EXECUTIVE SUMMARY
Is there a gender difference in the cholera disease burden in Sierra Leone?
At the national aggregate level, there is not a gender difference in the cholera burden, at least not of any significance. But when regional contexts and life stages are taken into account, there does appear to be distinct gendered patterns in the burden. According to the Directorate of Disease Prevention and Control‟s national database in 2012, 53 per cent of cholera cases are female and 48 per cent are male; as 51 per cent of Sierra Leone‟s population is female, the difference is only marginal. It has not been possible to test for statistical significance.
Regional disaggregation, however, reveals a higher frequency of male cases in Freetown and Kono District and higher frequencies of female cases in primarily agricultural districts, suggesting a more complex association between gender and livelihood zones and the vulnerability to cholera.
Analysing cholera by age and gender in Freetown and the Western Area reveals that although prevalence is higher in men overall, the highest number of cases fall within the 15 to 24 age group, and of these, most are female. More in-depth analysis of the data is required.
What accounts for gendered patterns in the data?
In a society that adheres to strict gender roles in the domestic, productive, and community settings, cholera transmission routes are more likely to be sex and age-specific.
There is a higher prevalence of female cholera cases in the rural, agricultural areas of Sierra Leone. The caretaking role of women and girls can expose them to sources of contamination in the household, particularly when caring for children and the sick. The predominance of women as rural petty traders, who travel to weekly luma markets in commercial centres (held for surrounding and remote villages), further increases their vulnerability to contracting cholera.
During the day, most of the men in Freetown are away from the domestic setting and are working, seeking work, or socializing. As a result they often eat and drink from locations which lack basic hygiene facilities, resulting in an increased risk of exposure to cholera; this is the likely explanation for the higher prevalence of the disease in males in the city (specifically in those aged 25 or over)
The prevalence of cholera among youth aged 15 to 24 in Freetown reflects the demographics in the city. Within this age group, there are more women than men, which may be why there is a higher prevalence of female cases, however this may also be associated with their increased vulnerability from caring for babies and children. Sierra Leone has high rates of early childbearing. In urban areas, a greater use of family planning among women in their 30s and 40s means they are less likely to be caring for small babies than in the rural areas. Women and girls with unstable socio-economic circumstances face the challenge of caring for small babies while working, for instance mobile traders who carry babies on their backs, with limited access to hygiene facilities.
