Methods Setting and study sites The survey was conducted from June to August 2008 in Zanzibar, http://www.selleckchem.com/products/Y-27632.html United Republic of Tanzania. This Indian Ocean archipelago consists of two major islands �C Unguja and Pemba �C inhabited by a rapidly growing population of approximately 1.2 million Kiswahili-speaking people, who are predominantly Muslim. Medical morbidity in the population of Zanzibar mainly results from communicable diseases like upper respiratory tract infections, including pneumonia (33% of outpatient visits to primary and secondary hospitals in 2008), malaria (9.7%) and diarrhoeal diseases (8.6%) [14]. According to the latest Tanzanian national census (2002), the health situation on the islands has been improving, and the life expectancy at birth rose from 47 to 57 years between 1988 and 2002 [15].

A peri-urban and a rural community (locally termed Shehia) in core areas for a subsequent mass vaccination campaign were selected as study sites. This campaign with the killed whole-cell oral cholera vaccine Dukoral? was conducted in January and February 2009. Interviews for this study were conducted simultaneously in the peri-urban Shehia of Chumbuni and the rural Shehia of Mwambe. A description of the study sites is given in Table Table1.1. Both Shehias are served by a primary healthcare unit within walking distance, which is staffed with nurses and stocked with basic drugs and equipment mainly for outpatient treatment [16].

Table 1 Overview of study sites Research framework and instrument Among the various formulations of cultural epidemiology for health social science research [17], this study is based on an approach for examining the distribution of community ideas of illness-related experience, meaning and behaviour [18,19]. A semi-structured Explanatory Model Interview Catalogue (EMIC) interview was developed to study community views of cholera and shigellosis in a peri-urban and rural community of Zanzibar. These EMIC interviews produce complementary data sets with numeric data for quantitative analysis and illness narrative data for qualitative analysis [20]. A first version of the interview was drafted in English during several scientific workshops and translated locally into Kiswahili. A series of focus group discussions and a field assistant training workshop with piloting of the instrument among people living adjacent to the study communities followed.

This was crucial to further refine the EMIC interview with regard to clarity, field applicability and questions concerning translation. Entinostat Because people without a current diarrhoeal disease were interviewed, rather than cases, the conditions that were the focus of the interview were introduced as clinical vignettes. For each condition, the respondent was asked to consider the case of a person typical of community residents with pathognomonic somatic symptoms presented in simple, easily understandable terms (see additional file 1).