In developing countries, transmitted infectious diseases are costly to the public and a public health problem [1] [2] [3] . These include those usually expressed by acute diarrhea such as cholera, Escherichia coli infection, Campylobacter jejuni infection, Rotavirus infection, Giardiasis, Intestinal amoebiasis, Salmonellosis, Shigellosis, etc. [4] [5] .

Cholera is a very old bacterial infectious disease (1503 by an officer of the explorer Vasco De Gama in Calcutta: the initial focus of the world on the Ganges River in India) and contagious [5] [6] . It is caused by a gram-negative bacillus called Vibrio cholerae (which has the tropism for the epithelium of the small intestine after oral ingestion by food and contaminated water). Clinically, cholera is characterized by colorless, painless, diarrhea, mainly starting from appearance and preceding vomiting [2] [3] [4] [5] . Severe dehydration following acute diarrhea leads the victims to death in the absence of treatment.

Cholera is an endemic and epidemic disease linked to defective hygiene conditions, the virulence of the responsible microorganism (Vibrio cholerae) and the capacity of the body to defend itself by the various natural and immune immunological mechanisms [2] [6] [7] .

Each year around 1.3 to 4 million cholera cases are reported with 21 miles to 143 thousand deaths worldwide [5] [7] [8] . For the World Health Organization, notifications appear to be less in some countries due to a deficit in national surveillance systems and a refusal to alert potential tourists for fear of risk of economic loss [8] .

Several cholera epidemics have been recorded worldwide and Africa is more concerned with prevalence and death [6] [8] [9] [10] , followed by Asia [11] . Europe and North America would be spared [9] [11] . The reasons seem to be unknown but the world of life and collective hygiene measures in these developed countries can have a great influence on the absence of cholera cases in Europe and North America [5] [6] [10] [11] [12] [13] [14] .

The Democratic Republic of the Congo (DRC) was among the five countries representing about eighty-five percent of cases notified with Ghana, Haiti, Nigeria and Afghanistan in 2013 [9] . In DRC, the first cases of cholera were reported in 1975. The most important cholera outbreaks are found in the Lake Provinces of North Kivu, South Kivu, and the former Katanga (including Moba) and along the Congo River where the disease has endemoepidemic cyclical characteristics. In the areas bordering Lake Tanganyika (Moba, Kalemie, Fizi and Uvira) in the DRC, cholera is endemic throughout most of the year with epidemic outbreaks accompanied by deaths, especially during the rainy season. In the context of Moba, several non-governmental organizations have been funded to combat the morbidity and mortality associated with Vibrio cholerae. Despite these financial means, cholera remains a public health problem (especially for health areas along Lake Tanganyika). This endemo-epidemic state of cholera in Moba had prompted us to ask a question: Why is the persistence of cholera in Moba? To answer this question, a preliminary study was first recommended. The objective of this study is to determine the level of knowledge of the population in relation to the factors favoring the endemicity and epidemicity of cholera among the populations exposed. The results of this study will be necessary tools to take into account by any partner involved in the fight against cholera in our province and middle of Moba.

During the period of our survey, 430 individuals had agreed to respond to our interview. 418 people (97.2%) were aware of cholera and 2.8% (n = 12) of those interviewed during the study period did not know the existence of cholera. Those persons who knew the existence of cholera were retained as a study population (418).

Vibrio cholerae colonizes the epithelium of the small intestine and produces a toxic toxin for enterocytes [4] [9] . The infected individual presents several symptoms including vomiting, fever, hypotension, muscle spasms and diarrhea. The greatest complication is dehydration with life-threatening risk following acute diarrhea [5] [6] [7] [12] [15] [16] . Cholera is the preferred companion of natural disasters, situations of conflicts with massive displacements of population and precarious hygiene [16] - [22] . Africa is the continent most affected by the cases notified to WHO [23] .

Among the most affected countries is the Democratic Republic of Congo, where Moba is one of the places where cholera is endemic with epidemics in some places [9] .

Our work consisted in highlighting the factors favoring this endemicity in order to contribute to the improvement of cholera control. In view of the results of interviewees, conditions are favorable for the occurrence and perpetuation of cholera in our environment. Indeed, while the majority of the population (97.2%) recognized the existence of cholera (which can be considered a good indicator of community awareness), knowledge about risk factors and control is disappointing.

The notion of factors favoring cholera has been mentioned by several authors, unanimous on the risk of triggering the cholera epidemic in case of deficient hygiene [3] - [10] . The World Health Organization, WHO in its acronym, is constantly encouraging member countries to see closely the various elements incriminated in the genesis of cholera [8] .

As regards this series of studies, as found by several authors [3] - [17] [22] , the main factors that could be evoked in this preliminary work would be, notwithstanding some positive points: low level of education, proximity with the rivers and Tanganyika Lake, the incorrect habits of the population to think of the mystic in the genesis of cholera, the low level of mobilization in favor of the fight against cholera, the poor knowledge on the means of transmission of cholera, poor drinking water treatment and inadequate water consumption, poor knowledge of critical handwashing times, low use of soap or ash when handwashing, large proportion of plots without latrines, poor management of household waste, poor organization of cholera upgrading sessions, poor knowledge of the available means to fight cholera, poor management of fecal peril and poor hygiene. In several studies, the absence of hygiene measures in relation to drinking water and food has been cited as one of the major elements in the occurrence and sustainability of a cholera epidemic [3] [8] [13] - [19] [22] [23] .

Water is an essentially reputed element in the cycle of cholera transmission. A significant proportion of the population consumes water that is unsuitable, poorly preserved and untreated, despite the various mobilizations in the health area: 50.5% consume mainly river and lake water, 2.6% for water from unprotected wells and only 40.4% consume treated water; 47.4% conserve drinking water in cans/big bottles and 28.0% in basins. Chlorination was mainly the

technique used and is usually carried out by agents of the Red Cross of the DRC, voluntarily posted to around Lake Tanganyika and rivers to add chlorine diluted in pulsed water. The use of cans to conserve drinking water is being extended to the DRC [24] and is the main alternative due to lack of financial resources.

The low consumption of tap water in this study (8.6%) is on the one hand related to the smallest extent of the distribution network of the “REGIDESO” (State Water Supply Company) and other irregularity in the distribution of water. The proximity to the lake and the consumption of its waters was mentioned in Kenyan [6] . Table 4 indicated that 68.9% of the population did not use soap or ash when washing hands, and knowledge of critical handwashing times was low. Handwashing is a determining factor in the circulation of germs during greetings [21] [22] . Hence, the use of soap should be recommended in order to combat the risk of contamination by the germs of dirty hand diseases.

During our investigation, the hygiene measures were not predominantly good according to the answers of the interviewees. Parts of the population (18.9%) lack latrines and among those who have it 68.2% are unhygienic. Waste management is not as satisfactory and landfill is only very low at 7.2% compared to 92.8%. The difference observed is statistically significant after resorting to the law of homogeneous distribution.

The various aforementioned arguments make it possible to perpetuate the endemicity of cholera and the episodic epidemic in our region, as also some authors [2] [5] [6] .

Finally, awareness-raising channels should be improved because it is from them that good, appropriate information can reach the population. No channel reaches 50% in respondents’ responses, although radio and church cover 49.3% and 28.2% specifically. Access to cholera information is not available for 73.9% of respondents and there are also several gaps in the control of cholera control (Table 6). The mobilization and information of the population in the fight against waterborne diseases and dirty hands are therefore necessary as pillars in the fight against cholera. It is said that “ignorance kills”.

The various elements listed above would explain why cholera is endemic in our environment, especially in the rainy seasons where fecal waste can easily contaminate drinking water. It is important to control them and adopt firm measures to reduce significantly the impact of these risk factors and remove Moba from the list of endemic areas of cholera according to problem trees and solution (see below) mentioned in this study.

The results of this preliminary study demonstrate our willingness to understand why cholera persists cyclically in our environment. Future studies could address the factors that determine the sustainability of cholera on a larger, multicenter sample and generalize the results to the region as a whole.

The conditions of poor knowledge of cholera and of deficient hygiene combined in our environment are favorable to the endemicity and the occurrence of cholera epidemics in our environment. In this study, low levels of education, environmental proximity to rivers and lakes, ignorance about ways or means of contamination and prevention of cholera, poor mobilization, improper water use, poor hygiene in terms of fecal peril and handwashing, limited access to quality information in place of fear and panic are favorable to endemo-epidemic persistence of cholera in the Regeza Health Area. To some extent, with limitations, these arguments can be applied in all the health areas around Lake Tanganyika. Efforts should be made in relation to the improvement of hygiene conditions (individual and collective), communication for behavioral change and education of the population in the fight against cholera. The solution tree (Table 7(a) and Table 7(b)) contained in this study may be the model to follow.

The authors do not report any conflicts of interest in this study.

The authors would like to thank the volunteers of the Red Cross of the DRC for the sacrifices in the fight against cholera: a mixture of chlorine in the water that the population draws from the waters of Lake Tanganyika. Also, we would like to thank Kibwile Lubeleyi and Jean Pierre for their help in data collects.

Kabemba, B.H., Ntambwe, A.M., Yamutalua, S.K., Prince, K., Yuma, G.A., Micheline, N.N., Lupueka, P.K., Ngoyi, E.N., Selemani, R. and Martine, K.M. (2018) Why the Endemoepidemicity Persistence of Cholera in Moba (DR. of Congo)?: Preliminary Study in the Health Area of Regeza in 2016. Open Access Library Journal, 5: e3500. https://doi.org/10.4236/oalib.1103500