Knowledge, Attitudes, and Practices Around Peri-Urban and Rural Water Access and Sanitation During a Cholera Outbreak: A Comparison of Two Communities in the Puerto Plata Region, Dominican Republic

Abstract

Many communities in the Dominican Republic have little or no access to safe drinking water or sanitation. The recent introduction of cholera from Haiti further highlights these limitations and their impact on human health. This research focused on two communities; a rural mountainous village and a peri-urban batey, which is a settlement community constructed by sugar cane companies to house primarily Haitian immigrant laborers. The purpose of this project was to examine community attitudes and behaviors surrounding water access and sanitation, barriers to access, and how this impacts cholera control. Research methods included community observations, household interviews, and interviews with local leaders. The results showed two dramatically different types of water access and sanitation. The mountainous village had regular access to local springs, consistent piped water, functioning latrines, and low population density. Community members voiced no dissatisfaction with their water system or waste disposal and reported no diarrheal disease. In contrast, the batey reported chronic diarrheal disease, high population density, and inconsistent access to safe water or latrines. Residents in the batey voiced frustration with the water infrastructure, with their inability to mobilize as a community, and with government run water services. Local Public Health officials in turn voiced frustration with the community for continuing to engage in behaviors that spread cholera. Overshadowing all of this were issues of anti-Haitian sentiment, poverty, inequality, urbanization, and ineffective decentralized water and sanitation services. In conclusion, if the sparsely populated mountain community maintains existing water and sanitation practices and current population and watershed levels they should be able to avoid cholera and other waterborne diseases and have consistent access to safe water and sanitation. In contrast, the densely populated peri-urban batey will continue to suffer chronic diarrhea and cholera outbreaks in the face of increasing urbanization, inconsistent water access, poor sanitation, limited community cohesion, discrimination, and poorly managed provincial water systems.