Exploring barriers and associated factors in the preparedness for cholera outbreak response in Public Health Centres of Addis Ababa, Ethiopia

Abstract

Cholera remains a significant public health threat in Ethiopia, where recurrent outbreaks disproportionately affect urban populations. Despite the critical role of primary healthcare centers in outbreak response, their level of preparedness (long-term planning, including protocols, training, and resource allocation) and readiness (immediate operational capacity for response) in Addis Ababa is not well understood. An Institutional-based, cross-sectional mixed-methods study was conducted from August to September 2024 across all 101 public health centers in Addis Ababa. Quantitative data were collected using a standardized 14-point WHO checklist (adapted from the Ethiopian national cholera preparedness guideline), which assessed preparedness and readiness and analyzed using binary logistic regression in SPSS version 25. Qualitative data from five key informant interviews and two focus group discussions with health administrators and providers were analyzed thematically to explore barriers.. A total of 101 health centers data found in Addis Ababa were analyzed. Preparedness was measured as meeting ≥75% of indicators (11/14), combining both structural preparedness and operational readiness components. From the total 101 health centers 56 (55.4%) with 95% CI (45.2-65.3) of them were prepared for cholera outbreak response. Having emergency preparedness response plan had significant association with cholera outbreak response preparedness in multivariable analysis at 95% CI (p < 0.05). (AOR = 6.88, 95% CI= (1.39-9.89)). The main themes that emerged were financial barriers, lack of cooperation and multi sectorial involvement, and lack of motivation from the health care workers. Cholera outbreak preparedness in health centers of Addis Ababa was found to be 56.7%. Having emergency preparedness response plan in health centers had significant association with cholera outbreak response preparedness. Lack of multi sectorial involvement, financial barrier and lack of motivation from healthcare providers were the main identified barriers towards cholera outbreak response preparedness. The government should develop and implement a comprehensive emergency preparedness response plan specifically addressing cholera outbreaks.