Adherence to cholera prevention measures and associated factors among adults in three health zones of Kinshasa, Democratic Republic of the Congo.

BACKGROUND: Cholera remains a major public health concern in the Democratic Republic of the Congo (DRC), particularly in urban settings with limited access to safe water and sanitation. Kinshasa is among the most affected cities. This study assessed adherence to cholera prevention measures and associated factors among adults in selected health zones of Kinshasa. METHODS: An analytical cross-sectional study was conducted from 15 October to 15 December 2025 in three health zones of Kinshasa using a multistage, non-probabilistic sampling approach. A total of 427 adults were included. Data were collected using an electronic questionnaire on sociodemographic characteristics, knowledge of cholera, adherence to preventive measures, and acceptability of oral cholera vaccination. Multivariable logistic regression was used to identify factors associated with adherence. RESULTS: Most participants (98%) had heard of cholera, and 66% demonstrated good knowledge of the disease. Overall, 52% showed sufficient adherence to cholera preventive measures. The most frequently reported barriers to adherence were negligence (74%), lack of information (66%), limited financial resources (54%), and traditional beliefs (26%). Acceptability of oral cholera vaccination was high, with 71.9% of participants reporting having been vaccinated. Higher educational level (aOR: 13.9; 95% CI: 1.7–33.3) and monthly income above USD 200 (aOR: 2.3; 95% CI: 1.1–4.8) were significantly associated with better adherence to preventive measures. CONCLUSION: Adherence to cholera prevention measures in the studied health zones was moderate and influenced by socioeconomic and informational factors. These findings highlight the importance of addressing social determinants when promoting cholera prevention specifically in the studied health zones and similar high burden urban settings in Kinshasa. CLINICAL TRIAL NUMBER: Not applicable.