (76.3% high). Anticipatory readiness was extremely limited, with 96.8% of respondents classified as having low preparedness levels. In the negative binomial model, knowledge (IRR = 1.069), practices (IRR = 1.072), and age between 36 and 60 years (IRR = 1.106) were significantly associated with the expected number of AA. Conclusions: Cholera preparedness remains limited despite high disease awareness and generally positive attitudes. Knowledge and preventive practices were the main factors associated with the adoption of AA, whereas attitudes and gender were not significantly associated in the adjusted model. These results underscore the need for integrated interventions that combine health education, strengthened WASH conditions, early warning mechanisms and gender-sensitive strategies.